|
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 |
$0.96
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$0.60
|
|
|
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 |
$0.24
|
| Rate for Payer: Anthem Medicare Advantage |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.24
|
| 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 |
$0.24
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$0.36
|
| 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 |
$0.24
|
| Rate for Payer: The Alliance Commercial |
$0.66
|
| Rate for Payer: United Healthcare Medicaid |
$0.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.24
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$0.60
|
|
|
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 |
$0.96
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$0.60
|
|
|
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 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
|
|
|
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
|
|
|
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
|
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 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 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
|
|
|
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 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
|
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
|
|
|
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
|
|
|
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: Quartz Beloit One Network |
$2,557.98
|
| 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 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
|
$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 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
|
|
