|
XR Neck Soft Tissue
|
Professional
|
$465.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
630307
|
| Min. Negotiated Rate |
$30.46 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Aetna Commercial |
$441.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.90
|
| Rate for Payer: Aetna Managed Medicare |
$30.46
|
| Rate for Payer: Anthem Medicare Advantage |
$30.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.46
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$441.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.46
|
| Rate for Payer: Health EOS Commercial |
$423.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.46
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.75
|
| Rate for Payer: Quartz Beloit One Network |
$204.60
|
| Rate for Payer: Quartz Commercial |
$265.05
|
| Rate for Payer: Quartz Medicare Advantage |
$30.46
|
| Rate for Payer: The Alliance Commercial |
$115.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.46
|
| Rate for Payer: WEA Trust Commercial |
$255.75
|
| Rate for Payer: WPS Commercial |
$152.30
|
|
|
XR Neck Soft Tissue
|
Facility
IP
|
$502.00
|
|
|
Service Code
|
CPT 70360 TC
|
| Hospital Charge Code |
1537208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$461.84 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$301.20
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$301.20
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
XR Neck Soft Tissue
|
Professional
|
$502.00
|
|
|
Service Code
|
CPT 70360 TC
|
| Hospital Charge Code |
1537208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$476.90 |
| Rate for Payer: Aetna Commercial |
$476.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Aetna Managed Medicare |
$22.00
|
| Rate for Payer: Anthem Medicare Advantage |
$22.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.00
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$476.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.00
|
| Rate for Payer: Health EOS Commercial |
$456.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.00
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Preferred Network Access Commercial |
$476.90
|
| Rate for Payer: Quartz Beloit One Network |
$220.88
|
| Rate for Payer: Quartz Commercial |
$286.14
|
| Rate for Payer: Quartz Medicare Advantage |
$22.00
|
| Rate for Payer: The Alliance Commercial |
$83.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.00
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$110.00
|
|
|
XR Neck Soft Tissue
|
Facility
OP
|
$465.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
630307
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$427.80 |
| Rate for Payer: Aetna Commercial |
$418.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.90
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.20
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$427.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$413.85
|
| Rate for Payer: HFN Commercial |
$427.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$427.80
|
| Rate for Payer: Quartz Beloit One Network |
$227.85
|
| Rate for Payer: Quartz Commercial |
$302.25
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$335.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$255.75
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$344.43
|
|
|
XR Neck Soft Tissue
|
Facility
OP
|
$502.00
|
|
|
Service Code
|
CPT 70360 TC
|
| Hospital Charge Code |
1537208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$140.56 |
| Max. Negotiated Rate |
$2,008.00 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Aetna Managed Medicare |
$140.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$376.50
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$301.20
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$326.30
|
| Rate for Payer: Quartz Medicare Advantage |
$301.20
|
| Rate for Payer: The Alliance Commercial |
$2,008.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
XR Neph Exchange Percutaneous
|
Professional
|
$3,505.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
4600648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.99 |
| Max. Negotiated Rate |
$3,329.75 |
| Rate for Payer: Aetna Commercial |
$3,329.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,014.30
|
| Rate for Payer: Aetna Managed Medicare |
$92.99
|
| Rate for Payer: Anthem Medicare Advantage |
$92.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.99
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,329.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,752.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.99
|
| Rate for Payer: Health EOS Commercial |
$3,189.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$332.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$332.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.99
|
| Rate for Payer: Multiplan Commercial |
$2,804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,329.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,542.20
|
| Rate for Payer: Quartz Commercial |
$1,997.85
|
| Rate for Payer: Quartz Medicare Advantage |
$92.99
|
| Rate for Payer: The Alliance Commercial |
$395.21
|
| Rate for Payer: United Healthcare Medicaid |
$367.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.99
|
| Rate for Payer: WEA Trust Commercial |
$1,927.75
|
| Rate for Payer: WPS Commercial |
$418.46
|
|
|
XR Neph Exchange Percutaneous
|
Facility
IP
|
$3,505.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
4600648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,717.45 |
| Max. Negotiated Rate |
$3,224.60 |
| Rate for Payer: Aetna Commercial |
$3,154.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.65
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,224.60
|
| Rate for Payer: Health EOS Commercial |
$3,119.45
|
| Rate for Payer: HFN Commercial |
$3,224.60
|
| Rate for Payer: Multiplan Commercial |
$2,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,103.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,224.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,717.45
|
| Rate for Payer: Quartz Commercial |
$2,103.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.75
|
| Rate for Payer: WPS Commercial |
$2,596.15
|
|
|
XR Neph Exchange Percutaneous
|
Facility
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
