|
Venography caval inferior serialography RS&I 7582526
|
Professional
|
Both
|
$996.00
|
|
|
Service Code
|
CPT 75825 26
|
| Hospital Charge Code |
5372742
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.31 |
| Max. Negotiated Rate |
$946.20 |
| Rate for Payer: Aetna Commercial |
$946.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.56
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cash Price |
$298.80
|
| Rate for Payer: Cigna Commercial |
$946.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$498.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$597.60
|
| Rate for Payer: Health EOS Commercial |
$906.36
|
| Rate for Payer: HFN Commercial |
$946.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.31
|
| Rate for Payer: Multiplan Commercial |
$796.80
|
| Rate for Payer: Preferred Network Access Commercial |
$946.20
|
| Rate for Payer: Quartz Beloit One Network |
$438.24
|
| Rate for Payer: Quartz Commercial |
$567.72
|
| Rate for Payer: The Alliance Commercial |
$498.00
|
| Rate for Payer: WEA Trust Commercial |
$547.80
|
| Rate for Payer: WPS Commercial |
$737.74
|
|
|
VENOGRAPHY CAVAL SUPERIOR SERIALOGRAPHY RS&I 7582726
|
Professional
|
Both
|
$1,414.00
|
|
|
Service Code
|
CPT 75827 26
|
| Hospital Charge Code |
6182587
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.48 |
| Max. Negotiated Rate |
$1,343.30 |
| Rate for Payer: Aetna Commercial |
$1,343.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,216.04
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cash Price |
$424.20
|
| Rate for Payer: Cigna Commercial |
$1,343.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$707.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.40
|
| Rate for Payer: Health EOS Commercial |
$1,286.74
|
| Rate for Payer: HFN Commercial |
$1,343.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.48
|
| Rate for Payer: Multiplan Commercial |
$1,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,343.30
|
| Rate for Payer: Quartz Beloit One Network |
$622.16
|
| Rate for Payer: Quartz Commercial |
$805.98
|
| Rate for Payer: The Alliance Commercial |
$707.00
|
| Rate for Payer: WEA Trust Commercial |
$777.70
|
| Rate for Payer: WPS Commercial |
$1,047.35
|
|
|
Venography Extremity Billateral RS&I 75822
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
CPT 75822
|
| Hospital Charge Code |
5192610
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$256.08 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Aetna Commercial |
$552.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$552.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.20
|
| Rate for Payer: Health EOS Commercial |
$529.62
|
| Rate for Payer: HFN Commercial |
$552.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.63
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Preferred Network Access Commercial |
$552.90
|
| Rate for Payer: Quartz Beloit One Network |
$256.08
|
| Rate for Payer: Quartz Commercial |
$331.74
|
| Rate for Payer: The Alliance Commercial |
$291.00
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
Venography Extremity Billateral RS&I 7582226
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
CPT 75822 26
|
| Hospital Charge Code |
5192611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$236.93 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Aetna Commercial |
$552.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$552.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.20
|
| Rate for Payer: Health EOS Commercial |
$529.62
|
| Rate for Payer: HFN Commercial |
$552.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.93
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Preferred Network Access Commercial |
$552.90
|
| Rate for Payer: Quartz Beloit One Network |
$256.08
|
| Rate for Payer: Quartz Commercial |
$331.74
|
| Rate for Payer: The Alliance Commercial |
$291.00
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
Venography Venous Sinus/Jugular Cath RS&I 75860
|
Professional
|
Both
|
$5,590.00
|
|
|
Service Code
|
CPT 75860
|
| Hospital Charge Code |
5190608
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$453.85 |
| Max. Negotiated Rate |
$5,310.50 |
| Rate for Payer: Aetna Commercial |
$5,310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,807.40
|
| Rate for Payer: Cash Price |
$1,677.00
|
| Rate for Payer: Cash Price |
$1,677.00
|
| Rate for Payer: Cigna Commercial |
$5,310.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,795.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,354.00
|
| Rate for Payer: Health EOS Commercial |
$5,086.90
|
| Rate for Payer: HFN Commercial |
$5,310.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$453.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$453.85
|
| Rate for Payer: Multiplan Commercial |
$4,472.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,310.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,459.60
|
| Rate for Payer: Quartz Commercial |
$3,186.30
|
| Rate for Payer: The Alliance Commercial |
$2,795.00
|
| Rate for Payer: WEA Trust Commercial |
$3,074.50
|
| Rate for Payer: WPS Commercial |
$4,140.51
|
|
|
Venography Venous Sinus/Jugular Cath RS&I 7586026
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
CPT 75860 26
|
| Hospital Charge Code |
5190609
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$185.47 |
| Max. Negotiated Rate |
$584.25 |
| Rate for Payer: Aetna Commercial |
$584.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$584.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$307.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$369.00
|
