|
XR Myelography Cervical Spine
|
Facility
|
OP
|
$3,116.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3072715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$3,165.60 |
| Rate for Payer: Aetna Commercial |
$2,804.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,679.76
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,967.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,374.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,255.49
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,651.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| 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 |
$2,866.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,743.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$2,773.24
|
| Rate for Payer: HFN Commercial |
$2,866.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| 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 |
$2,025.40
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,713.80
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$2,308.02
|
|
|
XR Myelography Lumbosacral
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3072716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$232.42 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Aetna Commercial |
$1,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,668.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$878.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.60
|
| Rate for Payer: Health EOS Commercial |
$1,597.96
|
| Rate for Payer: HFN Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$232.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$232.42
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,668.20
|
| Rate for Payer: Quartz Beloit One Network |
$772.64
|
| Rate for Payer: Quartz Commercial |
$1,000.92
|
| Rate for Payer: The Alliance Commercial |
$878.00
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
XR Myelography Lumbosacral
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3072716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$3,165.60 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,967.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,374.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,255.49
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$982.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,141.40
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
XR Myelography Lumbosacral
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3072716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$860.44 |
| Max. Negotiated Rate |
$1,615.52 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,053.60
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
XR Myelography Spine 2 Or More Areas
|
Facility
|
OP
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$3,779.36 |
| Rate for Payer: Aetna Commercial |
$3,697.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.88
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,967.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,374.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,255.49
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,177.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$3,779.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,298.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$3,656.12
|
| Rate for Payer: HFN Commercial |
$3,779.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$3,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,779.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.92
|
| Rate for Payer: Quartz Commercial |
$2,670.20
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,259.40
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$3,042.80
|
|
|
XR Myelography Spine 2 Or More Areas
|
Professional
|
Both
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$3,902.60 |
| Rate for Payer: Aetna Commercial |
$3,902.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.88
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$3,902.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,054.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,464.80
|
| Rate for Payer: Health EOS Commercial |
$3,738.28
|
| Rate for Payer: HFN Commercial |
$3,902.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.16
|
| Rate for Payer: Multiplan Commercial |
$3,286.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,902.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.52
|
| Rate for Payer: Quartz Commercial |
$2,341.56
|
| Rate for Payer: The Alliance Commercial |
$2,054.00
|
| Rate for Payer: WEA Trust Commercial |
$2,259.40
|
| Rate for Payer: WPS Commercial |
$3,042.80
|
|
|
XR Myelography Spine 2 Or More Areas
|
Facility
|
IP
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,012.92 |
| Max. Negotiated Rate |
$3,779.36 |
| Rate for Payer: Aetna Commercial |
$3,697.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,177.24
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$3,779.36
|
| Rate for Payer: Health EOS Commercial |
$3,656.12
|
| Rate for Payer: HFN Commercial |
$3,779.36
|
| Rate for Payer: Multiplan Commercial |
$3,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,464.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,779.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,012.92
|
| Rate for Payer: Quartz Commercial |
$2,464.80
|
| Rate for Payer: WEA Trust Commercial |
$2,259.40
|
| Rate for Payer: WPS Commercial |
$3,042.80
|
|
|
XR Myelography Thoracic Spine
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$3,165.60 |
| Rate for Payer: Aetna Commercial |
$2,610.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,494.86
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,967.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,374.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,255.49
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,668.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,623.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$2,581.89
|
| Rate for Payer: HFN Commercial |
$2,668.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$2,320.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,668.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.49
|
| Rate for Payer: Quartz Commercial |
$1,885.65
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$3,165.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,595.55
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$2,148.77
|
|
|
XR Myelography Thoracic Spine
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,421.49 |
| Max. Negotiated Rate |
$2,668.92 |
| Rate for Payer: Aetna Commercial |
$2,610.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,494.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,537.53
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,668.92
|
| Rate for Payer: Health EOS Commercial |
$2,581.89
|
| Rate for Payer: HFN Commercial |
$2,668.92
|
| Rate for Payer: Multiplan Commercial |
$2,320.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,740.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,668.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,421.49
|
| Rate for Payer: Quartz Commercial |
$1,740.60
|
| Rate for Payer: WEA Trust Commercial |
$1,595.55
|
| Rate for Payer: WPS Commercial |
$2,148.77
|
|
|
XR Myelography Thoracic Spine
|
Professional
|
Both
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$2,755.95 |
| Rate for Payer: Aetna Commercial |
$2,755.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,494.86
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,755.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,450.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,740.60
|
| Rate for Payer: Health EOS Commercial |
$2,639.91
|
| Rate for Payer: HFN Commercial |
$2,755.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.16
|
| Rate for Payer: Multiplan Commercial |
$2,320.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,755.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,276.44
|
| Rate for Payer: Quartz Commercial |
$1,653.57
|
| Rate for Payer: The Alliance Commercial |
$1,450.50
|
| Rate for Payer: WEA Trust Commercial |
$1,595.55
|
| Rate for Payer: WPS Commercial |
$2,148.77
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$187.67 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$229.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$229.80
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$202.37 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$247.80
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$247.80
