|
XR Venogram Lower Extremity Left
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072728
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$640.06 |
| Max. Negotiated Rate |
$1,201.74 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$783.74
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Lower Extremity Left
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072728
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.75 |
| Max. Negotiated Rate |
$1,240.93 |
| Rate for Payer: Aetna Commercial |
$1,240.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,240.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$653.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.74
|
| Rate for Payer: Health EOS Commercial |
$1,188.68
|
| Rate for Payer: HFN Commercial |
$1,240.93
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.93
|
| Rate for Payer: Quartz Beloit One Network |
$574.75
|
| Rate for Payer: Quartz Commercial |
$744.56
|
| Rate for Payer: The Alliance Commercial |
$653.12
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Lower Extremity Left
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072728
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,173.58 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Aetna Managed Medicare |
$365.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,173.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,938.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,691.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.99
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.68
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: NAPHCARE Commercial |
$783.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$849.06
|
| Rate for Payer: Quartz Medicare Advantage |
$783.74
|
| Rate for Payer: The Alliance Commercial |
$653.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Lower Extremity Right
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,RT
|
| Hospital Charge Code |
3072729
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.75 |
| Max. Negotiated Rate |
$1,240.93 |
| Rate for Payer: Aetna Commercial |
$1,240.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,240.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$653.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.74
|
| Rate for Payer: Health EOS Commercial |
$1,188.68
|
| Rate for Payer: HFN Commercial |
$1,240.93
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.93
|
| Rate for Payer: Quartz Beloit One Network |
$574.75
|
| Rate for Payer: Quartz Commercial |
$744.56
|
| Rate for Payer: The Alliance Commercial |
$653.12
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Lower Extremity Right
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,RT
|
| Hospital Charge Code |
3072729
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$640.06 |
| Max. Negotiated Rate |
$1,201.74 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$783.74
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Lower Extremity Right
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,RT
|
| Hospital Charge Code |
3072729
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,173.58 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Aetna Managed Medicare |
$365.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,173.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,938.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,691.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.99
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.68
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: NAPHCARE Commercial |
$783.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$849.06
|
| Rate for Payer: Quartz Medicare Advantage |
$783.74
|
| Rate for Payer: The Alliance Commercial |
$653.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Upper Extremity Bilateral
|
Professional
|
Both
|
$1,723.00
|
|
|
Service Code
|
CPT 75822 TC
|
| Hospital Charge Code |
3072722
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$65.33 |
| Max. Negotiated Rate |
$1,702.32 |
| Rate for Payer: Aetna Commercial |
$1,702.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Aetna Managed Medicare |
$65.33
|
| Rate for Payer: Anthem Medicare Advantage |
$65.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.33
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,702.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$895.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.33
|
| Rate for Payer: Health EOS Commercial |
$1,630.65
|
| Rate for Payer: HFN Commercial |
$1,702.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.33
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: NAPHCARE Commercial |
$98.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,702.32
|
| Rate for Payer: Quartz Beloit One Network |
$788.44
|
| Rate for Payer: Quartz Commercial |
$1,021.39
|
| Rate for Payer: Quartz Medicare Advantage |
$65.33
|
| Rate for Payer: The Alliance Commercial |
$248.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.33
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$326.66
|
|
|
XR Venogram Upper Extremity Bilateral
|
Facility
|
IP
|
$1,723.00
|
|
|
Service Code
|
CPT 75822 TC
|
| Hospital Charge Code |
3072722
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$878.04 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,075.15
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
XR Venogram Upper Extremity Bilateral
|
Facility
|
OP
|
$1,723.00
|
|
|
Service Code
|
CPT 75822 TC
|
| Hospital Charge Code |
3072722
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$261.33 |
| Max. Negotiated Rate |
$1,648.57 |
| Rate for Payer: Aetna Commercial |
$1,612.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.05
|
| Rate for Payer: Aetna Managed Medicare |
$501.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$895.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.72
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,648.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.79
|
| Rate for Payer: Health EOS Commercial |
$1,594.81
|
| Rate for Payer: HFN Commercial |
$1,648.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,343.94
|
| Rate for Payer: Multiplan Commercial |
$1,433.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.15
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.57
|
| Rate for Payer: Quartz Beloit One Network |
$878.04
|
| Rate for Payer: Quartz Commercial |
$1,164.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.15
|
| Rate for Payer: The Alliance Commercial |
$261.33
|
| Rate for Payer: WEA Trust Commercial |
$985.56
|
| Rate for Payer: WPS Commercial |
$1,327.23
|
|
|
XR Venogram Upper Extremity Left
