|
XR Mastoids Complete Bilateral
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Bilateral
|
Facility
|
IP
|
$1,298.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630325
|
| Min. Negotiated Rate |
$636.02 |
| Max. Negotiated Rate |
$1,194.16 |
| Rate for Payer: Aetna Commercial |
$1,168.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,116.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$687.94
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,194.16
|
| Rate for Payer: Health EOS Commercial |
$1,155.22
|
| Rate for Payer: HFN Commercial |
$1,194.16
|
| Rate for Payer: Multiplan Commercial |
$1,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,194.16
|
| Rate for Payer: Quartz Beloit One Network |
$636.02
|
| Rate for Payer: Quartz Commercial |
$778.80
|
| Rate for Payer: WEA Trust Commercial |
$713.90
|
| Rate for Payer: WPS Commercial |
$961.43
|
|
|
XR Mastoids Complete Bilateral
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630325
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$1,233.10 |
| Rate for Payer: Aetna Commercial |
$1,233.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,116.28
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,233.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$649.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.80
|
| Rate for Payer: Health EOS Commercial |
$1,181.18
|
| Rate for Payer: HFN Commercial |
$1,233.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.18
|
| Rate for Payer: Multiplan Commercial |
$1,038.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,233.10
|
| Rate for Payer: Quartz Beloit One Network |
$571.12
|
| Rate for Payer: Quartz Commercial |
$739.86
|
| Rate for Payer: The Alliance Commercial |
$649.00
|
| Rate for Payer: WEA Trust Commercial |
$713.90
|
| Rate for Payer: WPS Commercial |
$961.43
|
|
|
XR Mastoids Complete Bilateral
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Bilateral
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$641.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$641.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$337.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.00
|
| Rate for Payer: Health EOS Commercial |
$614.25
|
| Rate for Payer: HFN Commercial |
$641.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.18
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Preferred Network Access Commercial |
$641.25
|
| Rate for Payer: Quartz Beloit One Network |
$297.00
|
| Rate for Payer: Quartz Commercial |
$384.75
|
| Rate for Payer: The Alliance Commercial |
$337.50
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Left
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537192
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Left
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630323
|
| Min. Negotiated Rate |
$318.01 |
| Max. Negotiated Rate |
$597.08 |
| Rate for Payer: Aetna Commercial |
$584.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.97
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$597.08
|
| Rate for Payer: Health EOS Commercial |
$577.61
|
| Rate for Payer: HFN Commercial |
$597.08
|
| Rate for Payer: Multiplan Commercial |
$519.20
|
| Rate for Payer: NAPHCARE Commercial |
$389.40
|
| Rate for Payer: Preferred Network Access Commercial |
$597.08
|
| Rate for Payer: Quartz Beloit One Network |
$318.01
|
| Rate for Payer: Quartz Commercial |
$389.40
|
| Rate for Payer: WEA Trust Commercial |
$356.95
|
| Rate for Payer: WPS Commercial |
$480.71
|
|
|
XR Mastoids Complete Left
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537192
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$641.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$641.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$337.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.00
|
| Rate for Payer: Health EOS Commercial |
$614.25
|
| Rate for Payer: HFN Commercial |
$641.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.18
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Preferred Network Access Commercial |
$641.25
|
| Rate for Payer: Quartz Beloit One Network |
$297.00
|
| Rate for Payer: Quartz Commercial |
$384.75
|
| Rate for Payer: The Alliance Commercial |
$337.50
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Left
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630323
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Aetna Commercial |
$616.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$616.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$324.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.40
|
| Rate for Payer: Health EOS Commercial |
$590.59
|
| Rate for Payer: HFN Commercial |
$616.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.18
|
| Rate for Payer: Multiplan Commercial |
$519.20
|
| Rate for Payer: Preferred Network Access Commercial |
$616.55
|
| Rate for Payer: Quartz Beloit One Network |
$285.56
|
| Rate for Payer: Quartz Commercial |
$369.93
|
| Rate for Payer: The Alliance Commercial |
$324.50
|
| Rate for Payer: WEA Trust Commercial |
$356.95
|
| Rate for Payer: WPS Commercial |
$480.71
|
|
|
XR Mastoids Complete Left
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537192
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Left
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630323
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$597.08 |
| Rate for Payer: Aetna Commercial |
$584.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$421.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$324.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$311.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$597.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$577.61
|
| Rate for Payer: HFN Commercial |
$597.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$519.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$597.08
|
| Rate for Payer: Quartz Beloit One Network |
$318.01
|
| Rate for Payer: Quartz Commercial |
$421.85
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$356.95
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$480.71
|
|
|
XR Mastoids Complete Right
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 70130 RT,TC
|
| Hospital Charge Code |
1537194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Right
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 70130 RT,TC
|
| Hospital Charge Code |
1537194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$641.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$641.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$337.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.00
|
| Rate for Payer: Health EOS Commercial |
$614.25
|
| Rate for Payer: HFN Commercial |
$641.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.18
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Preferred Network Access Commercial |
$641.25
|
| Rate for Payer: Quartz Beloit One Network |
$297.00
|
| Rate for Payer: Quartz Commercial |
$384.75
|
| Rate for Payer: The Alliance Commercial |
