|
XR Drainage Lung Right
|
Facility
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
1536978
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Pancreas
|
Facility
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Pancreas
|
Professional
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661715
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,103.30 |
| Rate for Payer: Aetna Commercial |
$2,103.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.04
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,103.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,107.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,014.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.30
|
| Rate for Payer: Quartz Beloit One Network |
$974.16
|
| Rate for Payer: Quartz Commercial |
$1,261.98
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
XR Drainage Pancreas
|
Professional
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna Commercial |
$2,187.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,187.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,095.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.32
|
| Rate for Payer: Quartz Commercial |
$1,312.71
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
XR Drainage Pancreas
|
Facility
OP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661715
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$2,036.88 |
| Rate for Payer: Aetna Commercial |
$1,992.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.04
|
| Rate for Payer: Aetna Managed Medicare |
$619.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,439.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,107.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.42
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,036.88
|
| Rate for Payer: Health EOS Commercial |
$1,970.46
|
| Rate for Payer: HFN Commercial |
$2,036.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,660.50
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.86
|
| Rate for Payer: Quartz Commercial |
$1,439.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,328.40
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$1,639.91
|
|
|
XR Drainage Pancreas
|
Facility
IP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661715
|
| Min. Negotiated Rate |
$1,084.86 |
| Max. Negotiated Rate |
$2,036.88 |
| Rate for Payer: Aetna Commercial |
$1,992.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.42
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,036.88
|
| Rate for Payer: Health EOS Commercial |
$1,970.46
|
| Rate for Payer: HFN Commercial |
$2,036.88
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.86
|
| Rate for Payer: Quartz Commercial |
$1,328.40
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$1,639.91
|
|
|
XR Drainage Pancreas
|
Facility
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536980
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Peritoneal
|
Facility
IP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661717
|
| Min. Negotiated Rate |
$1,084.86 |
| Max. Negotiated Rate |
$2,036.88 |
| Rate for Payer: Aetna Commercial |
$1,992.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.42
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,036.88
|
| Rate for Payer: Health EOS Commercial |
$1,970.46
|
| Rate for Payer: HFN Commercial |
$2,036.88
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.86
|
| Rate for Payer: Quartz Commercial |
$1,328.40
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$1,639.91
|
|
|
XR Drainage Peritoneal
|
Facility
OP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661717
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$2,036.88 |
| Rate for Payer: Aetna Commercial |
$1,992.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.04
|
| Rate for Payer: Aetna Managed Medicare |
$619.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,439.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,107.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.42
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,036.88
|
| Rate for Payer: Health EOS Commercial |
$1,970.46
|
| Rate for Payer: HFN Commercial |
$2,036.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,660.50
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.86
|
| Rate for Payer: Quartz Commercial |
$1,439.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,328.40
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$1,639.91
|
|
|
XR Drainage Peritoneal
|
Facility
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536982
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Peritoneal
|
Facility
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536982
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Peritoneal
|
Professional
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536982
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna Commercial |
$2,187.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,187.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,095.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.32
|
| Rate for Payer: Quartz Commercial |
$1,312.71
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
XR Drainage Peritoneal
|
Professional
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661717
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,103.30 |
| Rate for Payer: Aetna Commercial |
$2,103.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.04
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,103.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,107.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,014.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.30
|
| Rate for Payer: Quartz Beloit One Network |
$974.16
|
| Rate for Payer: Quartz Commercial |
$1,261.98
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
XR Drainage Renal Bilateral
|
Facility
IP
|
$4,427.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661719
|
| Min. Negotiated Rate |
$2,169.23 |
| Max. Negotiated Rate |
$4,072.84 |
| Rate for Payer: Aetna Commercial |
$3,984.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,346.31
|
| Rate for Payer: Cash Price |
$1,328.10
|
| Rate for Payer: Cigna Commercial |
$4,072.84
|
| Rate for Payer: Health EOS Commercial |
$3,940.03
|
| Rate for Payer: HFN Commercial |
$4,072.84
|
| Rate for Payer: Multiplan Commercial |
$3,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,656.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.23
|
| Rate for Payer: Quartz Commercial |
$2,656.20
|
| Rate for Payer: WEA Trust Commercial |
$2,434.85
|
| Rate for Payer: WPS Commercial |
$3,279.08
|
|
|
XR Drainage Renal Bilateral
|
Facility
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
1536984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Renal Bilateral
|
Facility
OP
|
$4,427.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661719
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$4,072.84 |
| Rate for Payer: Aetna Commercial |
$3,984.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,807.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,877.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,346.31
