|
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
|
|
|
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
|
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 Midline Catheter
|
Facility
IP
|
$177.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5551924
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
XR Midline Catheter
|
Professional
|
$177.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5551924
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
XR Midline Catheter
|
Facility
OP
|
$177.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5551924
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Aetna Managed Medicare |
$49.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.05
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| Rate for Payer: Quartz Medicare Advantage |
$106.20
|
| Rate for Payer: The Alliance Commercial |
$708.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
XR Myelography Cervical Spine
|
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 |
$12,464.00 |
| Rate for Payer: Aetna Commercial |
$2,804.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,679.76
|
| Rate for Payer: Aetna Managed Medicare |
$872.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,025.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,558.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,495.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,651.48
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$2,866.72
|
| Rate for Payer: Health EOS Commercial |
$2,773.24
|
| Rate for Payer: HFN Commercial |
$2,866.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,337.00
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,869.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,866.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,526.84
|
| Rate for Payer: Quartz Commercial |
$2,025.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,869.60
|
| Rate for Payer: The Alliance Commercial |
$12,464.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,713.80
|
| Rate for Payer: WPS Commercial |
$2,308.02
|
|
|
XR Myelography Cervical Spine
|
Professional
|
$3,116.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3072715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.36 |
| Max. Negotiated Rate |
$2,960.20 |
| Rate for Payer: Aetna Commercial |
$2,960.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,679.76
|
| Rate for Payer: Aetna Managed Medicare |
$68.36
|
| Rate for Payer: Anthem Medicare Advantage |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.36
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$2,960.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,558.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.36
|
| Rate for Payer: Health EOS Commercial |
$2,835.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$242.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.36
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,960.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,371.04
|
| Rate for Payer: Quartz Commercial |
$1,776.12
|
| Rate for Payer: Quartz Medicare Advantage |
$68.36
|
| Rate for Payer: The Alliance Commercial |
$259.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.36
|
| Rate for Payer: WEA Trust Commercial |
$1,713.80
|
| Rate for Payer: WPS Commercial |
$341.80
|
|
|
XR Myelography Cervical Spine
|
Facility
IP
|
$3,116.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3072715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,526.84 |
| Max. Negotiated Rate |
$2,866.72 |
| Rate for Payer: Aetna Commercial |
$2,804.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,651.48
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$2,866.72
|
| Rate for Payer: Health EOS Commercial |
$2,773.24
|
| Rate for Payer: HFN Commercial |
$2,866.72
|
| Rate for Payer: Multiplan Commercial |
$2,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,869.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,866.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,526.84
|
| Rate for Payer: Quartz Commercial |
$1,869.60
|
| Rate for Payer: WEA Trust Commercial |
$1,713.80
|
| Rate for Payer: WPS Commercial |
$2,308.02
|
|
|
XR Myelography Lumbosacral
|
Professional
|
$1,756.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3072716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.71 |
| 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: Aetna Managed Medicare |
$67.71
|
| Rate for Payer: Anthem Medicare Advantage |
$67.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.71
|
| 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 |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$1,597.96
|
| 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: Independent Care Health Plan Medicare |
$67.71
|
| 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: Quartz Medicare Advantage |
$67.71
|
| Rate for Payer: The Alliance Commercial |
$257.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.71
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$338.55
|
|
|
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: 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 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 |
$7,024.00 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Aetna Managed Medicare |
$491.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,141.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$842.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| 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: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.00
|
| 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 |
$1,141.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,053.60
|
| Rate for Payer: The Alliance Commercial |
$7,024.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| 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 |
$16,432.00 |
| Rate for Payer: Aetna Commercial |
$3,697.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,532.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,150.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,670.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,054.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,971.84
|
| 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: Cash Price |
$1,232.40
|
| 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: Humana Commercial/EPO/HMO/POS/PPO |
$3,081.00
|
| 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 |
$2,670.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,464.80
|
| Rate for Payer: The Alliance Commercial |
$16,432.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| 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: 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 Spine 2 Or More Areas
|
Professional
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.72 |
| 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: Aetna Managed Medicare |
$95.72
|
| Rate for Payer: Anthem Medicare Advantage |
$95.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.72
|
| 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 |
$95.72
|
| Rate for Payer: Health EOS Commercial |
$3,738.28
|
| 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: Independent Care Health Plan Medicare |
$95.72
|
| 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: Quartz Medicare Advantage |
$95.72
|
| Rate for Payer: The Alliance Commercial |
$363.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.72
|
| Rate for Payer: WEA Trust Commercial |
$2,259.40
|
| Rate for Payer: WPS Commercial |
$478.60
|
|
|
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 |
$11,604.00 |
| Rate for Payer: Aetna Commercial |
$2,610.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,494.86
|
| Rate for Payer: Aetna Managed Medicare |
$812.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,885.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,450.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,392.48
|
| 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: Cash Price |
$870.30
|
| 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: Humana Commercial/EPO/HMO/POS/PPO |
$2,175.75
|
| 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 |
$1,885.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,740.60
|
| Rate for Payer: The Alliance Commercial |
$11,604.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,595.55
|
| 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: 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
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.72 |
| 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: Aetna Managed Medicare |
$95.72
|
| Rate for Payer: Anthem Medicare Advantage |
$95.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.72
|
| 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 |
$95.72
|
| Rate for Payer: Health EOS Commercial |
$2,639.91
|
| 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: Independent Care Health Plan Medicare |
$95.72
|
| 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: Quartz Medicare Advantage |
$95.72
|
| Rate for Payer: The Alliance Commercial |
$363.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.72
|
| Rate for Payer: WEA Trust Commercial |
$1,595.55
|
| Rate for Payer: WPS Commercial |
$478.60
|
|
|
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: 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
|
Professional
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$36.88 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna Commercial |
$363.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Aetna Managed Medicare |
$36.88
|
| Rate for Payer: Anthem Medicare Advantage |
$36.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.88
|
| 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 |
$36.88
|
| Rate for Payer: Health EOS Commercial |
$348.53
|
| 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: Independent Care Health Plan Medicare |
$36.88
|
| 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: Quartz Medicare Advantage |
$36.88
|
| Rate for Payer: The Alliance Commercial |
$140.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.88
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$184.40
|
|
|
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 |
$115.64 |
| Max. Negotiated Rate |
$1,652.00 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Aetna Managed Medicare |
$115.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| 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: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.75
|
| 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 |
$268.45
|
| Rate for Payer: Quartz Medicare Advantage |
$247.80
|
| Rate for Payer: The Alliance Commercial |
$1,652.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
XR Nasal Bones Minimum 3 Views
|
Professional
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.76 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna Commercial |
$392.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| 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 |
$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 |
$28.76
|
| Rate for Payer: Health EOS Commercial |
$375.83
|
| 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: Independent Care Health Plan Medicare |
$28.76
|
| 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: 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 |
$227.15
|
| Rate for Payer: WPS Commercial |
$143.80
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
OP
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$6.68 |
| Max. Negotiated Rate |
$352.36 |
| 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 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 |
$6.68
|
| 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 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: 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 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: 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
|
|