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$268.45
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
XR Nasal Bones Minimum 3 Views
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$128.42 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna Commercial |
$363.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$363.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.80
|
| Rate for Payer: Health EOS Commercial |
$348.53
|
| Rate for Payer: HFN Commercial |
$363.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.42
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Preferred Network Access Commercial |
$363.85
|
| Rate for Payer: Quartz Beloit One Network |
$168.52
|
| Rate for Payer: Quartz Commercial |
$218.31
|
| Rate for Payer: The Alliance Commercial |
$191.50
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
XR Nasal Bones Minimum 3 Views
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.98 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna Commercial |
$392.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$392.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.80
|
| Rate for Payer: Health EOS Commercial |
$375.83
|
| Rate for Payer: HFN Commercial |
$392.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.98
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Preferred Network Access Commercial |
$392.35
|
| Rate for Payer: Quartz Beloit One Network |
$181.72
|
| Rate for Payer: Quartz Commercial |
$235.41
|
| Rate for Payer: The Alliance Commercial |
$206.50
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$359.28 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.84
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$248.95
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
XR Neck Soft Tissue
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 70360 TC
|
| Hospital Charge Code |
1537208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$461.84 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$301.20
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$301.20
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
XR Neck Soft Tissue
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
630307
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$427.80 |
| Rate for Payer: Aetna Commercial |
$418.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.90
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.20
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$427.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$413.85
|
| Rate for Payer: HFN Commercial |
$427.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$427.80
|
| Rate for Payer: Quartz Beloit One Network |
$227.85
|
| Rate for Payer: Quartz Commercial |
$302.25
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$255.75
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$344.43
|
|
|
XR Neck Soft Tissue
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
CPT 70360 TC
|
| Hospital Charge Code |
1537208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$476.90 |
| Rate for Payer: Aetna Commercial |
$476.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$476.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.20
|
| Rate for Payer: Health EOS Commercial |
$456.82
|
| Rate for Payer: HFN Commercial |
$476.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.79
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: Preferred Network Access Commercial |
$476.90
|
| Rate for Payer: Quartz Beloit One Network |
$220.88
|
| Rate for Payer: Quartz Commercial |
$286.14
|
| Rate for Payer: The Alliance Commercial |
$251.00
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
XR Neck Soft Tissue
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
630307
|
| Min. Negotiated Rate |
$106.43 |
| Max. Negotiated Rate |
$441.75 |
| Rate for Payer: Aetna Commercial |
$441.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.90
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$441.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.00
|
| Rate for Payer: Health EOS Commercial |
$423.15
|
| Rate for Payer: HFN Commercial |
$441.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.43
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.75
|
| Rate for Payer: Quartz Beloit One Network |
$204.60
|
| Rate for Payer: Quartz Commercial |
$265.05
|
| Rate for Payer: The Alliance Commercial |
$232.50
|
| Rate for Payer: WEA Trust Commercial |
$255.75
|
| Rate for Payer: WPS Commercial |
$344.43
|
|
|
XR Neck Soft Tissue
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
630307
|
| Min. Negotiated Rate |
$227.85 |
| Max. Negotiated Rate |
$427.80 |
| Rate for Payer: Aetna Commercial |
$418.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.45
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$427.80
|
| Rate for Payer: Health EOS Commercial |
$413.85
|
| Rate for Payer: HFN Commercial |
$427.80
|
| Rate for Payer: Multiplan Commercial |
$372.00
|
| Rate for Payer: NAPHCARE Commercial |
$279.00
|
| Rate for Payer: Preferred Network Access Commercial |
$427.80
|
| Rate for Payer: Quartz Beloit One Network |
$227.85
|
| Rate for Payer: Quartz Commercial |
$279.00
|
| Rate for Payer: WEA Trust Commercial |
$255.75
|
| Rate for Payer: WPS Commercial |
$344.43
|
|
|
XR Neck Soft Tissue
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 70360 TC
|
| Hospital Charge Code |
1537208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$461.84 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$326.30
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
XR Neph Exchange Percutaneous
|
Facility
|
IP
|
$3,505.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
4600648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,717.45 |
| Max. Negotiated Rate |
$3,224.60 |
| Rate for Payer: Aetna Commercial |
$3,154.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,014.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.65
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,224.60
|
| Rate for Payer: Health EOS Commercial |
$3,119.45
|
| Rate for Payer: HFN Commercial |
$3,224.60
|
| Rate for Payer: Multiplan Commercial |
$2,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,103.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,224.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,717.45
|
| Rate for Payer: Quartz Commercial |
$2,103.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.75
|
| Rate for Payer: WPS Commercial |
$2,596.15
|
|
|
XR Neph Exchange Percutaneous
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
4600648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$3,154.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,014.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,278.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,752.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,682.40
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,857.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,224.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$3,119.45
|
| Rate for Payer: HFN Commercial |
$3,224.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$2,804.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,224.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,717.45
|
| Rate for Payer: Quartz Commercial |
$2,278.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,927.75
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$2,596.15
|
|
|
XR Neph Exchange Percutaneous
|
Professional
|
Both
|
$3,505.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
4600648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$332.91 |
| Max. Negotiated Rate |
$3,329.75 |
| Rate for Payer: Aetna Commercial |
$3,329.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,014.30
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,329.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$367.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,103.00
|
| Rate for Payer: Health EOS Commercial |
$3,189.55
|
| Rate for Payer: HFN Commercial |
$3,329.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$332.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$332.91
|
| Rate for Payer: Multiplan Commercial |
$2,804.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,329.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,542.20
|
| Rate for Payer: Quartz Commercial |
$1,997.85
|
| Rate for Payer: The Alliance Commercial |
$1,752.50
|
| Rate for Payer: United Healthcare Medicaid |
$367.08
|
| Rate for Payer: WEA Trust Commercial |
$1,927.75
|
| Rate for Payer: WPS Commercial |
$2,596.15
|
|
