|
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
|
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
|
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
|
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
|
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
|
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 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 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
|
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: 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
|
| 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
|
Professional
|
Both
|
$2,250.00
|
|
|
Service Code
|
CPT 75989 LT
|
| Hospital Charge Code |
5364634
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$423.00 |
| Max. Negotiated Rate |
$2,223.00 |
| Rate for Payer: Aetna Commercial |
$2,223.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,012.40
|
| 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 |
$2,223.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,170.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,404.00
|
| Rate for Payer: Health EOS Commercial |
$2,129.40
|
| Rate for Payer: HFN Commercial |
$2,223.00
|
| 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 |
$1,872.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.60
|
| Rate for Payer: Quartz Commercial |
$1,333.80
|
| Rate for Payer: The Alliance Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.17
|
|
|
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
|
|
|
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 |
$1,146.60 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,240.20
|
| Rate for Payer: Cash Price |
$675.00
|
| Rate for Payer: Cigna Commercial |
$2,152.80
|
| Rate for Payer: Health EOS Commercial |
$2,082.60
|
| Rate for Payer: HFN Commercial |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$1,872.00
|
| 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 |
$1,404.00
|
| Rate for Payer: WEA Trust Commercial |
$1,287.00
|
| Rate for Payer: WPS Commercial |
$1,733.17
|
|
|
XR PleurX Placement Lung Right
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$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 PleurX Placement Lung Right
|
Facility
|
IP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,173.61 |
| 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 PleurX Placement Lung Right
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989 RT
|
| Hospital Charge Code |
5364636
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$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 Pleurx Removal
|
Professional
|
Both
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$2,277.34 |
| Rate for Payer: Aetna Commercial |
$2,277.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,061.59
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,277.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,198.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$2,181.45
|
| Rate for Payer: HFN Commercial |
$2,277.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$1,917.76
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,054.77
|
| Rate for Payer: Quartz Commercial |
$1,366.40
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$1,318.46
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR Pleurx Removal
|
Facility
|
OP
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$2,205.42 |
| Rate for Payer: Aetna Commercial |
$2,157.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,061.59
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,270.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,205.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,341.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$2,133.51
|
| Rate for Payer: HFN Commercial |
$2,205.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$1,917.76
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,205.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.63
|
| Rate for Payer: Quartz Commercial |
$1,558.18
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,318.46
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,775.54
|
|
|
XR Pleurx Removal
|
Facility
|
IP
|
$2,305.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5364638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,174.63 |
| Max. Negotiated Rate |
$2,205.42 |
| Rate for Payer: Aetna Commercial |
$2,157.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,061.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,270.52
|
| Rate for Payer: Cash Price |
$691.50
|
| Rate for Payer: Cigna Commercial |
$2,205.42
|
| Rate for Payer: Health EOS Commercial |
$2,133.51
|
| Rate for Payer: HFN Commercial |
$2,205.42
|
| Rate for Payer: Multiplan Commercial |
$1,917.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,205.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.63
|
| Rate for Payer: Quartz Commercial |
$1,438.32
|
| Rate for Payer: WEA Trust Commercial |
$1,318.46
|
| Rate for Payer: WPS Commercial |
$1,775.54
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$32.06 |
| Max. Negotiated Rate |
$950.46 |
| Rate for Payer: Aetna Commercial |
$950.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Aetna Managed Medicare |
$32.06
|
| Rate for Payer: Anthem Medicare Advantage |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.06
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$950.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$500.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.06
|
| Rate for Payer: Health EOS Commercial |
$910.44
|
| Rate for Payer: HFN Commercial |
$950.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.06
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: NAPHCARE Commercial |
$48.09
|
| Rate for Payer: Preferred Network Access Commercial |
$950.46
|
| Rate for Payer: Quartz Beloit One Network |
$440.21
|
| Rate for Payer: Quartz Commercial |
$570.27
|
| Rate for Payer: Quartz Medicare Advantage |
$32.06
|
| Rate for Payer: The Alliance Commercial |
$121.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.06
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$160.32
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.23
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$650.31
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 73600
|
| Hospital Charge Code |
2448821
|
| Min. Negotiated Rate |
$490.24 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
XR Pod Ankle 2 Views Bilateral
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 73600 LT
|
| Hospital Charge Code |
2587253
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.29 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$311.38
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