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072730
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.75 |
| Max. Negotiated Rate |
$1,240.93 |
| Rate for Payer: Aetna Commercial |
$1,240.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,240.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$653.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.74
|
| Rate for Payer: Health EOS Commercial |
$1,188.68
|
| Rate for Payer: HFN Commercial |
$1,240.93
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.93
|
| Rate for Payer: Quartz Beloit One Network |
$574.75
|
| Rate for Payer: Quartz Commercial |
$744.56
|
| Rate for Payer: The Alliance Commercial |
$653.12
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Upper Extremity Left
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072730
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$640.06 |
| Max. Negotiated Rate |
$1,201.74 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$783.74
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Upper Extremity Left
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072730
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,173.58 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Aetna Managed Medicare |
$365.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,173.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,938.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,691.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.99
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.68
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: NAPHCARE Commercial |
$783.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$849.06
|
| Rate for Payer: Quartz Medicare Advantage |
$783.74
|
| Rate for Payer: The Alliance Commercial |
$653.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Upper Extremity Right
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,RT
|
| Hospital Charge Code |
3072731
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$574.75 |
| Max. Negotiated Rate |
$1,240.93 |
| Rate for Payer: Aetna Commercial |
$1,240.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,240.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$653.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.74
|
| Rate for Payer: Health EOS Commercial |
$1,188.68
|
| Rate for Payer: HFN Commercial |
$1,240.93
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.93
|
| Rate for Payer: Quartz Beloit One Network |
$574.75
|
| Rate for Payer: Quartz Commercial |
$744.56
|
| Rate for Payer: The Alliance Commercial |
$653.12
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Upper Extremity Right
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,RT
|
| Hospital Charge Code |
3072731
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,173.58 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Aetna Managed Medicare |
$365.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,173.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,938.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,691.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.99
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$979.68
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: NAPHCARE Commercial |
$783.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$849.06
|
| Rate for Payer: Quartz Medicare Advantage |
$783.74
|
| Rate for Payer: The Alliance Commercial |
$653.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venogram Upper Extremity Right
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,RT
|
| Hospital Charge Code |
3072731
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$640.06 |
| Max. Negotiated Rate |
$1,201.74 |
| Rate for Payer: Aetna Commercial |
$1,175.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,123.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$692.31
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,201.74
|
| Rate for Payer: Health EOS Commercial |
$1,162.55
|
| Rate for Payer: HFN Commercial |
$1,201.74
|
| Rate for Payer: Multiplan Commercial |
$1,044.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.74
|
| Rate for Payer: Quartz Beloit One Network |
$640.06
|
| Rate for Payer: Quartz Commercial |
$783.74
|
| Rate for Payer: WEA Trust Commercial |
$718.43
|
| Rate for Payer: WPS Commercial |
$967.50
|
|
|
XR Venous Access Patency Check
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
CPT 36598 TC
|
| Hospital Charge Code |
6219656
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.87 |
| Max. Negotiated Rate |
$1,004.80 |
| Rate for Payer: Aetna Commercial |
$1,004.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$909.60
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cigna Commercial |
$1,004.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$528.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$634.61
|
| Rate for Payer: Health EOS Commercial |
$962.49
|
| Rate for Payer: HFN Commercial |
$1,004.80
|
| Rate for Payer: Multiplan Commercial |
$846.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,004.80
|
| Rate for Payer: Quartz Beloit One Network |
$465.38
|
| Rate for Payer: Quartz Commercial |
$602.88
|
| Rate for Payer: The Alliance Commercial |
$528.84
|
| Rate for Payer: United Healthcare Medicaid |
$109.87
|
| Rate for Payer: WEA Trust Commercial |
$581.72
|
| Rate for Payer: WPS Commercial |
$783.40
|
|
|
XR Venous Access Patency Check
|
Facility
|
IP
|
$1,017.00
|
|
|
Service Code
|
CPT 36598 TC
|
| Hospital Charge Code |
6219656
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$518.26 |
| Max. Negotiated Rate |
$973.07 |
| Rate for Payer: Aetna Commercial |
$951.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$909.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.57
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cigna Commercial |
$973.07
|
| Rate for Payer: Health EOS Commercial |
$941.34
|
| Rate for Payer: HFN Commercial |
$973.07
|
| Rate for Payer: Multiplan Commercial |
$846.14
|
| Rate for Payer: Preferred Network Access Commercial |
$973.07
|
| Rate for Payer: Quartz Beloit One Network |
$518.26
|
| Rate for Payer: Quartz Commercial |
$634.61
|
| Rate for Payer: WEA Trust Commercial |
$581.72
|
| Rate for Payer: WPS Commercial |
$783.40
|
|
|
XR Venous Access Patency Check
|
Facility
|
OP
|
$1,017.00
|
|
|
Service Code
|
CPT 36598 TC
|
| Hospital Charge Code |
6219656
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$296.15 |
| Max. Negotiated Rate |
$973.07 |
| Rate for Payer: Aetna Commercial |
$951.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$909.60
|
| Rate for Payer: Aetna Managed Medicare |
