|
XR PICC Line Placement
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2587247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Commercial |
$2,255.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,155.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,628.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,253.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,202.88
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,328.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,305.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$2,230.34
|
| Rate for Payer: HFN Commercial |
$2,305.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,305.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,227.94
|
| Rate for Payer: Quartz Commercial |
$1,628.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,378.30
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$1,856.19
|
|
|
XR PICC Line Placement
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2587247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,227.94 |
| Max. Negotiated Rate |
$2,305.52 |
| Rate for Payer: Aetna Commercial |
$2,255.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,155.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,328.18
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,305.52
|
| Rate for Payer: Health EOS Commercial |
$2,230.34
|
| Rate for Payer: HFN Commercial |
$2,305.52
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,503.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,305.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,227.94
|
| Rate for Payer: Quartz Commercial |
$1,503.60
|
| Rate for Payer: WEA Trust Commercial |
$1,378.30
|
| Rate for Payer: WPS Commercial |
$1,856.19
|
|
|
XR PICC Line Placement
|
Professional
|
Both
|
$2,506.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2448799
|
| Min. Negotiated Rate |
$93.02 |
| Max. Negotiated Rate |
$2,380.70 |
| Rate for Payer: Aetna Commercial |
$2,380.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,155.16
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,380.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.60
|
| Rate for Payer: Health EOS Commercial |
$2,280.46
|
| Rate for Payer: HFN Commercial |
$2,380.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$312.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$312.48
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,380.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.64
|
| Rate for Payer: Quartz Commercial |
$1,428.42
|
| Rate for Payer: The Alliance Commercial |
$1,253.00
|
| Rate for Payer: United Healthcare Medicaid |
$93.02
|
| Rate for Payer: WEA Trust Commercial |
$1,378.30
|
| Rate for Payer: WPS Commercial |
$1,856.19
|
|
|
XR PICC Line Placement
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2448799
|
| Min. Negotiated Rate |
$1,202.88 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$2,255.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,155.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,628.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,253.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,202.88
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,328.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,305.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$2,230.34
|
| Rate for Payer: HFN Commercial |
$2,305.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,305.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,227.94
|
| Rate for Payer: Quartz Commercial |
$1,628.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: WEA Trust Commercial |
$1,378.30
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$1,856.19
|
|
|
XR PICC Line Placement
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2448799
|
| Min. Negotiated Rate |
$1,227.94 |
| Max. Negotiated Rate |
$2,305.52 |
| Rate for Payer: Aetna Commercial |
$2,255.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,155.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,328.18
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,305.52
|
| Rate for Payer: Health EOS Commercial |
$2,230.34
|
| Rate for Payer: HFN Commercial |
$2,305.52
|
| Rate for Payer: Multiplan Commercial |
$2,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,503.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,305.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,227.94
|
| Rate for Payer: Quartz Commercial |
$1,503.60
|
| Rate for Payer: WEA Trust Commercial |
$1,378.30
|
| Rate for Payer: WPS Commercial |
$1,856.19
|
|
|
XR Picc Line Replacement
|
Facility
|
OP
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2542799
|
| Min. Negotiated Rate |
$1,333.92 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$2,501.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,389.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,806.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,389.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,333.92
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,472.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,556.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$2,473.31
|
| Rate for Payer: HFN Commercial |
$2,556.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$2,223.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,556.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,361.71
|
| Rate for Payer: Quartz Commercial |
$1,806.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$2,058.41
|
|
|
XR Picc Line Replacement
|
Facility
|
IP
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2542799
|
| Min. Negotiated Rate |
$1,361.71 |
| Max. Negotiated Rate |
$2,556.68 |
| Rate for Payer: Aetna Commercial |
$2,501.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,389.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,472.87
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,556.68
|
| Rate for Payer: Health EOS Commercial |
$2,473.31
|
| Rate for Payer: HFN Commercial |
$2,556.68
|
| Rate for Payer: Multiplan Commercial |
$2,223.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,667.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,556.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,361.71
|
| Rate for Payer: Quartz Commercial |
$1,667.40
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: WPS Commercial |
$2,058.41
|
|
|
XR Picc Line Replacement
|
Professional
|
Both
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2542799
|
| Min. Negotiated Rate |
$200.12 |
| Max. Negotiated Rate |
$2,640.05 |
| Rate for Payer: Aetna Commercial |
