|
XR Drainage Renal Left
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
1536986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Renal Left
|
Facility
|
IP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661721
|
| Min. Negotiated Rate |
$1,128.25 |
| Max. Negotiated Rate |
$2,118.36 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.36
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,118.36
|
| Rate for Payer: Health EOS Commercial |
$2,049.28
|
| Rate for Payer: HFN Commercial |
$2,118.36
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.25
|
| Rate for Payer: Quartz Commercial |
$1,381.54
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,705.44
|
|
|
XR Drainage Renal Right
|
Facility
|
OP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661723
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$2,118.36 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Aetna Managed Medicare |
$644.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.36
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,118.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.55
|
| Rate for Payer: Health EOS Commercial |
$2,049.28
|
| Rate for Payer: HFN Commercial |
$2,118.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.92
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.25
|
| Rate for Payer: Quartz Commercial |
$1,496.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.54
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,705.44
|
|
|
XR Drainage Renal Right
|
Professional
|
Both
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661723
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$2,187.43 |
| Rate for Payer: Aetna Commercial |
$2,187.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,187.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$2,095.33
|
| Rate for Payer: HFN Commercial |
$2,187.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.13
|
| Rate for Payer: Quartz Commercial |
$1,312.46
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
XR Drainage Renal Right
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 TC,RT
|
| Hospital Charge Code |
2980117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Renal Right
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
1536988
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$2,275.36 |
| Rate for Payer: Aetna Commercial |
$2,275.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| 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 |
$2,275.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,197.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,437.07
|
| Rate for Payer: Health EOS Commercial |
$2,179.56
|
| Rate for Payer: HFN Commercial |
$2,275.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.85
|
| Rate for Payer: Quartz Commercial |
$1,365.22
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Renal Right
|
Facility
|
IP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661723
|
| Min. Negotiated Rate |
$1,128.25 |
| Max. Negotiated Rate |
$2,118.36 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.36
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,118.36
|
| Rate for Payer: Health EOS Commercial |
$2,049.28
|
| Rate for Payer: HFN Commercial |
$2,118.36
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.25
|
| Rate for Payer: Quartz Commercial |
$1,381.54
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,705.44
|
|
|
XR Drainage Renal Right
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 TC,RT
|
| Hospital Charge Code |
2980117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Renal Right
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 TC,RT
|
| Hospital Charge Code |
2980117
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$2,275.36 |
| Rate for Payer: Aetna Commercial |
$2,275.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| 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 |
$2,275.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,197.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,437.07
|
| Rate for Payer: Health EOS Commercial |
$2,179.56
|
| Rate for Payer: HFN Commercial |
$2,275.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.85
|
| Rate for Payer: Quartz Commercial |
$1,365.22
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Renal Right
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
1536988
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Renal Right
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
1536988
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$1,197.56
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Retroperitoneal Abscess
|
Facility
|
OP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661725
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$2,118.36 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Aetna Managed Medicare |
$644.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.36
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,118.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.55
|
| Rate for Payer: Health EOS Commercial |
$2,049.28
|
| Rate for Payer: HFN Commercial |
$2,118.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.92
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.25
|
| Rate for Payer: Quartz Commercial |
$1,496.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.54
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,705.44
|
|
|
XR Drainage Retroperitoneal Abscess
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| 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 |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Retroperitoneal Abscess
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Retroperitoneal Abscess
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$2,275.36 |
| Rate for Payer: Aetna Commercial |
$2,275.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| 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 |
$2,275.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,197.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$2,179.56
|
| Rate for Payer: HFN Commercial |
$2,275.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.85
|
| Rate for Payer: Quartz Commercial |
$1,365.22
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
XR Drainage Retroperitoneal Abscess
|
Facility
|
IP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661725
|
| Min. Negotiated Rate |
$1,128.25 |
| Max. Negotiated Rate |
$2,118.36 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.36
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,118.36
|
| Rate for Payer: Health EOS Commercial |
$2,049.28
|
| Rate for Payer: HFN Commercial |
$2,118.36
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.25
|
| Rate for Payer: Quartz Commercial |
$1,381.54
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,705.44
|
|
|
XR Drainage Retroperitoneal Abscess
|
Professional
|
Both
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661725
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$2,187.43 |
| Rate for Payer: Aetna Commercial |
$2,187.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,187.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$2,095.33
|
| Rate for Payer: HFN Commercial |
$2,187.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.13
|
| Rate for Payer: Quartz Commercial |
$1,312.46
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
XR Drainage Subdiaphragm/Subphrenic
|
Professional
|
Both
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661727
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$2,187.43 |
| Rate for Payer: Aetna Commercial |
$2,187.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,187.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,151.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$2,095.33
|
| Rate for Payer: HFN Commercial |
$2,187.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.13
|
| Rate for Payer: Quartz Commercial |
$1,312.46
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
XR Drainage Subdiaphragm/Subphrenic
|
Facility
|
IP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661727
|
| Min. Negotiated Rate |
$1,128.25 |
| Max. Negotiated Rate |
$2,118.36 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.36
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,118.36
|
| Rate for Payer: Health EOS Commercial |
$2,049.28
|
| Rate for Payer: HFN Commercial |
$2,118.36
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.25
|
| Rate for Payer: Quartz Commercial |
$1,381.54
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,705.44
|
|
|
XR Drainage Subdiaphragm/Subphrenic
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,173.61 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,437.07
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Drainage Subdiaphragm/Subphrenic
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$2,275.36 |
| Rate for Payer: Aetna Commercial |
$2,275.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| 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 |
$2,275.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,197.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$2,179.56
|
| Rate for Payer: HFN Commercial |
$2,275.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.85
|
| Rate for Payer: Quartz Commercial |
$1,365.22
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
XR Drainage Subdiaphragm/Subphrenic
|
Facility
|
OP
|
$2,214.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
661727
|
| Min. Negotiated Rate |
$447.24 |
| Max. Negotiated Rate |
$2,118.36 |
| Rate for Payer: Aetna Commercial |
$2,072.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Aetna Managed Medicare |
$644.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,496.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,151.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,105.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,220.36
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,118.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,288.55
|
| Rate for Payer: Health EOS Commercial |
$2,049.28
|
| Rate for Payer: HFN Commercial |
$2,118.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,726.92
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: NAPHCARE Commercial |
$1,381.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,118.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,128.25
|
| Rate for Payer: Quartz Commercial |
$1,496.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,381.54
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,705.44
|
|
|
XR Drainage Subdiaphragm/Subphrenic
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536992
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| 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 |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
|
XR Elbow 2 Views Bilateral
|
Facility
|
IP
|
$1,006.00
|
|
|
Service Code
|
CPT 73070
|
| Hospital Charge Code |
630691
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
XR Elbow 2 Views Bilateral
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 73070 LT,TC
|
| Hospital Charge Code |
1536996
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.12 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Aetna Managed Medicare |
$158.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.03
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$338.83
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| Rate for Payer: Quartz Medicare Advantage |
$338.83
|
| Rate for Payer: The Alliance Commercial |
$282.36
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