4600648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$7,762.64 |
| Rate for Payer: Aetna Commercial |
$3,154.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,014.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,278.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,752.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,682.40
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,224.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$3,119.45
|
| Rate for Payer: HFN Commercial |
$3,224.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$2,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,224.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,717.45
|
| Rate for Payer: Quartz Commercial |
$2,278.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$7,762.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.75
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$2,596.15
|
|
|
XR Nephrostogram
|
Professional
|
$796.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2587235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.85 |
| Max. Negotiated Rate |
$756.20 |
| Rate for Payer: Aetna Commercial |
$756.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Aetna Managed Medicare |
$132.85
|
| Rate for Payer: Anthem Medicare Advantage |
$132.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.85
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$756.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$398.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.85
|
| Rate for Payer: Health EOS Commercial |
$724.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$473.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$473.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.85
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$756.20
|
| Rate for Payer: Quartz Beloit One Network |
$350.24
|
| Rate for Payer: Quartz Commercial |
$453.72
|
| Rate for Payer: Quartz Medicare Advantage |
$132.85
|
| Rate for Payer: The Alliance Commercial |
$504.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.85
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$664.25
|
|
|
XR Nephrostogram
|
Facility
OP
|
$796.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2587235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,425.45 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,425.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.34
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$732.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$708.44
|
| Rate for Payer: HFN Commercial |
$732.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$732.32
|
| Rate for Payer: Quartz Beloit One Network |
$390.04
|
| Rate for Payer: Quartz Commercial |
$517.40
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$439.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
XR Nephrostogram
|
Facility
IP
|
$796.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2587235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$390.04 |
| Max. Negotiated Rate |
$732.32 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.88
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$732.32
|
| Rate for Payer: Health EOS Commercial |
$708.44
|
| Rate for Payer: HFN Commercial |
$732.32
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: NAPHCARE Commercial |
$477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$732.32
|
| Rate for Payer: Quartz Beloit One Network |
$390.04
|
| Rate for Payer: Quartz Commercial |
$477.60
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
XR Nephrostomy Dilation Bilateral
|
Facility
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 LT,TC
|
| Hospital Charge Code |
2587238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,648.00 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Aetna Managed Medicare |
$605.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,405.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,037.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,209.86
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,621.50
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,405.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,297.20
|
| Rate for Payer: The Alliance Commercial |
$8,648.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Bilateral
|
Professional
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 LT,TC
|
| Hospital Charge Code |
2587238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$951.28 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna Commercial |
$2,053.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,053.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,081.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.20
|
| Rate for Payer: Health EOS Commercial |
$1,967.42
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.90
|
| Rate for Payer: Quartz Beloit One Network |
$951.28
|
| Rate for Payer: Quartz Commercial |
$1,232.34
|
| Rate for Payer: The Alliance Commercial |
$1,081.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Bilateral
|
Facility
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 LT,TC
|
| Hospital Charge Code |
2587238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,059.38 |
| Max. Negotiated Rate |
$1,989.04 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,297.20
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Left
|
Facility
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,LT
|
| Hospital Charge Code |
2587241
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,648.00 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Aetna Managed Medicare |
$605.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,405.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,037.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,209.86
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,621.50
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,405.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,297.20
|
| Rate for Payer: The Alliance Commercial |
$8,648.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Left
|
Facility
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,LT
|
| Hospital Charge Code |
2587241
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,059.38 |
| Max. Negotiated Rate |
$1,989.04 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,297.20
