|
XR Pelvis Complete Minimum 3 Views
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
630281
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$462.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$355.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$341.45
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$398.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$462.38
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
630281
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$675.79 |
| Rate for Payer: Aetna Commercial |
$675.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Aetna Managed Medicare |
$42.93
|
| Rate for Payer: Anthem Medicare Advantage |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.93
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$675.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$355.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.93
|
| Rate for Payer: Health EOS Commercial |
$647.34
|
| Rate for Payer: HFN Commercial |
$675.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.93
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: NAPHCARE Commercial |
$64.40
|
| Rate for Payer: Preferred Network Access Commercial |
$675.79
|
| Rate for Payer: Quartz Beloit One Network |
$313.00
|
| Rate for Payer: Quartz Commercial |
$405.48
|
| Rate for Payer: Quartz Medicare Advantage |
$42.93
|
| Rate for Payer: The Alliance Commercial |
$163.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.93
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: WPS Commercial |
$214.66
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
CPT 72190 TC
|
| Hospital Charge Code |
1537230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$702.47 |
| Rate for Payer: Aetna Commercial |
$702.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.92
|
| Rate for Payer: Aetna Managed Medicare |
$30.72
|
| Rate for Payer: Anthem Medicare Advantage |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.72
|
| 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 |
$702.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.72
|
| Rate for Payer: Health EOS Commercial |
$672.89
|
| Rate for Payer: HFN Commercial |
$702.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$591.55
|
| Rate for Payer: NAPHCARE Commercial |
$46.08
|
| Rate for Payer: Preferred Network Access Commercial |
$702.47
|
| Rate for Payer: Quartz Beloit One Network |
$325.35
|
| Rate for Payer: Quartz Commercial |
$421.48
|
| Rate for Payer: Quartz Medicare Advantage |
$30.72
|
| Rate for Payer: The Alliance Commercial |
$116.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.72
|
| Rate for Payer: WEA Trust Commercial |
$406.69
|
| Rate for Payer: WPS Commercial |
$153.61
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 73540
|
| Hospital Charge Code |
630287
|
| Min. Negotiated Rate |
$176.47 |
| Max. Negotiated Rate |
$579.82 |
| Rate for Payer: Aetna Commercial |
$567.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Aetna Managed Medicare |
$176.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$409.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$315.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$302.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.03
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$579.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.69
|
| Rate for Payer: Health EOS Commercial |
$560.91
|
| Rate for Payer: HFN Commercial |
$579.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.68
|
| Rate for Payer: Multiplan Commercial |
$504.19
|
| Rate for Payer: NAPHCARE Commercial |
$378.14
|
| Rate for Payer: Preferred Network Access Commercial |
$579.82
|
| Rate for Payer: Quartz Beloit One Network |
$308.82
|
| Rate for Payer: Quartz Commercial |
$409.66
|
| Rate for Payer: Quartz Medicare Advantage |
$378.14
|
| Rate for Payer: The Alliance Commercial |
$315.12
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 73540
|
| Hospital Charge Code |
630287
|
| Min. Negotiated Rate |
$308.82 |
| Max. Negotiated Rate |
$579.82 |
| Rate for Payer: Aetna Commercial |
$567.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.03
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$579.82
|
| Rate for Payer: Health EOS Commercial |
$560.91
|
| Rate for Payer: HFN Commercial |
$579.82
|
| Rate for Payer: Multiplan Commercial |
$504.19
|
| Rate for Payer: Preferred Network Access Commercial |
$579.82
|
| Rate for Payer: Quartz Beloit One Network |
$308.82
|
| Rate for Payer: Quartz Commercial |
$378.14
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
|
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 |
$122.89 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Aetna Managed Medicare |
$188.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| 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 |
$618.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.97
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.88
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: NAPHCARE Commercial |
$403.10
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$436.70
|
| Rate for Payer: Quartz Medicare Advantage |
$403.10
|
| Rate for Payer: The Alliance Commercial |
$122.89
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
XR Pelvis + Hips Infant/Child
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$638.25 |
| Rate for Payer: Aetna Commercial |
$638.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Aetna Managed Medicare |
$30.72
|
| Rate for Payer: Anthem Medicare Advantage |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.72
|
| 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 |
$638.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.72
|
| Rate for Payer: Health EOS Commercial |
$611.37
|
