|
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 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
|
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 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 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 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 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
|
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 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 Tunneled
|
Facility
|
OP
|
$2,904.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
3052429
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,479.88 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$2,718.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,597.34
|
| 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 |
$1,600.68
|
| 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 |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cash Price |
$871.20
|
| Rate for Payer: Cigna Commercial |
$2,778.55
|
| 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 |
$2,687.94
|
| Rate for Payer: HFN Commercial |
$2,778.55
|
| 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 |
$2,416.13
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| 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 |
$1,963.10
|
| 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 |
$1,661.09
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$2,236.95
|
|
|
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
|
|
|
Venous Cath Reposition
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
3913415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$275.81
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
Venous Cath Reposition
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 36597
|
| Hospital Charge Code |
3913415
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| 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 |
$243.63
|
| 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 |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| 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 |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| 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 |
$367.74
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$298.79
|
| 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 |
$252.82
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
VENOUS MECH THROMBECTOMY 37187
|
Professional
|
Both
|
$1,889.00
|
|
|
Service Code
|
CPT 37187
|
| Hospital Charge Code |
3014544
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$325.93 |
| Max. Negotiated Rate |
$2,424.62 |
| Rate for Payer: Aetna Commercial |
$1,866.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.52
|
| Rate for Payer: Aetna Managed Medicare |
$325.93
|
| Rate for Payer: Anthem Medicare Advantage |
$325.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$325.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$325.93
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cash Price |
$566.70
|
| Rate for Payer: Cigna Commercial |
$1,866.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,424.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.93
|
| Rate for Payer: Health EOS Commercial |
$1,787.75
|
| Rate for Payer: HFN Commercial |
$1,866.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,336.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,336.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$325.93
|
| Rate for Payer: Multiplan Commercial |
$1,571.65
|
| Rate for Payer: NAPHCARE Commercial |
$488.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,866.33
|
| Rate for Payer: Quartz Beloit One Network |
$864.41
|
| Rate for Payer: Quartz Commercial |
$1,119.80
|
| Rate for Payer: Quartz Medicare Advantage |
$325.93
|
| Rate for Payer: The Alliance Commercial |
$1,385.18
|
| Rate for Payer: United Healthcare Medicaid |
$2,424.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$325.93
|
| Rate for Payer: WEA Trust Commercial |
$1,080.51
|
| Rate for Payer: WPS Commercial |
$1,466.67
|
|
|
VENT CATHETER LEFT 16FR HEART 12116
|
Facility
|
OP
|
$471.00
|
|
| Hospital Charge Code |
2971147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$137.16 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Aetna Managed Medicare |
$137.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$318.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$235.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.12
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.38
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: NAPHCARE Commercial |
$293.90
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$318.40
|
| Rate for Payer: Quartz Medicare Advantage |
$293.90
|
| Rate for Payer: The Alliance Commercial |
$244.92
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
VENT CATHETER LEFT 16FR HEART 12116
|
Facility
|
IP
|
$471.00
|
|
| Hospital Charge Code |
2971147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$240.02 |
| Max. Negotiated Rate |
$450.65 |
| Rate for Payer: Aetna Commercial |
$440.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.62
|
| Rate for Payer: Cash Price |
$141.30
|
| Rate for Payer: Cigna Commercial |
$450.65
|
| Rate for Payer: Health EOS Commercial |
$435.96
|
| Rate for Payer: HFN Commercial |
$450.65
|
| Rate for Payer: Multiplan Commercial |