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Left
|
Professional
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,LT
|
| Hospital Charge Code |
2587241
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$951.28 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna Commercial |
$2,053.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,053.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,081.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.20
|
| Rate for Payer: Health EOS Commercial |
$1,967.42
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.90
|
| Rate for Payer: Quartz Beloit One Network |
$951.28
|
| Rate for Payer: Quartz Commercial |
$1,232.34
|
| Rate for Payer: The Alliance Commercial |
$1,081.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Right
|
Professional
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 RT,TC
|
| Hospital Charge Code |
2587244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,188.88 |
| Max. Negotiated Rate |
$2,566.90 |
| Rate for Payer: Aetna Commercial |
$2,566.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.72
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,566.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,351.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,621.20
|
| Rate for Payer: Health EOS Commercial |
$2,458.82
|
| Rate for Payer: Multiplan Commercial |
$2,161.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.88
|
| Rate for Payer: Quartz Commercial |
$1,540.14
|
| Rate for Payer: The Alliance Commercial |
$1,351.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.10
|
| Rate for Payer: WPS Commercial |
$2,001.37
|
|
|
XR Nephrostomy Dilation Right
|
Facility
OP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 RT,TC
|
| Hospital Charge Code |
2587244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$10,808.00 |
| Rate for Payer: Aetna Commercial |
$2,431.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.72
|
| Rate for Payer: Aetna Managed Medicare |
$756.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,296.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.06
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,485.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.04
|
| Rate for Payer: Health EOS Commercial |
$2,404.78
|
| Rate for Payer: HFN Commercial |
$2,485.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,026.50
|
| Rate for Payer: Multiplan Commercial |
$2,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.98
|
| Rate for Payer: Quartz Commercial |
$1,756.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.20
|
| Rate for Payer: The Alliance Commercial |
$10,808.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.10
|
| Rate for Payer: WPS Commercial |
$2,001.37
|
|
|
XR Nephrostomy Dilation Right
|
Facility
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,RT
|
| Hospital Charge Code |
5430655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,059.38 |
| Max. Negotiated Rate |
$1,989.04 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,297.20
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Right
|
Facility
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,RT
|
| Hospital Charge Code |
5430655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,648.00 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Aetna Managed Medicare |
$605.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,405.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,037.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,209.86
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,621.50
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,405.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,297.20
|
| Rate for Payer: The Alliance Commercial |
$8,648.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Right
|
Professional
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,RT
|
| Hospital Charge Code |
5430655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$951.28 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna Commercial |
$2,053.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,053.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,081.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.20
|
| Rate for Payer: Health EOS Commercial |
$1,967.42
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.90
|
| Rate for Payer: Quartz Beloit One Network |
$951.28
|
| Rate for Payer: Quartz Commercial |
$1,232.34
|
| Rate for Payer: The Alliance Commercial |
$1,081.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Right
|
Facility
IP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 RT,TC
|
| Hospital Charge Code |
2587244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,323.98 |
| Max. Negotiated Rate |
$2,485.84 |
| Rate for Payer: Aetna Commercial |
$2,431.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.06
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,485.84
|
| Rate for Payer: Health EOS Commercial |
$2,404.78
|
| Rate for Payer: HFN Commercial |
$2,485.84
|
| Rate for Payer: Multiplan Commercial |
$2,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.98
|
| Rate for Payer: Quartz Commercial |
$1,621.20
|
| Rate for Payer: WEA Trust Commercial |
$1,486.10
|
| Rate for Payer: WPS Commercial |
$2,001.37
|
|
|
XR Optic Foramina Left
|
Facility
IP
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630305
|
| Min. Negotiated Rate |
$239.61 |
| Max. Negotiated Rate |
$449.88 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.17
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$449.88
|
| Rate for Payer: Health EOS Commercial |
$435.21
|
| Rate for Payer: HFN Commercial |
$449.88
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: NAPHCARE Commercial |
$293.40
|
| Rate for Payer: Preferred Network Access Commercial |
$449.88
|
| Rate for Payer: Quartz Beloit One Network |
$239.61
|
| Rate for Payer: Quartz Commercial |
$293.40
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
|
XR Optic Foramina Left
|
Facility
IP
|
$509.00
|
|
|
Service Code
|
CPT 70190 LT,TC
|
| Hospital Charge Code |
1537210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$468.28 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$305.40
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
