|
Venogram IVC S&I
|
Facility
|
OP
|
$10,717.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
4378733
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$10,031.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,585.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,244.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,572.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,349.93
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,907.21
|
| 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 |
$3,215.10
|
| Rate for Payer: Cash Price |
$3,215.10
|
| Rate for Payer: Cigna Commercial |
$10,254.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,237.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$9,919.66
|
| Rate for Payer: HFN Commercial |
$10,254.03
|
| 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 |
$8,916.54
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$10,254.03
|
| Rate for Payer: Quartz Beloit One Network |
$5,461.38
|
| Rate for Payer: Quartz Commercial |
$7,244.69
|
| 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: WEA Trust Commercial |
$6,130.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$8,255.31
|
|
|
Venogram IVC S&I
|
Facility
|
IP
|
$10,717.00
|
|
|
Service Code
|
CPT 75825
|
| Hospital Charge Code |
4378733
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,461.38 |
| Max. Negotiated Rate |
$10,254.03 |
| Rate for Payer: Aetna Commercial |
$10,031.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,585.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,907.21
|
| Rate for Payer: Cash Price |
$3,215.10
|
| Rate for Payer: Cigna Commercial |
$10,254.03
|
| Rate for Payer: Health EOS Commercial |
$9,919.66
|
| Rate for Payer: HFN Commercial |
$10,254.03
|
| Rate for Payer: Multiplan Commercial |
$8,916.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,254.03
|
| Rate for Payer: Quartz Beloit One Network |
$5,461.38
|
| Rate for Payer: Quartz Commercial |
$6,687.41
|
| Rate for Payer: WEA Trust Commercial |
$6,130.12
|
| Rate for Payer: WPS Commercial |
$8,255.31
|
|
|
Venogram SVC S&I
|
Facility
|
IP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
4378738
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,608.82 |
| Max. Negotiated Rate |
$8,653.30 |
| Rate for Payer: Aetna Commercial |
$8,465.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,088.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,985.05
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,653.30
|
| Rate for Payer: Health EOS Commercial |
$8,371.13
|
| Rate for Payer: HFN Commercial |
$8,653.30
|
| Rate for Payer: Multiplan Commercial |
$7,524.61
|
| Rate for Payer: Preferred Network Access Commercial |
$8,653.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,608.82
|
| Rate for Payer: Quartz Commercial |
$5,643.46
|
| Rate for Payer: WEA Trust Commercial |
$5,173.17
|
| Rate for Payer: WPS Commercial |
$6,966.59
|
|
|
Venogram SVC S&I
|
Facility
|
OP
|
$9,044.00
|
|
|
Service Code
|
CPT 75827
|
| Hospital Charge Code |
4378738
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,656.63 |
| Max. Negotiated Rate |
$8,653.30 |
| Rate for Payer: Aetna Commercial |
$8,465.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,088.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,113.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,702.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,514.76
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,985.05
|
| 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 |
$2,713.20
|
| Rate for Payer: Cash Price |
$2,713.20
|
| Rate for Payer: Cigna Commercial |
$8,653.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,263.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$8,371.13
|
| Rate for Payer: HFN Commercial |
$8,653.30
|
| 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 |
$7,524.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,653.30
|
| Rate for Payer: Quartz Beloit One Network |
$4,608.82
|
| Rate for Payer: Quartz Commercial |
$6,113.74
|
| 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 |
$5,173.17
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$6,966.59
|
|
|
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 |
$50.60 |
| Max. Negotiated Rate |
$984.05 |
| Rate for Payer: Aetna Commercial |
$984.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$890.82
|
| Rate for Payer: Aetna Managed Medicare |
$50.60
|
| Rate for Payer: Anthem Medicare Advantage |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.60
|
| 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 |
$984.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$517.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$942.61
|
| Rate for Payer: HFN Commercial |
$984.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$828.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.89
|
| Rate for Payer: Preferred Network Access Commercial |