$296.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$687.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$528.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$507.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.57
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cigna Commercial |
$973.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$591.89
|
| Rate for Payer: Health EOS Commercial |
$941.34
|
| Rate for Payer: HFN Commercial |
$973.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$793.26
|
| Rate for Payer: Multiplan Commercial |
$846.14
|
| Rate for Payer: NAPHCARE Commercial |
$634.61
|
| Rate for Payer: Preferred Network Access Commercial |
$973.07
|
| Rate for Payer: Quartz Beloit One Network |
$518.26
|
| Rate for Payer: Quartz Commercial |
$687.49
|
| Rate for Payer: Quartz Medicare Advantage |
$634.61
|
| Rate for Payer: The Alliance Commercial |
$528.84
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$581.72
|
| Rate for Payer: WPS Commercial |
$783.40
|
|
|
XR Wrist 2 Views Bilateral
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613630
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna Commercial |
$819.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$782.60
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$591.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$455.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$436.80
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$837.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$509.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$809.90
|
| Rate for Payer: HFN Commercial |
$837.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$837.20
|
| Rate for Payer: Quartz Beloit One Network |
$445.90
|
| Rate for Payer: Quartz Commercial |
$591.50
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$500.50
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$674.01
|
|
|
XR Wrist 2 Views Bilateral
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613630
|
| Min. Negotiated Rate |
$445.90 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna Commercial |
$819.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$782.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.30
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$837.20
|
| Rate for Payer: Health EOS Commercial |
$809.90
|
| Rate for Payer: HFN Commercial |
$837.20
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: Preferred Network Access Commercial |
$837.20
|
| Rate for Payer: Quartz Beloit One Network |
$445.90
|
| Rate for Payer: Quartz Commercial |
$546.00
|
| Rate for Payer: WEA Trust Commercial |
$500.50
|
| Rate for Payer: WPS Commercial |
$674.01
|
|
|
XR Wrist 2 Views Bilateral
|
Professional
|
Both
|
$875.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
613630
|
| Min. Negotiated Rate |
$34.06 |
| Max. Negotiated Rate |
$864.50 |
| Rate for Payer: Aetna Commercial |
$864.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$782.60
|
| Rate for Payer: Aetna Managed Medicare |
$34.06
|
| Rate for Payer: Anthem Medicare Advantage |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.06
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$864.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$455.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.06
|
| Rate for Payer: Health EOS Commercial |
$828.10
|
| Rate for Payer: HFN Commercial |
$864.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.09
|
| Rate for Payer: Preferred Network Access Commercial |
$864.50
|
| Rate for Payer: Quartz Beloit One Network |
$400.40
|
| Rate for Payer: Quartz Commercial |
$518.70
|
| Rate for Payer: Quartz Medicare Advantage |
$34.06
|
| Rate for Payer: The Alliance Commercial |
$129.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.06
|
| Rate for Payer: WEA Trust Commercial |
$500.50
|
| Rate for Payer: WPS Commercial |
$170.30
|
|
|
XR Wrist 2 Views Bilateral
|
Facility
|
OP
|
$456.00
|
|
|
Service Code
|
CPT 73100 LT,TC
|
| Hospital Charge Code |
1537481
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Aetna Managed Medicare |
$132.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.39
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.68
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: NAPHCARE Commercial |
$284.54
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: Quartz Medicare Advantage |
$284.54
|
| Rate for Payer: The Alliance Commercial |
$237.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
XR Wrist 2 Views Bilateral
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
CPT 73100 LT,TC
|
| Hospital Charge Code |
1537481
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.67 |
| Max. Negotiated Rate |
$450.53 |
| Rate for Payer: Aetna Commercial |
$450.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$450.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.54
|
| Rate for Payer: Health EOS Commercial |
$431.56
|
| Rate for Payer: HFN Commercial |
$450.53
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: Preferred Network Access Commercial |
$450.53
|
| Rate for Payer: Quartz Beloit One Network |
$208.67
|
| Rate for Payer: Quartz Commercial |
$270.32
|
| Rate for Payer: The Alliance Commercial |
$237.12
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
XR Wrist 2 Views Bilateral
|
Facility
|
IP
|
$456.00
|
|
|
Service Code
|
CPT 73100 LT,TC
|
| Hospital Charge Code |
1537481
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.38 |
| Max. Negotiated Rate |
$436.30 |
| Rate for Payer: Aetna Commercial |
$426.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$407.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.35
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$436.30
|
| Rate for Payer: Health EOS Commercial |
$422.07
|
| Rate for Payer: HFN Commercial |
$436.30
|
| Rate for Payer: Multiplan Commercial |
$379.39
|
| Rate for Payer: Preferred Network Access Commercial |
$436.30
|
| Rate for Payer: Quartz Beloit One Network |
$232.38
|
| Rate for Payer: Quartz Commercial |
$284.54
|
| Rate for Payer: WEA Trust Commercial |
$260.83
|
| Rate for Payer: WPS Commercial |
$351.26
|
|
|
XR Wrist 2 Views Left
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 73100 LT,TC
|
| Hospital Charge Code |
1537483
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.85 |
| Max. Negotiated Rate |
$472.66 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Aetna Managed Medicare |
$143.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.51
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.32
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: NAPHCARE Commercial |
$308.26
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$333.94
|
| Rate for Payer: Quartz Medicare Advantage |
$308.26
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