|
| Rate for Payer: Cash Price |
$1,328.10
|
| Rate for Payer: Cash Price |
$1,328.10
|
| Rate for Payer: Cigna Commercial |
$4,072.84
|
| Rate for Payer: Health EOS Commercial |
$3,940.03
|
| Rate for Payer: HFN Commercial |
$4,072.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,320.25
|
| Rate for Payer: Multiplan Commercial |
$3,541.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,656.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,169.23
|
| Rate for Payer: Quartz Commercial |
$2,877.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,656.20
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: WEA Trust Commercial |
$2,434.85
|
| Rate for Payer: WPS Commercial |
$3,279.08
|
|
|
XR Drainage Renal Bilateral
|
Facility
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
1536984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Renal Bilateral
|
Professional
|
$4,427.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661719
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$4,205.65 |
| Rate for Payer: Aetna Commercial |
$4,205.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,807.22
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$1,328.10
|
| Rate for Payer: Cash Price |
$1,328.10
|
| Rate for Payer: Cigna Commercial |
$4,205.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,213.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$4,028.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$3,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,205.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,947.88
|
| Rate for Payer: Quartz Commercial |
$2,523.39
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$2,434.85
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
XR Drainage Renal Bilateral
|
Professional
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
1536984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,013.32 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna Commercial |
$2,187.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,187.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,381.80
|
| Rate for Payer: Health EOS Commercial |
$2,095.73
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.32
|
| Rate for Payer: Quartz Commercial |
$1,312.71
|
| Rate for Payer: The Alliance Commercial |
$1,151.50
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Renal Left
|
Professional
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
1536986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,013.32 |
| Max. Negotiated Rate |
$2,187.85 |
| Rate for Payer: Aetna Commercial |
$2,187.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,187.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,381.80
|
| Rate for Payer: Health EOS Commercial |
$2,095.73
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.32
|
| Rate for Payer: Quartz Commercial |
$1,312.71
|
| Rate for Payer: The Alliance Commercial |
$1,151.50
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Renal Left
|
Facility
IP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661721
|
| Min. Negotiated Rate |
$1,084.86 |
| Max. Negotiated Rate |
$2,036.88 |
| Rate for Payer: Aetna Commercial |
$1,992.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.42
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,036.88
|
| Rate for Payer: Health EOS Commercial |
$1,970.46
|
| Rate for Payer: HFN Commercial |
$2,036.88
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.86
|
| Rate for Payer: Quartz Commercial |
$1,328.40
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$1,639.91
|
|
|
XR Drainage Renal Left
|
Facility
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
1536986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,128.47 |
| Max. Negotiated Rate |
$2,118.76 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,381.80
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
|
XR Drainage Renal Left
|
Professional
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661721
|
| Min. Negotiated Rate |
$108.89 |
| Max. Negotiated Rate |
$2,103.30 |
| Rate for Payer: Aetna Commercial |
$2,103.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.04
|
| Rate for Payer: Aetna Managed Medicare |
$108.89
|
| Rate for Payer: Anthem Medicare Advantage |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.89
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,103.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,107.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$2,014.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$406.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.89
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.30
|
| Rate for Payer: Quartz Beloit One Network |
$974.16
|
| Rate for Payer: Quartz Commercial |
$1,261.98
|
| Rate for Payer: Quartz Medicare Advantage |
$108.89
|
| Rate for Payer: The Alliance Commercial |
$413.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.89
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
XR Drainage Renal Left
|
Facility
OP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661721
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$2,036.88 |
| Rate for Payer: Aetna Commercial |
$1,992.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.04
|
| Rate for Payer: Aetna Managed Medicare |
$619.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,439.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,107.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,062.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,173.42
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,036.88
|
| Rate for Payer: Health EOS Commercial |
$1,970.46
|
| Rate for Payer: HFN Commercial |
$2,036.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,660.50
|
| Rate for Payer: Multiplan Commercial |
$1,771.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,328.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,036.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,084.86
|
| Rate for Payer: Quartz Commercial |
$1,439.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,328.40
|
| Rate for Payer: The Alliance Commercial |
$6.44
|
| Rate for Payer: WEA Trust Commercial |
$1,217.70
|
| Rate for Payer: WPS Commercial |
$1,639.91
|
|
|
XR Drainage Renal Left
|
Facility
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
1536986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,212.00 |
| Rate for Payer: Aetna Commercial |
$2,072.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| Rate for Payer: Aetna Managed Medicare |
$644.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.59
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Health EOS Commercial |
$2,049.67
|
| Rate for Payer: HFN Commercial |
$2,118.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.25
|
| Rate for Payer: Multiplan Commercial |
$1,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.47
|
| Rate for Payer: Quartz Commercial |
$1,496.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.80
|
| Rate for Payer: The Alliance Commercial |
$9,212.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,266.65
|
| Rate for Payer: WPS Commercial |
$1,705.83
|
|