$2,640.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,389.94
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,640.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$366.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,667.40
|
| Rate for Payer: Health EOS Commercial |
$2,528.89
|
| Rate for Payer: HFN Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.12
|
| Rate for Payer: Multiplan Commercial |
$2,223.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,222.76
|
| Rate for Payer: Quartz Commercial |
$1,584.03
|
| Rate for Payer: The Alliance Commercial |
$1,389.50
|
| Rate for Payer: United Healthcare Medicaid |
$366.75
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: WPS Commercial |
$2,058.41
|
|
|
XR PICC Line Replacement
|
Facility
|
IP
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2587250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,361.71 |
| Max. Negotiated Rate |
$2,556.68 |
| Rate for Payer: Aetna Commercial |
$2,501.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,389.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,472.87
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,556.68
|
| Rate for Payer: Health EOS Commercial |
$2,473.31
|
| Rate for Payer: HFN Commercial |
$2,556.68
|
| Rate for Payer: Multiplan Commercial |
$2,223.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,667.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,556.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,361.71
|
| Rate for Payer: Quartz Commercial |
$1,667.40
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: WPS Commercial |
$2,058.41
|
|
|
XR PICC Line Replacement
|
Professional
|
Both
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2587250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$200.12 |
| Max. Negotiated Rate |
$2,640.05 |
| Rate for Payer: Aetna Commercial |
$2,640.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,389.94
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,640.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$366.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,667.40
|
| Rate for Payer: Health EOS Commercial |
$2,528.89
|
| Rate for Payer: HFN Commercial |
$2,640.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.12
|
| Rate for Payer: Multiplan Commercial |
$2,223.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,222.76
|
| Rate for Payer: Quartz Commercial |
$1,584.03
|
| Rate for Payer: The Alliance Commercial |
$1,389.50
|
| Rate for Payer: United Healthcare Medicaid |
$366.75
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: WPS Commercial |
$2,058.41
|
|
|
XR PICC Line Replacement
|
Facility
|
OP
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2587250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$2,501.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,389.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,806.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,389.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,333.92
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,472.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,556.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$2,473.31
|
| Rate for Payer: HFN Commercial |
$2,556.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$2,223.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,556.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,361.71
|
| Rate for Payer: Quartz Commercial |
$1,806.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$2,058.41
|
|
|
XR PleurX Placement Abdomen
|
Facility
|
OP
|
$4,109.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
5364632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$16,436.00 |
| Rate for Payer: Aetna Commercial |
$3,698.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,533.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,150.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,670.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,054.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,972.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,177.77
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cigna Commercial |
$3,780.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,299.40
|
| Rate for Payer: Health EOS Commercial |
$3,657.01
|
| Rate for Payer: HFN Commercial |
$3,780.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,081.75
|
| Rate for Payer: Multiplan Commercial |
$3,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,465.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,780.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,013.41
|
| Rate for Payer: Quartz Commercial |
$2,670.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,465.40
|
| Rate for Payer: The Alliance Commercial |
$16,436.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,259.95
|
| Rate for Payer: WPS Commercial |
$3,043.54
|
|
|
XR PleurX Placement Abdomen
|
Professional
|
Both
|
$4,109.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
5364632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$406.73 |
| Max. Negotiated Rate |
$3,903.55 |
| Rate for Payer: Aetna Commercial |
$3,903.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,533.74
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cigna Commercial |
$3,903.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,054.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,465.40
|
| Rate for Payer: Health EOS Commercial |
$3,739.19
|
| Rate for Payer: HFN Commercial |
$3,903.55
|
| 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: Multiplan Commercial |
$3,287.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,903.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.96
|
| Rate for Payer: Quartz Commercial |
$2,342.13
|
| Rate for Payer: The Alliance Commercial |
$2,054.50
|
| Rate for Payer: WEA Trust Commercial |
$2,259.95
|
| Rate for Payer: WPS Commercial |
$3,043.54
|
|
|
XR PleurX Placement Abdomen
|
Facility
|
IP
|
$4,109.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
5364632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,013.41 |
| Max. Negotiated Rate |
$3,780.28 |
| Rate for Payer: Aetna Commercial |
$3,698.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,533.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,177.77
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cigna Commercial |
$3,780.28
|
| Rate for Payer: Health EOS Commercial |
$3,657.01
|
| Rate for Payer: HFN Commercial |
$3,780.28
|
| Rate for Payer: Multiplan Commercial |
$3,287.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,465.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,780.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,013.41