| Rate for Payer: Health EOS Commercial |
$559.65
|
| Rate for Payer: HFN Commercial |
$584.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.47
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Preferred Network Access Commercial |
$584.25
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$350.55
|
| Rate for Payer: The Alliance Commercial |
$307.50
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
Venous Access Fluoro Guidance S&I +
|
Facility
|
IP
|
$916.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
4253580
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$448.84 |
| Max. Negotiated Rate |
$842.72 |
| Rate for Payer: Aetna Commercial |
$824.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.48
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$842.72
|
| Rate for Payer: Health EOS Commercial |
$815.24
|
| Rate for Payer: HFN Commercial |
$842.72
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: NAPHCARE Commercial |
$549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$842.72
|
| Rate for Payer: Quartz Beloit One Network |
$448.84
|
| Rate for Payer: Quartz Commercial |
$549.60
|
| Rate for Payer: WEA Trust Commercial |
$503.80
|
| Rate for Payer: WPS Commercial |
$678.48
|
|
|
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 |
$225.68 |
| Max. Negotiated Rate |
$3,224.00 |
| Rate for Payer: Aetna Commercial |
$725.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$693.16
|
| Rate for Payer: Aetna Managed Medicare |
$225.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$403.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$386.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$427.18
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$741.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$451.04
|
| Rate for Payer: Health EOS Commercial |
$717.34
|
| Rate for Payer: HFN Commercial |
$741.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$604.50
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: NAPHCARE Commercial |
$483.60
|
| Rate for Payer: Preferred Network Access Commercial |
$741.52
|
| Rate for Payer: Quartz Beloit One Network |
$394.94
|
| Rate for Payer: Quartz Commercial |
$523.90
|
| Rate for Payer: Quartz Medicare Advantage |
$483.60
|
| Rate for Payer: The Alliance Commercial |
$3,224.00
|
| Rate for Payer: WEA Trust Commercial |
$443.30
|
| Rate for Payer: WPS Commercial |
$597.00
|
|
|
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 |
$394.94 |
| Max. Negotiated Rate |
$741.52 |
| Rate for Payer: Aetna Commercial |
$725.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$693.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$427.18
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$741.52
|
| Rate for Payer: Health EOS Commercial |
$717.34
|
| Rate for Payer: HFN Commercial |
$741.52
|
| Rate for Payer: Multiplan Commercial |
$644.80
|
| Rate for Payer: NAPHCARE Commercial |
$483.60
|
| Rate for Payer: Preferred Network Access Commercial |
$741.52
|
| Rate for Payer: Quartz Beloit One Network |
$394.94
|
| Rate for Payer: Quartz Commercial |
$483.60
|
| Rate for Payer: WEA Trust Commercial |
$443.30
|
| Rate for Payer: WPS Commercial |
$597.00
|
|
|
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 |
$256.48 |
| Max. Negotiated Rate |
$3,664.00 |
| Rate for Payer: Aetna Commercial |
$824.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.76
|
| Rate for Payer: Aetna Managed Medicare |
$256.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$595.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$458.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.48
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$842.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.59
|
| Rate for Payer: Health EOS Commercial |
$815.24
|
| Rate for Payer: HFN Commercial |
$842.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.00
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: NAPHCARE Commercial |
$549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$842.72
|
| Rate for Payer: Quartz Beloit One Network |
$448.84
|
| Rate for Payer: Quartz Commercial |
$595.40
|
| Rate for Payer: Quartz Medicare Advantage |
$549.60
|
| Rate for Payer: The Alliance Commercial |
$3,664.00
|
| Rate for Payer: WEA Trust Commercial |
$503.80
|
| Rate for Payer: WPS Commercial |
$678.48
|
|
|
Venous Cath Contrast Inj
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
4253589
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Aetna Managed Medicare |
$211.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.85
|
| 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 |
$396.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.85
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$788.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.85
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$317.78
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$280.15
|
| Rate for Payer: Quartz Medicare Advantage |
$211.85
|
| Rate for Payer: The Alliance Commercial |
$847.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.85
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: Wellcare Medicare |
$211.85
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
Venous Cath Contrast Inj
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
CPT 36598
|
| Hospital Charge Code |
4253589
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$211.19 |
| Max. Negotiated Rate |
$396.52 |
| Rate for Payer: Aetna Commercial |
$387.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.43
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$396.52
|
| Rate for Payer: Health EOS Commercial |
