|
XR Pelvis Complete Minimum 3 Views
|
Facility
OP
|
$711.00
|
|
|
Service Code
|
CPT 72190 TC
|
| Hospital Charge Code |
1537230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.08 |
| Max. Negotiated Rate |
$2,844.00 |
| Rate for Payer: Aetna Commercial |
$639.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.46
|
| Rate for Payer: Aetna Managed Medicare |
$199.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$462.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$355.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$341.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$376.83
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$654.12
|
| Rate for Payer: Health EOS Commercial |
$632.79
|
| Rate for Payer: HFN Commercial |
$654.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$533.25
|
| Rate for Payer: Multiplan Commercial |
$568.80
|
| Rate for Payer: NAPHCARE Commercial |
$426.60
|
| Rate for Payer: Preferred Network Access Commercial |
$654.12
|
| Rate for Payer: Quartz Beloit One Network |
$348.39
|
| Rate for Payer: Quartz Commercial |
$462.15
|
| Rate for Payer: Quartz Medicare Advantage |
$426.60
|
| Rate for Payer: The Alliance Commercial |
$2,844.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$391.05
|
| Rate for Payer: WPS Commercial |
$526.64
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
OP
|
$606.00
|
|
|
Service Code
|
CPT 73540
|
| Hospital Charge Code |
630287
|
| Min. Negotiated Rate |
$169.68 |
| Max. Negotiated Rate |
$2,424.00 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Aetna Managed Medicare |
$169.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$393.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$290.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.50
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.60
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$393.90
|
| Rate for Payer: Quartz Medicare Advantage |
$363.60
|
| Rate for Payer: The Alliance Commercial |
$2,424.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
OP
|
$646.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.88 |
| Max. Negotiated Rate |
$2,584.00 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$180.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.50
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$419.90
|
| Rate for Payer: Quartz Medicare Advantage |
$387.60
|
| Rate for Payer: The Alliance Commercial |
$2,584.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
XR Pelvis + Hips Infant/Child
|
Professional
|
$606.00
|
|
|
Service Code
|
CPT 73540
|
| Hospital Charge Code |
630287
|
| Min. Negotiated Rate |
$266.64 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Aetna Commercial |
$575.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$575.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.60
|
| Rate for Payer: Health EOS Commercial |
$551.46
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$575.70
|
| Rate for Payer: Quartz Beloit One Network |
$266.64
|
| Rate for Payer: Quartz Commercial |
$345.42
|
| Rate for Payer: The Alliance Commercial |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
IP
|
$606.00
|
|
|
Service Code
|
CPT 73540
|
| Hospital Charge Code |
630287
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.60
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$363.60
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
XR Pelvis + Hips Infant/Child
|
Professional
|
$646.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$613.70 |
| Rate for Payer: Aetna Commercial |
$613.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.40
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$613.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$323.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.40
|
| Rate for Payer: Health EOS Commercial |
$587.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.40
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: Preferred Network Access Commercial |
$613.70
|
| Rate for Payer: Quartz Beloit One Network |
$284.24
|
| Rate for Payer: Quartz Commercial |
$368.22
|
| Rate for Payer: Quartz Medicare Advantage |
$29.40
|
| Rate for Payer: The Alliance Commercial |
$111.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$147.00
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
IP
|
$646.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
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: 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
|
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 |
$118,345.16 |
| 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 |
$118,345.16
|
| 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 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: 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
|
Facility
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2448799
|
| Min. Negotiated Rate |
$1,202.88 |
| Max. Negotiated Rate |
$12,967.60 |
| 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 |
$12,967.60
|
| 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
|
Professional
|
$2,506.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2448799
|
| Min. Negotiated Rate |
$86.15 |
| 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: Aetna Managed Medicare |
$86.15
|
| Rate for Payer: Anthem Medicare Advantage |
$86.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.15
|
| 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 |
$1,253.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.15
|
| Rate for Payer: Health EOS Commercial |
$2,280.46
|
| 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: Independent Care Health Plan Medicare |
$86.15
|
| 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: Quartz Medicare Advantage |
$86.15
|
| Rate for Payer: The Alliance Commercial |
$366.14
|
| Rate for Payer: United Healthcare Medicaid |
$93.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.15
|
| Rate for Payer: WEA Trust Commercial |
$1,378.30
|
| Rate for Payer: WPS Commercial |
$387.68
|
|
|
XR PICC Line Placement
|
Professional
|
$2,506.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2587247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.52 |
| 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: Aetna Managed Medicare |
$78.52
|
| Rate for Payer: Anthem Medicare Advantage |
$78.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.52
|
| 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 |
$1,253.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.52
|
| Rate for Payer: Health EOS Commercial |
$2,280.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.52
|
| 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: Quartz Medicare Advantage |
$78.52
|
| Rate for Payer: The Alliance Commercial |
$333.71
|
| Rate for Payer: United Healthcare Medicaid |
$308.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.52
|
| Rate for Payer: WEA Trust Commercial |
$1,378.30
|
| Rate for Payer: WPS Commercial |
$353.34
|
|
|
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 |
$20,943.68 |
| 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 |
$20,943.68
|
| 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
|
Professional
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2542799
|
| Min. Negotiated Rate |
$54.82 |
| 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: Aetna Managed Medicare |
$54.82
|
| Rate for Payer: Anthem Medicare Advantage |
$54.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.82
|
| 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 |
$1,389.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.82
|
| Rate for Payer: Health EOS Commercial |
$2,528.89
|
| 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: Independent Care Health Plan Medicare |
$54.82
|
| 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: Quartz Medicare Advantage |
$54.82
|
| Rate for Payer: The Alliance Commercial |
$232.98
|
| Rate for Payer: United Healthcare Medicaid |
$366.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.82
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: WPS Commercial |
$246.69
|
|
|
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: 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
|
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 |
$20,943.68 |
| 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 |
$20,943.68
|
| 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 PICC Line Replacement
|
Professional
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2587250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$54.82 |
| 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: Aetna Managed Medicare |
$54.82
|
| Rate for Payer: Anthem Medicare Advantage |
$54.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.82
|
| 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 |
$1,389.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.82
|
| Rate for Payer: Health EOS Commercial |
$2,528.89
|
| 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: Independent Care Health Plan Medicare |
$54.82
|
| 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: Quartz Medicare Advantage |
$54.82
|
| Rate for Payer: The Alliance Commercial |
$232.98
|
| Rate for Payer: United Healthcare Medicaid |
$366.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.82
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: WPS Commercial |
$246.69
|
|
|
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: 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 PleurX Placement Abdomen
|
Professional
|
$4,109.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
5364632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.89 |
| 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: 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 |
$1,232.70
|
| 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 |
$108.89
|
| Rate for Payer: Health EOS Commercial |
$3,739.19
|
| 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 |
$3,287.20
|
| 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: 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 |
$2,259.95
|
| Rate for Payer: WPS Commercial |
$544.45
|
|
|
XR PleurX Placement Abdomen
|
Facility
OP
|
$4,109.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
5364632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$6.44 |
| 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: 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: 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: 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 |
$6.44
|
| 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
|
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: 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: 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: 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: 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
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
5364634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$990.00 |
| 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: 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: 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
|
|