| Rate for Payer: HFN Commercial |
$638.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: NAPHCARE Commercial |
$46.08
|
| Rate for Payer: Preferred Network Access Commercial |
$638.25
|
| Rate for Payer: Quartz Beloit One Network |
$295.61
|
| Rate for Payer: Quartz Commercial |
$382.95
|
| Rate for Payer: Quartz Medicare Advantage |
$30.72
|
| Rate for Payer: The Alliance Commercial |
$116.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.72
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$153.61
|
|
|
XR Pelvis + Hips Infant/Child
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
CPT 73540
|
| Hospital Charge Code |
630287
|
| Min. Negotiated Rate |
$277.31 |
| Max. Negotiated Rate |
$598.73 |
| Rate for Payer: Aetna Commercial |
$598.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$598.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.14
|
| Rate for Payer: Health EOS Commercial |
$573.52
|
| Rate for Payer: HFN Commercial |
$598.73
|
| Rate for Payer: Multiplan Commercial |
$504.19
|
| Rate for Payer: Preferred Network Access Commercial |
$598.73
|
| Rate for Payer: Quartz Beloit One Network |
$277.31
|
| Rate for Payer: Quartz Commercial |
$359.24
|
| Rate for Payer: The Alliance Commercial |
$315.12
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
|
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 |
$329.20 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$403.10
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
XR PICC Line Placement
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2587247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$2,345.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,694.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,303.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| 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 |
$2,397.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$2,319.55
|
| Rate for Payer: HFN Commercial |
$2,397.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.06
|
| Rate for Payer: Quartz Commercial |
$1,694.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$1,930.37
|
|
|
XR PICC Line Placement
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2448799
|
| Min. Negotiated Rate |
$1,277.06 |
| Max. Negotiated Rate |
$2,397.74 |
| Rate for Payer: Aetna Commercial |
$2,345.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.31
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,397.74
|
| Rate for Payer: Health EOS Commercial |
$2,319.55
|
| Rate for Payer: HFN Commercial |
$2,397.74
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.06
|
| Rate for Payer: Quartz Commercial |
$1,563.74
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: WPS Commercial |
$1,930.37
|
|
|
XR PICC Line Placement
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2448799
|
| Min. Negotiated Rate |
$1,251.00 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$2,345.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,694.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,303.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,397.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$2,319.55
|
| Rate for Payer: HFN Commercial |
$2,397.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.06
|
| Rate for Payer: Quartz Commercial |
$1,694.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$1,930.37
|
|
|
XR PICC Line Placement
|
Professional
|
Both
|
$2,506.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
2448799
|
| Min. Negotiated Rate |
$81.11 |
| Max. Negotiated Rate |
$2,475.93 |
| Rate for Payer: Aetna Commercial |
$2,475.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Aetna Managed Medicare |
$81.11
|
| Rate for Payer: Anthem Medicare Advantage |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.11
|
| 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 |
$2,475.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.11
|
| Rate for Payer: Health EOS Commercial |
$2,371.68
|
| Rate for Payer: HFN Commercial |
$2,475.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$324.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.11
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: NAPHCARE Commercial |
$121.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,475.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.75
|
| Rate for Payer: Quartz Commercial |
$1,485.56
|
| Rate for Payer: Quartz Medicare Advantage |
$81.11
|
| Rate for Payer: The Alliance Commercial |
$344.72
|
| Rate for Payer: United Healthcare Medicaid |
$96.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.11
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: WPS Commercial |
$364.99
|
|
|
XR PICC Line Placement
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2587247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,277.06 |
| Max. Negotiated Rate |
$2,397.74 |
| Rate for Payer: Aetna Commercial |
$2,345.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.31
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,397.74
|
| Rate for Payer: Health EOS Commercial |
$2,319.55
|
| Rate for Payer: HFN Commercial |
$2,397.74
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.06
|
| Rate for Payer: Quartz Commercial |
$1,563.74
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: WPS Commercial |
$1,930.37
|
|
|
XR PICC Line Placement
|
Professional
|
Both
|
$2,506.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2587247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.24 |
| Max. Negotiated Rate |
$2,475.93 |
| Rate for Payer: Aetna Commercial |
$2,475.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Aetna Managed Medicare |
$70.24
|
| Rate for Payer: Anthem Medicare Advantage |
$70.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.24
|
