|
XR Mandible Complete Minimum 4 Views
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
630339
|
| Min. Negotiated Rate |
$29.16 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$223.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.12
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| 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 |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| 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 |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$223.60
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$29.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
XR Mandible Complete Minimum 4 Views
|
Facility
OP
|
$371.00
|
|
|
Service Code
|
CPT 70110 TC
|
| Hospital Charge Code |
1537178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$1,484.00 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$103.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.25
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$241.15
|
| Rate for Payer: Quartz Medicare Advantage |
$222.60
|
| Rate for Payer: The Alliance Commercial |
$1,484.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
XR Mandible Complete Minimum 4 Views
|
Professional
|
$344.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
630339
|
| Min. Negotiated Rate |
$41.84 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$326.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$41.84
|
| Rate for Payer: Anthem Medicare Advantage |
$41.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.84
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$326.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.84
|
| Rate for Payer: Health EOS Commercial |
$313.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.84
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$326.80
|
| Rate for Payer: Quartz Beloit One Network |
$151.36
|
| Rate for Payer: Quartz Commercial |
$196.08
|
| Rate for Payer: Quartz Medicare Advantage |
$41.84
|
| Rate for Payer: The Alliance Commercial |
$158.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.84
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$209.20
|
|
|
XR Mandible Complete Minimum 4 Views
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 70110
|
| Hospital Charge Code |
630339
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$316.48 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$206.40
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
XR Mandible Complete Minimum 4 Views
|
Facility
IP
|
$371.00
|
|
|
Service Code
|
CPT 70110 TC
|
| Hospital Charge Code |
1537178
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.79 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
XR Mandible Partial Less Than 4 Views
|
Facility
OP
|
$626.00
|
|
|
Service Code
|
CPT 70100 TC
|
| Hospital Charge Code |
1537180
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.28 |
| Max. Negotiated Rate |
$2,504.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$175.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$313.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$375.60
|
| Rate for Payer: The Alliance Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
XR Mandible Partial Less Than 4 Views
|
Facility
IP
|
$580.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
630337
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
XR Mandible Partial Less Than 4 Views
|
Professional
|
$580.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
630337
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$37.22
|
| Rate for Payer: Anthem Medicare Advantage |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.22
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$551.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.22
|
| Rate for Payer: Health EOS Commercial |
$527.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.22
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$551.00
|
| Rate for Payer: Quartz Beloit One Network |
$255.20
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: Quartz Medicare Advantage |
$37.22
|
| Rate for Payer: The Alliance Commercial |
$141.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.22
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$186.10
|
|
|
XR Mandible Partial Less Than 4 Views
|
Professional
|
$626.00
|
|
|
Service Code
|
CPT 70100 TC
|
| Hospital Charge Code |
1537180
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$28.76
|
| Rate for Payer: Anthem Medicare Advantage |
$28.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.76
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.76
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.76
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: Quartz Medicare Advantage |
$28.76
|
| Rate for Payer: The Alliance Commercial |
$109.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.76
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$143.80
|
|
|
XR Mandible Partial Less Than 4 Views
|
Facility
OP
|
$580.00
|
|
|
Service Code
|
CPT 70100
|
| Hospital Charge Code |
630337
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$377.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$290.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$278.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| 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 |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| 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 |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$6.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
XR Mandible Partial Less Than 4 Views
|
Facility
IP
|
$626.00
|
|
|
Service Code
|
CPT 70100 TC
|
| Hospital Charge Code |
1537180
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
XR Mastoids < 3 Views Bilateral
|
Professional
|
$687.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630335
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Aetna Commercial |
$652.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Aetna Managed Medicare |
$37.22
|
| Rate for Payer: Anthem Medicare Advantage |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.22
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$652.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$343.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.22
|
| Rate for Payer: Health EOS Commercial |
$625.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.22
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$652.65
|
| Rate for Payer: Quartz Beloit One Network |
$302.28
|
| Rate for Payer: Quartz Commercial |
$391.59
|
| Rate for Payer: Quartz Medicare Advantage |
$37.22
|
| Rate for Payer: The Alliance Commercial |
$141.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.22
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$186.10
|
|
|
XR Mastoids < 3 Views Bilateral
|
Facility
IP
|
$687.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630335
|
| Min. Negotiated Rate |
$336.63 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$412.20
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
XR Mastoids < 3 Views Bilateral
|
Facility
OP
|
$687.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630335
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$446.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$343.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$329.76
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| 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 |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| 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 |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$446.55
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$124.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
XR Mastoids < 3 Views Bilateral
|
Facility
IP
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.42 |
| Max. Negotiated Rate |
$329.36 |
| Rate for Payer: Aetna Commercial |
$322.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.74
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$329.36
|
| Rate for Payer: Health EOS Commercial |
$318.62
|
| Rate for Payer: HFN Commercial |
$329.36
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: NAPHCARE Commercial |