$391.87
|
| Rate for Payer: Preferred Network Access Commercial |
$450.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.02
|
| Rate for Payer: Quartz Commercial |
$293.90
|
| Rate for Payer: WEA Trust Commercial |
$269.41
|
| Rate for Payer: WPS Commercial |
$362.81
|
|
|
VENTILATING TUBE REMOVAL REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$13,956.63
|
|
|
Service Code
|
CPT 69424
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| 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 |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
|
|
VENTILATION ASSISTANCE AND MANAGEMENT
|
Facility
|
OP
|
$257.05
|
|
|
Service Code
|
EAPG 00067
|
| Min. Negotiated Rate |
$247.17 |
| Max. Negotiated Rate |
$257.05 |
| Rate for Payer: Anthem Medicaid |
$247.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$247.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.17
|
| Rate for Payer: Dean Health Medicaid |
$247.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$247.17
|
| Rate for Payer: Managed Health Services Medicaid |
$257.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$247.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$247.17
|
| Rate for Payer: United Healthcare Medicaid |
$247.17
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$12,626.37
|
|
|
Service Code
|
APR-DRG 0221
|
| Min. Negotiated Rate |
$11,215.53 |
| Max. Negotiated Rate |
$12,626.37 |
| Rate for Payer: Anthem Medicaid |
$12,090.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,090.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,090.44
|
| Rate for Payer: Dean Health Medicaid |
$12,090.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,215.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12,626.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,090.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,090.44
|
| Rate for Payer: United Healthcare Medicaid |
$12,090.44
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$23,323.70
|
|
|
Service Code
|
APR-DRG 0223
|
| Min. Negotiated Rate |
$20,717.57 |
| Max. Negotiated Rate |
$23,323.70 |
| Rate for Payer: Anthem Medicaid |
$22,333.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,333.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,333.73
|
| Rate for Payer: Dean Health Medicaid |
$22,333.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,717.57
|
| Rate for Payer: Managed Health Services Medicaid |
$23,323.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,333.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,333.73
|
| Rate for Payer: United Healthcare Medicaid |
$22,333.73
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$15,870.64
|
|
|
Service Code
|
APR-DRG 0222
|
| Min. Negotiated Rate |
$14,097.29 |
| Max. Negotiated Rate |
$15,870.64 |
| Rate for Payer: Anthem Medicaid |
$15,197.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,197.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,197.01
|
| Rate for Payer: Dean Health Medicaid |
$15,197.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,097.29
|
| Rate for Payer: Managed Health Services Medicaid |
$15,870.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,197.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,197.01
|
| Rate for Payer: United Healthcare Medicaid |
$15,197.01
|
|
|
VENTRICULAR SHUNT PROCEDURES
|
Facility
|
IP
|
$42,175.57
|
|
|
Service Code
|
APR-DRG 0224
|
| Min. Negotiated Rate |
$37,462.97 |
| Max. Negotiated Rate |
$42,175.57 |
| Rate for Payer: Anthem Medicaid |
$40,385.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$40,385.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40,385.43
|
| Rate for Payer: Dean Health Medicaid |
$40,385.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37,462.97
|
| Rate for Payer: Managed Health Services Medicaid |
$42,175.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,385.43
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$40,385.43
|
| Rate for Payer: United Healthcare Medicaid |
$40,385.43
|
|
|
VENTRICULAR SHUNT PROCEDURES WITH CC
|
Facility
|
IP
|
$59,884.24
|
|
|
Service Code
|
MSDRG 032
|
| Min. Negotiated Rate |
$16,826.40 |
| Max. Negotiated Rate |
$59,884.24 |
| Rate for Payer: Aetna Managed Medicare |
$16,826.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,496.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,639.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,859.71
|
| Rate for Payer: Anthem Medicare Advantage |
$16,826.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,826.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,826.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,826.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,587.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,826.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,679.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,826.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,826.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,826.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,826.40
|
| Rate for Payer: NAPHCARE Commercial |
$25,239.60
|
| Rate for Payer: Quartz Medicare Advantage |
$16,826.40
|
| Rate for Payer: The Alliance Commercial |
$59,884.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,826.40
|
| Rate for Payer: United Healthcare PPO |
$34,004.71
|
| Rate for Payer: Wellcare Medicare |
$16,826.40
|
|