$984.05
|
| Rate for Payer: Quartz Beloit One Network |
$455.77
|
| Rate for Payer: Quartz Commercial |
$590.43
|
| Rate for Payer: Quartz Medicare Advantage |
$50.60
|
| Rate for Payer: The Alliance Commercial |
$192.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.60
|
| Rate for Payer: WEA Trust Commercial |
$569.71
|
| Rate for Payer: WPS Commercial |
$252.98
|
|
|
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 |
$51.03 |
| Max. Negotiated Rate |
$1,397.03 |
| Rate for Payer: Aetna Commercial |
$1,397.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,264.68
|
| Rate for Payer: Aetna Managed Medicare |
$51.03
|
| Rate for Payer: Anthem Medicare Advantage |
$51.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.03
|
| 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 |
$1,397.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$735.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.03
|
| Rate for Payer: Health EOS Commercial |
$1,338.21
|
| Rate for Payer: HFN Commercial |
$1,397.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.03
|
| Rate for Payer: Multiplan Commercial |
$1,176.45
|
| Rate for Payer: NAPHCARE Commercial |
$76.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.03
|
| Rate for Payer: Quartz Beloit One Network |
$647.05
|
| Rate for Payer: Quartz Commercial |
$838.22
|
| Rate for Payer: Quartz Medicare Advantage |
$51.03
|
| Rate for Payer: The Alliance Commercial |
$193.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.03
|
| Rate for Payer: WEA Trust Commercial |
$808.81
|
| Rate for Payer: WPS Commercial |
$255.16
|
|
|
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 |
$131.72 |
| Max. Negotiated Rate |
$658.58 |
| Rate for Payer: Aetna Commercial |
$575.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$520.54
|
| Rate for Payer: Aetna Managed Medicare |
$131.72
|
| Rate for Payer: Anthem Medicare Advantage |
$131.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$131.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$131.72
|
| 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 |
$575.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$302.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.72
|
| Rate for Payer: Health EOS Commercial |
$550.80
|
| Rate for Payer: HFN Commercial |
$575.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$497.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$497.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$131.72
|
| Rate for Payer: Multiplan Commercial |
$484.22
|
| Rate for Payer: NAPHCARE Commercial |
$197.57
|
| Rate for Payer: Preferred Network Access Commercial |
$575.02
|
| Rate for Payer: Quartz Beloit One Network |
$266.32
|
| Rate for Payer: Quartz Commercial |
$345.01
|
| Rate for Payer: Quartz Medicare Advantage |
$131.72
|
| Rate for Payer: The Alliance Commercial |
$500.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.72
|
| Rate for Payer: WEA Trust Commercial |
$332.90
|
| Rate for Payer: WPS Commercial |
$658.58
|
|
|
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 |
$66.38 |
| Max. Negotiated Rate |
$575.02 |
| Rate for Payer: Aetna Commercial |
$575.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$520.54
|
| Rate for Payer: Aetna Managed Medicare |
$66.38
|
| Rate for Payer: Anthem Medicare Advantage |
$66.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.38
|
| 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 |
$575.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$302.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.38
|
| Rate for Payer: Health EOS Commercial |
$550.80
|
| Rate for Payer: HFN Commercial |
$575.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.38
|
| Rate for Payer: Multiplan Commercial |
$484.22
|
| Rate for Payer: NAPHCARE Commercial |
$99.57
|
| Rate for Payer: Preferred Network Access Commercial |
$575.02
|
| Rate for Payer: Quartz Beloit One Network |
$266.32
|
| Rate for Payer: Quartz Commercial |
$345.01
|
| Rate for Payer: Quartz Medicare Advantage |
$66.38
|
| Rate for Payer: The Alliance Commercial |
$252.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.38
|
| Rate for Payer: WEA Trust Commercial |
$332.90
|
| Rate for Payer: WPS Commercial |
$331.92
|
|
|
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 |
$127.81 |
| Max. Negotiated Rate |
$5,522.92 |
| Rate for Payer: Aetna Commercial |
$5,522.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,999.70
|
| Rate for Payer: Aetna Managed Medicare |
$127.81
|
| Rate for Payer: Anthem Medicare Advantage |
$127.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.81
|
| 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 |
$5,522.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,906.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.81
|
| Rate for Payer: Health EOS Commercial |
$5,290.38
|
| Rate for Payer: HFN Commercial |