| 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 |
$2,475.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$320.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.24
|
| Rate for Payer: Health EOS Commercial |
$2,371.68
|
| Rate for Payer: HFN Commercial |
$2,475.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.24
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: NAPHCARE Commercial |
$105.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,475.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.75
|
| Rate for Payer: Quartz Commercial |
$1,485.56
|
| Rate for Payer: Quartz Medicare Advantage |
$70.24
|
| Rate for Payer: The Alliance Commercial |
$298.53
|
| Rate for Payer: United Healthcare Medicaid |
$320.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.24
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: WPS Commercial |
$316.09
|
|
|
XR Picc Line Replacement
|
Professional
|
Both
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2542799
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$2,745.65 |
| Rate for Payer: Aetna Commercial |
$2,745.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,485.54
|
| Rate for Payer: Aetna Managed Medicare |
$49.36
|
| Rate for Payer: Anthem Medicare Advantage |
$49.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.36
|
| 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 |
$2,745.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$381.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.36
|
| Rate for Payer: Health EOS Commercial |
$2,630.05
|
| Rate for Payer: HFN Commercial |
$2,745.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$208.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.36
|
| Rate for Payer: Multiplan Commercial |
$2,312.13
|
| Rate for Payer: NAPHCARE Commercial |
$74.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,745.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.67
|
| Rate for Payer: Quartz Commercial |
$1,647.39
|
| Rate for Payer: Quartz Medicare Advantage |
$49.36
|
| Rate for Payer: The Alliance Commercial |
$209.77
|
| Rate for Payer: United Healthcare Medicaid |
$381.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.36
|
| Rate for Payer: WEA Trust Commercial |
$1,589.59
|
| Rate for Payer: WPS Commercial |
$222.11
|
|
|
XR Picc Line Replacement
|
Facility
|
IP
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2542799
|
| Min. Negotiated Rate |
$1,416.18 |
| Max. Negotiated Rate |
$2,658.95 |
| Rate for Payer: Aetna Commercial |
$2,601.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,485.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,531.78
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,658.95
|
| Rate for Payer: Health EOS Commercial |
$2,572.24
|
| Rate for Payer: HFN Commercial |
$2,658.95
|
| Rate for Payer: Multiplan Commercial |
$2,312.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,658.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.18
|
| Rate for Payer: Quartz Commercial |
$1,734.10
|
| Rate for Payer: WEA Trust Commercial |
$1,589.59
|
| Rate for Payer: WPS Commercial |
$2,140.66
|
|
|
XR Picc Line Replacement
|
Facility
|
OP
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2542799
|
| Min. Negotiated Rate |
$1,387.28 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$2,601.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,485.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,878.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,445.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,387.28
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,531.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,658.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$2,572.24
|
| Rate for Payer: HFN Commercial |
$2,658.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$2,312.13
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,658.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.18
|
| Rate for Payer: Quartz Commercial |
$1,878.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: WEA Trust Commercial |
$1,589.59
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$2,140.66
|
|
|
XR PICC Line Replacement
|
Facility
|
OP
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2587250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$2,601.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,485.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,878.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,445.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,387.28
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,531.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| 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 |
$2,658.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$2,572.24
|
| Rate for Payer: HFN Commercial |
$2,658.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$2,312.13
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,658.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.18
|
| Rate for Payer: Quartz Commercial |
$1,878.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,589.59
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$2,140.66
|
|
|
XR PICC Line Replacement
|
Facility
|
IP
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2587250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,416.18 |
| Max. Negotiated Rate |
$2,658.95 |
| Rate for Payer: Aetna Commercial |
$2,601.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,485.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,531.78
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,658.95
|
| Rate for Payer: Health EOS Commercial |
$2,572.24
|
| Rate for Payer: HFN Commercial |
$2,658.95
|
| Rate for Payer: Multiplan Commercial |