$337.50
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Right
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,RT
|
| Hospital Charge Code |
2979984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$641.25 |
| Rate for Payer: Aetna Commercial |
$641.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$641.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$337.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.00
|
| Rate for Payer: Health EOS Commercial |
$614.25
|
| Rate for Payer: HFN Commercial |
$641.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.18
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: Preferred Network Access Commercial |
$641.25
|
| Rate for Payer: Quartz Beloit One Network |
$297.00
|
| Rate for Payer: Quartz Commercial |
$384.75
|
| Rate for Payer: The Alliance Commercial |
$337.50
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Right
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630320
|
| Min. Negotiated Rate |
$318.01 |
| Max. Negotiated Rate |
$597.08 |
| Rate for Payer: Aetna Commercial |
$584.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.97
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$597.08
|
| Rate for Payer: Health EOS Commercial |
$577.61
|
| Rate for Payer: HFN Commercial |
$597.08
|
| Rate for Payer: Multiplan Commercial |
$519.20
|
| Rate for Payer: NAPHCARE Commercial |
$389.40
|
| Rate for Payer: Preferred Network Access Commercial |
$597.08
|
| Rate for Payer: Quartz Beloit One Network |
$318.01
|
| Rate for Payer: Quartz Commercial |
$389.40
|
| Rate for Payer: WEA Trust Commercial |
$356.95
|
| Rate for Payer: WPS Commercial |
$480.71
|
|
|
XR Mastoids Complete Right
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630320
|
| Min. Negotiated Rate |
$213.18 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Aetna Commercial |
$616.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$616.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$324.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.40
|
| Rate for Payer: Health EOS Commercial |
$590.59
|
| Rate for Payer: HFN Commercial |
$616.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.18
|
| Rate for Payer: Multiplan Commercial |
$519.20
|
| Rate for Payer: Preferred Network Access Commercial |
$616.55
|
| Rate for Payer: Quartz Beloit One Network |
$285.56
|
| Rate for Payer: Quartz Commercial |
$369.93
|
| Rate for Payer: The Alliance Commercial |
$324.50
|
| Rate for Payer: WEA Trust Commercial |
$356.95
|
| Rate for Payer: WPS Commercial |
$480.71
|
|
|
XR Mastoids Complete Right
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 70130 RT,TC
|
| Hospital Charge Code |
1537194
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Right
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,RT
|
| Hospital Charge Code |
2979984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Right
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$597.08 |
| Rate for Payer: Aetna Commercial |
$584.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$421.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$324.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$311.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$597.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$577.61
|
| Rate for Payer: HFN Commercial |
$597.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$519.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$597.08
|
| Rate for Payer: Quartz Beloit One Network |
$318.01
|
| Rate for Payer: Quartz Commercial |
$421.85
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$356.95
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$480.71
|
|
|
XR Mastoids Complete Right
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,RT
|
| Hospital Charge Code |
2979984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$330.75 |
| Max. Negotiated Rate |
$621.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$621.00
|
| Rate for Payer: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$540.00
|
| Rate for Payer: NAPHCARE Commercial |
$405.00
|
| Rate for Payer: Preferred Network Access Commercial |
$621.00
|
| Rate for Payer: Quartz Beloit One Network |
$330.75
|
| Rate for Payer: Quartz Commercial |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Midline Catheter
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5551924
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
XR Midline Catheter
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5551924
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: HFN Commercial |
$168.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.03
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: United Healthcare Medicaid |
$10.11
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
XR Midline Catheter
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5551924
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Aetna Managed Medicare |
$49.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| Rate for Payer: Quartz Medicare Advantage |
$106.20
|
| Rate for Payer: The Alliance Commercial |
$708.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
XR Myelography Cervical Spine
|
Professional
|
Both
|
$3,116.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3072715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.86 |
| Max. Negotiated Rate |
$2,960.20 |
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,679.76
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$2,960.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,558.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,869.60
|
| Rate for Payer: Health EOS Commercial |
$2,835.56
|
| Rate for Payer: HFN Commercial |
$2,960.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$242.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.86
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,960.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,371.04
|
| Rate for Payer: Quartz Commercial |
$1,776.12
|
| Rate for Payer: The Alliance Commercial |
$1,558.00
|
| Rate for Payer: WEA Trust Commercial |
$1,713.80
|
| Rate for Payer: WPS Commercial |
$2,308.02
|
|
|
XR Myelography Cervical Spine
|
Facility
|
IP
|
$3,116.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3072715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,526.84 |
| Max. Negotiated Rate |
$2,866.72 |
| Rate for Payer: Aetna Commercial |
$2,804.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,679.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,651.48
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$2,866.72
|
| Rate for Payer: Health EOS Commercial |
$2,773.24
|
| Rate for Payer: HFN Commercial |
$2,866.72
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,869.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,866.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,526.84
|
| Rate for Payer: Quartz Commercial |
$1,869.60
|
| Rate for Payer: WEA Trust Commercial |
$1,713.80
|
| Rate for Payer: WPS Commercial |
$2,308.02
|
|