$214.80
|
| Rate for Payer: Preferred Network Access Commercial |
$329.36
|
| Rate for Payer: Quartz Beloit One Network |
$175.42
|
| Rate for Payer: Quartz Commercial |
$214.80
|
| Rate for Payer: WEA Trust Commercial |
$196.90
|
| Rate for Payer: WPS Commercial |
$265.17
|
|
|
XR Mastoids < 3 Views Bilateral
|
Professional
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.52 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna Commercial |
$340.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.88
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$340.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.80
|
| Rate for Payer: Health EOS Commercial |
$325.78
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Preferred Network Access Commercial |
$340.10
|
| Rate for Payer: Quartz Beloit One Network |
$157.52
|
| Rate for Payer: Quartz Commercial |
$204.06
|
| Rate for Payer: The Alliance Commercial |
$179.00
|
| Rate for Payer: WEA Trust Commercial |
$196.90
|
| Rate for Payer: WPS Commercial |
$265.17
|
|
|
XR Mastoids < 3 Views Bilateral
|
Facility
OP
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.24 |
| Max. Negotiated Rate |
$1,432.00 |
| Rate for Payer: Aetna Commercial |
$322.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.88
|
| Rate for Payer: Aetna Managed Medicare |
$100.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$232.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.74
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$329.36
|
| Rate for Payer: Health EOS Commercial |
$318.62
|
| Rate for Payer: HFN Commercial |
$329.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: NAPHCARE Commercial |
$214.80
|
| Rate for Payer: Preferred Network Access Commercial |
$329.36
|
| Rate for Payer: Quartz Beloit One Network |
$175.42
|
| Rate for Payer: Quartz Commercial |
$232.70
|
| Rate for Payer: Quartz Medicare Advantage |
$214.80
|
| Rate for Payer: The Alliance Commercial |
$1,432.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$196.90
|
| Rate for Payer: WPS Commercial |
$265.17
|
|
|
XR Mastoids < 3 Views Left
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630333
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$316.48 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$206.40
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
XR Mastoids < 3 Views Left
|
Professional
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630333
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$326.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$37.22
|
| Rate for Payer: Anthem Medicare Advantage |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.22
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$326.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.22
|
| Rate for Payer: Health EOS Commercial |
$313.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.22
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$326.80
|
| Rate for Payer: Quartz Beloit One Network |
$151.36
|
| Rate for Payer: Quartz Commercial |
$196.08
|
| Rate for Payer: Quartz Medicare Advantage |
$37.22
|
| Rate for Payer: The Alliance Commercial |
$141.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.22
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$186.10
|
|
|
XR Mastoids < 3 Views Left
|
Facility
OP
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537186
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.24 |
| Max. Negotiated Rate |
$1,432.00 |
| Rate for Payer: Aetna Commercial |
$322.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.88
|
| Rate for Payer: Aetna Managed Medicare |
$100.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$232.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.74
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$329.36
|
| Rate for Payer: Health EOS Commercial |
$318.62
|
| Rate for Payer: HFN Commercial |
$329.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: NAPHCARE Commercial |
$214.80
|
| Rate for Payer: Preferred Network Access Commercial |
$329.36
|
| Rate for Payer: Quartz Beloit One Network |
$175.42
|
| Rate for Payer: Quartz Commercial |
$232.70
|
| Rate for Payer: Quartz Medicare Advantage |
$214.80
|
| Rate for Payer: The Alliance Commercial |
$1,432.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$196.90
|
| Rate for Payer: WPS Commercial |
$265.17
|
|
|
XR Mastoids < 3 Views Left
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630333
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$223.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.12
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| 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 |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| 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 |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$223.60
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$124.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
XR Mastoids < 3 Views Left
|
Facility
IP
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537186
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.42 |
| Max. Negotiated Rate |
$329.36 |
| Rate for Payer: Aetna Commercial |
$322.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.74
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$329.36
|
| Rate for Payer: Health EOS Commercial |
$318.62
|
| Rate for Payer: HFN Commercial |
$329.36
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: NAPHCARE Commercial |
$214.80
|
| Rate for Payer: Preferred Network Access Commercial |
$329.36
|
| Rate for Payer: Quartz Beloit One Network |
$175.42
|
| Rate for Payer: Quartz Commercial |
$214.80
|
| Rate for Payer: WEA Trust Commercial |
$196.90
|
| Rate for Payer: WPS Commercial |
$265.17
|
|
|
XR Mastoids < 3 Views Left
|
Professional
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537186
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.52 |
| Max. Negotiated Rate |
$340.10 |
| Rate for Payer: Aetna Commercial |
$340.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.88
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$340.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.80
|
| Rate for Payer: Health EOS Commercial |
$325.78
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: Preferred Network Access Commercial |
$340.10
|
| Rate for Payer: Quartz Beloit One Network |
$157.52
|
| Rate for Payer: Quartz Commercial |
$204.06
|
| Rate for Payer: The Alliance Commercial |
$179.00
|
| Rate for Payer: WEA Trust Commercial |
$196.90
|
| Rate for Payer: WPS Commercial |
$265.17
|
|
|
XR Mastoids < 3 Views Right
|
Professional
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630327
|
| Min. Negotiated Rate |
$37.22 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$326.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$37.22
|
| Rate for Payer: Anthem Medicare Advantage |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.22
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$326.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.22
|
| Rate for Payer: Health EOS Commercial |
$313.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.22
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$326.80
|
| Rate for Payer: Quartz Beloit One Network |
$151.36
|
| Rate for Payer: Quartz Commercial |
$196.08
|
| Rate for Payer: Quartz Medicare Advantage |
$37.22
|
| Rate for Payer: The Alliance Commercial |
$141.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.22
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$186.10
|
|
|
XR Mastoids < 3 Views Right
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630327
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$404.25 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$223.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.12
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| 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 |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| 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 |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$223.60
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$124.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