|
| Rate for Payer: Quartz Commercial |
$2,465.40
|
| Rate for Payer: WEA Trust Commercial |
$2,259.95
|
| Rate for Payer: WPS Commercial |
$3,043.54
|
|
|
XR PleurX Placement Lung Left
|
Facility
|
OP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
5364634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,000.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Aetna Managed Medicare |
$630.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,462.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,125.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,080.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,259.10
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,687.50
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,462.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,350.00
|
| Rate for Payer: The Alliance Commercial |
$9,000.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
XR PleurX Placement Lung Left
|
Facility
|
IP
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
5364634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,102.50 |
| Max. Negotiated Rate |
$2,070.00 |
| Rate for Payer: Aetna Commercial |
$2,025.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,192.50
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,070.00
|
| Rate for Payer: Health EOS Commercial |
$2,002.50
|
| Rate for Payer: HFN Commercial |
$2,070.00
|
| Rate for Payer: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,350.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,070.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,102.50
|
| Rate for Payer: Quartz Commercial |
$1,350.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
XR PleurX Placement Lung Left
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
5364634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$406.73 |
| Max. Negotiated Rate |
$2,137.50 |
| Rate for Payer: Aetna Commercial |
$2,137.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,935.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,137.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,350.00
|
| Rate for Payer: Health EOS Commercial |
$2,047.50
|
| Rate for Payer: HFN Commercial |
$2,137.50
|
| 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: Multiplan Commercial |
$1,800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,137.50
|
| Rate for Payer: Quartz Beloit One Network |
$990.00
|
| Rate for Payer: Quartz Commercial |
$1,282.50
|
| Rate for Payer: The Alliance Commercial |
$1,125.00
|
| Rate for Payer: WEA Trust Commercial |
$1,237.50
|
| Rate for Payer: WPS Commercial |
$1,666.58
|
|
|
XR PleurX Placement Lung Right
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
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: Cigna Commercial |
$2,118.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.76
|
| 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 PleurX Placement Lung Right
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,980.58
|
| 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 PleurX Placement Lung Right
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$406.73 |
| 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: 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: HFN Commercial |
$2,187.85
|
| 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: 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 Pleurx Removal
|
Facility
|
OP
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$2,120.60 |
| Rate for Payer: Aetna Commercial |
$2,074.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.30
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$908.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.27
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,120.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,289.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$2,051.45
|
| Rate for Payer: HFN Commercial |
$2,120.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$1,844.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.45
|
| Rate for Payer: Quartz Commercial |
$1,498.25
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,267.75
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,707.31
|
|
|
XR Pleurx Removal
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$2,189.75 |
| Rate for Payer: Aetna Commercial |
$2,189.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.30
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,189.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,152.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,383.00
|
| Rate for Payer: Health EOS Commercial |
$2,097.55
|
| Rate for Payer: HFN Commercial |
$2,189.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.21
|
| Rate for Payer: Multiplan Commercial |
$1,844.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,014.20
|
| Rate for Payer: Quartz Commercial |
$1,313.85
|
| Rate for Payer: The Alliance Commercial |
$1,152.50
|
| Rate for Payer: WEA Trust Commercial |
$1,267.75
|
| Rate for Payer: WPS Commercial |
$1,707.31
|
|
|
XR Pleurx Removal
|
Facility
|
IP
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,129.45 |
| Max. Negotiated Rate |
$2,120.60 |
| Rate for Payer: Aetna Commercial |
$2,074.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,221.65
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,120.60
|
| Rate for Payer: Health EOS Commercial |
$2,051.45
|
| Rate for Payer: HFN Commercial |
$2,120.60
|
| Rate for Payer: Multiplan Commercial |
$1,844.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,383.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,120.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.45
|
| Rate for Payer: Quartz Commercial |
$1,383.00
|
| Rate for Payer: WEA Trust Commercial |
$1,267.75
|
| Rate for Payer: WPS Commercial |
$1,707.31
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.76
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| 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 |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$538.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| 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 |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$625.30
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$712.55
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| 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 |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| 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 |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