$383.59
|
| Rate for Payer: HFN Commercial |
$396.52
|
| Rate for Payer: Multiplan Commercial |
$344.80
|
| Rate for Payer: NAPHCARE Commercial |
$258.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.52
|
| Rate for Payer: Quartz Beloit One Network |
$211.19
|
| Rate for Payer: Quartz Commercial |
$258.60
|
| Rate for Payer: WEA Trust Commercial |
$237.05
|
| Rate for Payer: WPS Commercial |
$319.24
|
|
|
Venous Cath Insertion Non-Tunneled
|
Facility
|
OP
|
$728.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
4076141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$356.72 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$655.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.08
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.84
|
| 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 |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$669.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$647.92
|
| Rate for Payer: HFN Commercial |
$669.76
|
| 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 |
$582.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$669.76
|
| Rate for Payer: Quartz Beloit One Network |
$356.72
|
| Rate for Payer: Quartz Commercial |
$473.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$400.40
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$539.23
|
|
|
Venous Cath Insertion Non-Tunneled
|
Facility
|
IP
|
$728.00
|
|
|
Service Code
|
CPT 36556
|
| Hospital Charge Code |
4076141
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$356.72 |
| Max. Negotiated Rate |
$669.76 |
| Rate for Payer: Aetna Commercial |
$655.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.84
|
| Rate for Payer: Cash Price |
$218.40
|
| Rate for Payer: Cigna Commercial |
$669.76
|
| Rate for Payer: Health EOS Commercial |
$647.92
|
| Rate for Payer: HFN Commercial |
$669.76
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: NAPHCARE Commercial |
$436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$669.76
|
| Rate for Payer: Quartz Beloit One Network |
$356.72
|
| Rate for Payer: Quartz Commercial |
$436.80
|
| Rate for Payer: WEA Trust Commercial |
$400.40
|
| Rate for Payer: WPS Commercial |
$539.23
|
|
|
Venous Cath Insertion Tunneled
|
Facility
|
IP
|
$3,407.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
3052428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,669.43 |
| Max. Negotiated Rate |
$3,134.44 |
| Rate for Payer: Aetna Commercial |
$3,066.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,930.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,805.71
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cigna Commercial |
$3,134.44
|
| Rate for Payer: Health EOS Commercial |
$3,032.23
|
| Rate for Payer: HFN Commercial |
$3,134.44
|
| Rate for Payer: Multiplan Commercial |
$2,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,044.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,134.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,669.43
|
| Rate for Payer: Quartz Commercial |
$2,044.20
|
| Rate for Payer: WEA Trust Commercial |
$1,873.85
|
| Rate for Payer: WPS Commercial |
$2,523.56
|
|
|
Venous Cath Insertion Tunneled
|
Facility
|
OP
|
$3,407.00
|
|
|
Service Code
|
CPT 36558
|
| Hospital Charge Code |
3052428
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,669.43 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$3,066.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,930.02
|
| 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 |
$1,805.71
|
| 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 |
$1,022.10
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cash Price |
$1,022.10
|
| Rate for Payer: Cigna Commercial |
$3,134.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$3,032.23
|
| Rate for Payer: HFN Commercial |
$3,134.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$2,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,134.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,669.43
|
| Rate for Payer: Quartz Commercial |
$2,214.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$1,873.85
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$2,523.56
|
|
|
Venous Cath Removal Tunneled
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
3052430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$436.59 |
| Max. Negotiated Rate |
$819.72 |
| Rate for Payer: Aetna Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.23
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$819.72
|
| Rate for Payer: Health EOS Commercial |
$792.99
|
| Rate for Payer: HFN Commercial |
$819.72
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: NAPHCARE Commercial |
$534.60
|
| Rate for Payer: Preferred Network Access Commercial |
$819.72
|
| Rate for Payer: Quartz Beloit One Network |
$436.59
|
| Rate for Payer: Quartz Commercial |
$534.60
|
| Rate for Payer: WEA Trust Commercial |
$490.05
|
| Rate for Payer: WPS Commercial |
$659.96
|
|
|
Venous Cath Removal Tunneled
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 36589
|
| Hospital Charge Code |
3052430
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$436.59 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$766.26
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$472.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| 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 |
$819.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Health EOS Commercial |
$792.99
|
| Rate for Payer: HFN Commercial |
$819.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: Multiplan Commercial |
$712.80