$5,522.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$472.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.81
|
| Rate for Payer: Multiplan Commercial |
$4,650.88
|
| Rate for Payer: NAPHCARE Commercial |
$191.71
|
| Rate for Payer: Preferred Network Access Commercial |
$5,522.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,557.98
|
| Rate for Payer: Quartz Commercial |
$3,313.75
|
| Rate for Payer: Quartz Medicare Advantage |
$127.81
|
| Rate for Payer: The Alliance Commercial |
$485.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.81
|
| Rate for Payer: WEA Trust Commercial |
$3,197.48
|
| Rate for Payer: WPS Commercial |
$639.03
|
|
|
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 |
$52.38 |
| Max. Negotiated Rate |
$607.62 |
| Rate for Payer: Aetna Commercial |
$607.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$52.38
|
| Rate for Payer: Anthem Medicare Advantage |
$52.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.38
|
| 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 |
$607.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.38
|
| Rate for Payer: Health EOS Commercial |
$582.04
|
| Rate for Payer: HFN Commercial |
$607.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.38
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$78.58
|
| Rate for Payer: Preferred Network Access Commercial |
$607.62
|
| Rate for Payer: Quartz Beloit One Network |
$281.42
|
| Rate for Payer: Quartz Commercial |
$364.57
|
| Rate for Payer: Quartz Medicare Advantage |
$52.38
|
| Rate for Payer: The Alliance Commercial |
$199.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.38
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$261.92
|
|
|
Venous Access Fluoro Guidance S&I +
|
Facility
|
OP
|
$916.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
4253580
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$266.74 |
| Max. Negotiated Rate |
$876.43 |
| Rate for Payer: Aetna Commercial |
$857.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.27
|
| Rate for Payer: Aetna Managed Medicare |
$266.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$619.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$457.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.90
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$876.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$533.11
|
| Rate for Payer: Health EOS Commercial |
$847.85
|
| Rate for Payer: HFN Commercial |
$876.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.48
|
| Rate for Payer: Multiplan Commercial |
$762.11
|
| Rate for Payer: NAPHCARE Commercial |
$571.58
|
| Rate for Payer: Preferred Network Access Commercial |
$876.43
|
| Rate for Payer: Quartz Beloit One Network |
$466.79
|
| Rate for Payer: Quartz Commercial |
$619.22
|
| Rate for Payer: Quartz Medicare Advantage |
$571.58
|
| Rate for Payer: The Alliance Commercial |
$390.33
|
| Rate for Payer: WEA Trust Commercial |
$523.95
|
| Rate for Payer: WPS Commercial |
$705.59
|
|
|
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 |
$466.79 |
| Max. Negotiated Rate |
$876.43 |
| Rate for Payer: Aetna Commercial |
$857.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.90
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$876.43
|
| Rate for Payer: Health EOS Commercial |
$847.85
|
| Rate for Payer: HFN Commercial |
$876.43
|
| Rate for Payer: Multiplan Commercial |
$762.11
|
| Rate for Payer: Preferred Network Access Commercial |
$876.43
|
| Rate for Payer: Quartz Beloit One Network |
$466.79
|
| Rate for Payer: Quartz Commercial |
$571.58
|
| Rate for Payer: WEA Trust Commercial |
$523.95
|
| Rate for Payer: WPS Commercial |
$705.59
|
|
|
Venous Access Fluoro Guidance S&I +
|
Facility
|
IP
|
$806.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
4294726
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$410.74 |
| Max. Negotiated Rate |
$771.18 |
| Rate for Payer: Aetna Commercial |
$754.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$720.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.27
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$771.18
|
| Rate for Payer: Health EOS Commercial |
$746.03
|
| Rate for Payer: HFN Commercial |
$771.18
|
| Rate for Payer: Multiplan Commercial |
$670.59
|
| Rate for Payer: Preferred Network Access Commercial |
$771.18
|
| Rate for Payer: Quartz Beloit One Network |
$410.74
|
| Rate for Payer: Quartz Commercial |
$502.94
|
| Rate for Payer: WEA Trust Commercial |
$461.03
|
| Rate for Payer: WPS Commercial |
$620.86
|
|
|
Venous Access Fluoro Guidance S&I +
|
Facility
|
OP
|
$806.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
4294726
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$234.71 |
| Max. Negotiated Rate |
$771.18 |
| Rate for Payer: Aetna Commercial |
$754.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$720.89
|
| Rate for Payer: Aetna Managed Medicare |