$2,312.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,658.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.18
|
| Rate for Payer: Quartz Commercial |
$1,734.10
|
| Rate for Payer: WEA Trust Commercial |
$1,589.59
|
| Rate for Payer: WPS Commercial |
$2,140.66
|
|
|
XR PICC Line Replacement
|
Professional
|
Both
|
$2,779.00
|
|
|
Service Code
|
CPT 36584
|
| Hospital Charge Code |
2587250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.36 |
| Max. Negotiated Rate |
$2,745.65 |
| Rate for Payer: Aetna Commercial |
$2,745.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,485.54
|
| Rate for Payer: Aetna Managed Medicare |
$49.36
|
| Rate for Payer: Anthem Medicare Advantage |
$49.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.36
|
| 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 |
$2,745.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$381.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.36
|
| Rate for Payer: Health EOS Commercial |
$2,630.05
|
| Rate for Payer: HFN Commercial |
$2,745.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$208.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.36
|
| Rate for Payer: Multiplan Commercial |
$2,312.13
|
| Rate for Payer: NAPHCARE Commercial |
$74.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,745.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.67
|
| Rate for Payer: Quartz Commercial |
$1,647.39
|
| Rate for Payer: Quartz Medicare Advantage |
$49.36
|
| Rate for Payer: The Alliance Commercial |
$209.77
|
| Rate for Payer: United Healthcare Medicaid |
$381.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.36
|
| Rate for Payer: WEA Trust Commercial |
$1,589.59
|
| Rate for Payer: WPS Commercial |
$222.11
|
|
|
XR PleurX Placement Abdomen
|
Facility
|
IP
|
$4,109.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
5364632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,093.95 |
| Max. Negotiated Rate |
$3,931.49 |
| Rate for Payer: WEA Trust Commercial |
$2,350.35
|
| Rate for Payer: WPS Commercial |
$3,165.16
|
| Rate for Payer: Aetna Commercial |
$3,846.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,675.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,264.88
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cigna Commercial |
$3,931.49
|
| Rate for Payer: Health EOS Commercial |
$3,803.29
|
| Rate for Payer: HFN Commercial |
$3,931.49
|
| Rate for Payer: Multiplan Commercial |
$3,418.69
|
| Rate for Payer: Preferred Network Access Commercial |
$3,931.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,093.95
|
| Rate for Payer: Quartz Commercial |
$2,564.02
|
|
|
XR PleurX Placement Abdomen
|
Facility
|
OP
|
$4,109.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
5364632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$3,931.49 |
| Rate for Payer: Aetna Commercial |
$3,846.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,675.09
|
| Rate for Payer: Aetna Managed Medicare |
$1,196.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,777.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,136.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,051.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,264.88
|
| 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 |
$3,931.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,391.44
|
| Rate for Payer: Health EOS Commercial |
$3,803.29
|
| Rate for Payer: HFN Commercial |
$3,931.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,205.02
|
| Rate for Payer: Multiplan Commercial |
$3,418.69
|
| Rate for Payer: NAPHCARE Commercial |
$2,564.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,931.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,093.95
|
| Rate for Payer: Quartz Commercial |
$2,777.68
|
| Rate for Payer: Quartz Medicare Advantage |
$2,564.02
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,350.35
|
| Rate for Payer: WPS Commercial |
$3,165.16
|
|
|
XR PleurX Placement Abdomen
|
Professional
|
Both
|
$4,109.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
5364632
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$4,059.69 |
| Rate for Payer: Aetna Commercial |
$4,059.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,675.09
|
| 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 |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cash Price |
$1,232.70
|
| Rate for Payer: Cigna Commercial |
$4,059.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$3,888.76
|
| Rate for Payer: HFN Commercial |
$4,059.69
|
| 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 |
$3,418.69
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,059.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,880.28
|
| Rate for Payer: Quartz Commercial |
$2,435.82
|
| 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 |
$2,350.35
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
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 |
$313.04 |
| Max. Negotiated Rate |
$2,152.80 |
| Rate for Payer: Aetna Commercial |
$2,106.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| Rate for Payer: Aetna Managed Medicare |
$655.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,521.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,170.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,123.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,309.50
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,755.00
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,404.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,152.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.60
|
| Rate for Payer: Quartz Commercial |
$1,521.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,404.00
|
| Rate for Payer: The Alliance Commercial |
$1,170.00
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.17
|
|