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$819.72
|
| Rate for Payer: Quartz Beloit One Network |
$436.59
|
| Rate for Payer: Quartz Commercial |
$579.15
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$2,483.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: WEA Trust Commercial |
$490.05
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$659.96
|
|
|
Venous Cath Replace Non-Tunneled
|
Facility
|
IP
|
$918.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
4125711
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$449.82 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna Commercial |
$826.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.54
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$844.56
|
| Rate for Payer: Health EOS Commercial |
$817.02
|
| Rate for Payer: HFN Commercial |
$844.56
|
| Rate for Payer: Multiplan Commercial |
$734.40
|
| Rate for Payer: NAPHCARE Commercial |
$550.80
|
| Rate for Payer: Preferred Network Access Commercial |
$844.56
|
| Rate for Payer: Quartz Beloit One Network |
$449.82
|
| Rate for Payer: Quartz Commercial |
$550.80
|
| Rate for Payer: WEA Trust Commercial |
$504.90
|
| Rate for Payer: WPS Commercial |
$679.96
|
|
|
Venous Cath Replace Non-Tunneled
|
Facility
|
OP
|
$918.00
|
|
|
Service Code
|
CPT 36580
|
| Hospital Charge Code |
4125711
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$449.82 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$826.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.54
|
| 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 |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$844.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$817.02
|
| Rate for Payer: HFN Commercial |
$844.56
|
| 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 |
$734.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$844.56
|
| Rate for Payer: Quartz Beloit One Network |
$449.82
|
| Rate for Payer: Quartz Commercial |
$596.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$504.90
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$679.96
|
|
|
Venous Cath Replace Tunneled
|
Facility
|
IP
|
$2,904.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
3052429
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,422.96 |
| Max. Negotiated Rate |
$2,671.68 |
| Rate for Payer: Aetna Commercial |
$2,613.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,497.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,539.12
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cigna Commercial |
$2,671.68
|
| Rate for Payer: Health EOS Commercial |
$2,584.56
|
| Rate for Payer: HFN Commercial |
$2,671.68
|
| Rate for Payer: Multiplan Commercial |
$2,323.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,742.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,671.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.96
|
| Rate for Payer: Quartz Commercial |
$1,742.40
|
| Rate for Payer: WEA Trust Commercial |
$1,597.20
|
| Rate for Payer: WPS Commercial |
$2,150.99
|
|
|
Venous Cath Replace Tunneled
|
Facility
|
OP
|
$2,904.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
3052429
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,422.96 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$2,613.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,497.44
|
| 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 |
$1,539.12
|
| 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 |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cigna Commercial |
$2,671.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$2,584.56
|
| Rate for Payer: HFN Commercial |
$2,671.68
|
| 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 |
$2,323.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,671.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,422.96
|
| Rate for Payer: Quartz Commercial |
$1,887.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$1,597.20
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$2,150.99
|
|
|
Venous Cath Reposition
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
3913415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| 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 |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| 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 |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$287.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
Venous Cath Reposition
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
3913415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
|
VENOUS MECH THROMBECTOMY 37187
|
Professional
|
Both
|
$1,889.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
3014544
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$831.16 |
| Max. Negotiated Rate |
$2,331.37 |
| Rate for Payer: Aetna Commercial |
$1,794.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,624.54
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,794.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,331.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.40
|
| Rate for Payer: Health EOS Commercial |
$1,718.99
|
| Rate for Payer: HFN Commercial |
$1,794.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,284.85
|
| Rate for Payer: Multiplan Commercial |
$1,511.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.55
|
| Rate for Payer: Quartz Beloit One Network |
$831.16
|
| Rate for Payer: Quartz Commercial |
$1,076.73
|
| Rate for Payer: The Alliance Commercial |
$944.50
|
| Rate for Payer: United Healthcare Medicaid |
$2,331.37
|
| Rate for Payer: WEA Trust Commercial |
$1,038.95
|
| Rate for Payer: WPS Commercial |
$1,399.18
|
|