$234.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$544.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$419.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$402.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$444.27
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$771.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.09
|
| Rate for Payer: Health EOS Commercial |
$746.03
|
| Rate for Payer: HFN Commercial |
$771.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.68
|
| Rate for Payer: Multiplan Commercial |
$670.59
|
| Rate for Payer: NAPHCARE Commercial |
$502.94
|
| Rate for Payer: Preferred Network Access Commercial |
$771.18
|
| Rate for Payer: Quartz Beloit One Network |
$410.74
|
| Rate for Payer: Quartz Commercial |
$544.86
|
| Rate for Payer: Quartz Medicare Advantage |
$502.94
|
| Rate for Payer: The Alliance Commercial |
$390.33
|
| Rate for Payer: WEA Trust Commercial |
$461.03
|
| Rate for Payer: WPS Commercial |
$620.86
|
|
|
Venous Cath Contrast Inj
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
4253589
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
Venous Cath Contrast Inj
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
4253589
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$223.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.85
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$223.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$223.85
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$832.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$223.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$223.85
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$335.77
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$223.85
|
| Rate for Payer: The Alliance Commercial |
$895.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.85
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: Wellcare Medicare |
$223.85
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
Venous Cath Insertion Non-Tunneled
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
4076141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$696.55 |
| Rate for Payer: Aetna Commercial |
$681.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.27
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$696.55
|
| Rate for Payer: Health EOS Commercial |
$673.84
|
| Rate for Payer: HFN Commercial |
$696.55
|
| Rate for Payer: Multiplan Commercial |
$605.70
|
| Rate for Payer: Preferred Network Access Commercial |
$696.55
|
| Rate for Payer: Quartz Beloit One Network |
$370.99
|
| Rate for Payer: Quartz Commercial |
$454.27
|
| Rate for Payer: WEA Trust Commercial |
$416.42
|
| Rate for Payer: WPS Commercial |
$560.78
|
|
|
Venous Cath Insertion Non-Tunneled
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
4076141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$681.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.12
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.27
|
| 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 |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$696.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$673.84
|
| Rate for Payer: HFN Commercial |
$696.55
|
| 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 |
$605.70
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$696.55
|
| Rate for Payer: Quartz Beloit One Network |
$370.99
|
| Rate for Payer: Quartz Commercial |
$492.13
|
| 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 |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$416.42
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$560.78
|
|
|
Venous Cath Insertion Tunneled
|
Facility
|
OP
|
$3,407.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
3052428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,736.21 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$3,188.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,047.22
|
| 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 |
$1,877.94
|
| 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 |
$1,022.10
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cigna Commercial |
$3,259.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$3,153.52
|
| Rate for Payer: HFN Commercial |
$3,259.82
|
| 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 |
$2,834.62
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,259.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,736.21
|
| Rate for Payer: Quartz Commercial |
$2,303.13
|
| 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 |
$1,948.80
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$2,624.41
|
|
|
Venous Cath Insertion Tunneled
|
Facility
|
IP
|
$3,407.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
3052428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,736.21 |
| Max. Negotiated Rate |
$3,259.82 |
| Rate for Payer: Aetna Commercial |
