|
XR Mastoids < 3 Views Right
|
Facility
OP
|
$371.00
|
|
|
Service Code
|
CPT 70120 RT,TC
|
| Hospital Charge Code |
1537188
|
|
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 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
|
|
|
XR Mastoids < 3 Views Right
|
Facility
IP
|
$371.00
|
|
|
Service Code
|
CPT 70120 RT,TC
|
| Hospital Charge Code |
1537188
|
|
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 Mastoids < 3 Views Right
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630327
|
| 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 Right
|
Facility
OP
|
$358.00
|
|
|
Service Code
|
CPT 70120 TC,RT
|
| Hospital Charge Code |
2979983
|
|
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 Right
|
Professional
|
$371.00
|
|
|
Service Code
|
CPT 70120 RT,TC
|
| Hospital Charge Code |
1537188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna Commercial |
$352.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$352.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.60
|
| Rate for Payer: Health EOS Commercial |
$337.61
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.45
|
| Rate for Payer: Quartz Beloit One Network |
$163.24
|
| Rate for Payer: Quartz Commercial |
$211.47
|
| Rate for Payer: The Alliance Commercial |
$185.50
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
XR Mastoids < 3 Views Right
|
Facility
IP
|
$358.00
|
|
|
Service Code
|
CPT 70120 TC,RT
|
| Hospital Charge Code |
2979983
|
|
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 Complete Bilateral
|
Facility
OP
|
$1,298.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630325
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,852.80 |
| Rate for Payer: Aetna Commercial |
$1,168.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,116.28
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$843.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$623.04
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$687.94
|
| 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 |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,194.16
|
| 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 |
$1,155.22
|
| Rate for Payer: HFN Commercial |
$1,194.16
|
| 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 |
$1,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,194.16
|
| Rate for Payer: Quartz Beloit One Network |
$636.02
|
| Rate for Payer: Quartz Commercial |
$843.70
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$1,852.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$713.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$961.43
|
|
|
XR Mastoids Complete Bilateral
|
Professional
|
$1,298.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630325
|
| Min. Negotiated Rate |
$60.45 |
| 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: Aetna Managed Medicare |
$60.45
|
| Rate for Payer: Anthem Medicare Advantage |
$60.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.45
|
| 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 |
$60.45
|
| Rate for Payer: Health EOS Commercial |
$1,181.18
|
| 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: Independent Care Health Plan Medicare |
$60.45
|
| 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: Quartz Medicare Advantage |
$60.45
|
| Rate for Payer: The Alliance Commercial |
$229.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.45
|
| Rate for Payer: WEA Trust Commercial |
$713.90
|
| Rate for Payer: WPS Commercial |
$302.25
|
|
|
XR Mastoids Complete Bilateral
|
Professional
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.00 |
| 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: 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: 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 Bilateral
|
Facility
OP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$189.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| 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: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$506.25
|
| 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 |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$405.00
|
| Rate for Payer: The Alliance Commercial |
$2,700.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
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: 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
|
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: 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 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: 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
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630323
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Aetna Commercial |
$616.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
| Rate for Payer: Aetna Managed Medicare |
$60.45
|
| Rate for Payer: Anthem Medicare Advantage |
$60.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.45
|
| 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 |
$60.45
|
| Rate for Payer: Health EOS Commercial |
$590.59
|
| 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: Independent Care Health Plan Medicare |
$60.45
|
| 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: Quartz Medicare Advantage |
$60.45
|
| Rate for Payer: The Alliance Commercial |
$229.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.45
|
| Rate for Payer: WEA Trust Commercial |
$356.95
|
| Rate for Payer: WPS Commercial |
$302.25
|
|
|
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 |
$189.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$189.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| 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: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$506.25
|
| 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 |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$405.00
|
| Rate for Payer: The Alliance Commercial |
$2,700.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
XR Mastoids Complete Left
|
Professional
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537192
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.00 |
| 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: 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: 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: 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
OP
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630323
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,852.80 |
| 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 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 |
$1,852.80
|
| 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: 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
|
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: 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
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,RT
|
| Hospital Charge Code |
2979984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.00 |
| 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: 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: 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
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630320
|
| Min. Negotiated Rate |
$60.45 |
| Max. Negotiated Rate |
$616.55 |
| Rate for Payer: Aetna Commercial |
$616.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.14
|
| Rate for Payer: Aetna Managed Medicare |
$60.45
|
| Rate for Payer: Anthem Medicare Advantage |
$60.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.45
|
| 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 |
$60.45
|
| Rate for Payer: Health EOS Commercial |
$590.59
|
| 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: Independent Care Health Plan Medicare |
$60.45
|
| 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: Quartz Medicare Advantage |
$60.45
|
| Rate for Payer: The Alliance Commercial |
$229.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.45
|
| Rate for Payer: WEA Trust Commercial |
$356.95
|
| Rate for Payer: WPS Commercial |
$302.25
|
|
|
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 |
$189.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$189.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| 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: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$506.25
|
| 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 |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$405.00
|
| Rate for Payer: The Alliance Commercial |
$2,700.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
|
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 |
$189.00 |
| Max. Negotiated Rate |
$2,700.00 |
| Rate for Payer: Aetna Commercial |
$607.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.50
|
| Rate for Payer: Aetna Managed Medicare |
$189.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$324.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.75
|
| 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: Health EOS Commercial |
$600.75
|
| Rate for Payer: HFN Commercial |
$621.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$506.25
|
| 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 |
$438.75
|
| Rate for Payer: Quartz Medicare Advantage |
$405.00
|
| Rate for Payer: The Alliance Commercial |
$2,700.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$371.25
|
| Rate for Payer: WPS Commercial |
$499.97
|
|