$3,188.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,047.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,877.94
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cigna Commercial |
$3,259.82
|
| Rate for Payer: Health EOS Commercial |
$3,153.52
|
| Rate for Payer: HFN Commercial |
$3,259.82
|
| Rate for Payer: Multiplan Commercial |
$2,834.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,259.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,736.21
|
| Rate for Payer: Quartz Commercial |
$2,125.97
|
| Rate for Payer: WEA Trust Commercial |
$1,948.80
|
| Rate for Payer: WPS Commercial |
$2,624.41
|
|
|
Venous Cath Removal Tunneled
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
3052430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$454.05 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$833.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.91
|
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$491.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$852.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Health EOS Commercial |
$824.71
|
| Rate for Payer: HFN Commercial |
$852.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: Multiplan Commercial |
$741.31
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Preferred Network Access Commercial |
$852.51
|
| Rate for Payer: Quartz Beloit One Network |
$454.05
|
| Rate for Payer: Quartz Commercial |
$602.32
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: WEA Trust Commercial |
$509.65
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
| Rate for Payer: WPS Commercial |
$686.34
|
|
|
Venous Cath Removal Tunneled
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
3052430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$454.05 |
| Max. Negotiated Rate |
$852.51 |
| Rate for Payer: Aetna Commercial |
$833.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$491.12
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$852.51
|
| Rate for Payer: Health EOS Commercial |
$824.71
|
| Rate for Payer: HFN Commercial |
$852.51
|
| Rate for Payer: Multiplan Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$852.51
|
| Rate for Payer: Quartz Beloit One Network |
$454.05
|
| Rate for Payer: Quartz Commercial |
$555.98
|
| Rate for Payer: WEA Trust Commercial |
$509.65
|
| Rate for Payer: WPS Commercial |
$686.34
|
|
|
Venous Cath Replace Non-Tunneled
|
Facility
|
IP
|
$918.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
4125711
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$467.81 |
| Max. Negotiated Rate |
$878.34 |
| Rate for Payer: Aetna Commercial |
$859.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.00
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$878.34
|
| Rate for Payer: Health EOS Commercial |
$849.70
|
| Rate for Payer: HFN Commercial |
$878.34
|
| Rate for Payer: Multiplan Commercial |
$763.78
|
| Rate for Payer: Preferred Network Access Commercial |
$878.34
|
| Rate for Payer: Quartz Beloit One Network |
$467.81
|
| Rate for Payer: Quartz Commercial |
$572.83
|
| Rate for Payer: WEA Trust Commercial |
$525.10
|
| Rate for Payer: WPS Commercial |
$707.14
|
|
|
Venous Cath Replace Non-Tunneled
|
Facility
|
OP
|
$918.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
4125711
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$467.81 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$859.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.00
|
| 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 |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$878.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$849.70
|
| Rate for Payer: HFN Commercial |
$878.34
|
| 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 |
$763.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$878.34
|
| Rate for Payer: Quartz Beloit One Network |
$467.81
|
| Rate for Payer: Quartz Commercial |
$620.57
|
| 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: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$525.10
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$707.14
|
|
|
Venous Cath Replace Tunneled
|
Facility
|
IP
|
$2,904.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
3052429
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,479.88 |
| Max. Negotiated Rate |
$2,778.55 |
| Rate for Payer: Aetna Commercial |
$2,718.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,597.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,600.68
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cigna Commercial |
$2,778.55
|
| Rate for Payer: Health EOS Commercial |
$2,687.94
|
| Rate for Payer: HFN Commercial |
$2,778.55
|
| Rate for Payer: Multiplan Commercial |
$2,416.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,778.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,479.88
|
| Rate for Payer: Quartz Commercial |
$1,812.10
|
| Rate for Payer: WEA Trust Commercial |
$1,661.09
|
| Rate for Payer: WPS Commercial |
$2,236.95
|
|
