|
XR Salivary Gland Calculus Right
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT 70380 RT
|
| Hospital Charge Code |
1537274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Salivary Gland Calculus Right
|
Professional
|
$596.00
|
|
|
Service Code
|
CPT 70380 RT
|
| Hospital Charge Code |
1537274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.24 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Aetna Commercial |
$566.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$566.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.60
|
| Rate for Payer: Health EOS Commercial |
$542.36
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$566.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.24
|
| Rate for Payer: Quartz Commercial |
$339.72
|
| Rate for Payer: The Alliance Commercial |
$298.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Salivary Gland Calculus Right
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT 70380 TC,RT
|
| Hospital Charge Code |
2979986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Salivary Gland Calculus Right
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT 70380 RT
|
| Hospital Charge Code |
1537274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Salivary Gland Calculus Right
|
Facility
IP
|
$596.00
|
|
|
Service Code
|
CPT 70380 TC,RT
|
| Hospital Charge Code |
2979986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Salivary Gland Calculus Right
|
Professional
|
$596.00
|
|
|
Service Code
|
CPT 70380 TC,RT
|
| Hospital Charge Code |
2979986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.24 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Aetna Commercial |
$566.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$566.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.60
|
| Rate for Payer: Health EOS Commercial |
$542.36
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$566.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.24
|
| Rate for Payer: Quartz Commercial |
$339.72
|
| Rate for Payer: The Alliance Commercial |
$298.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Salivary Gland Calcus Bilateral
|
Facility
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630180
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,918.88 |
| Rate for Payer: Aetna Commercial |
$1,031.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$985.56
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$744.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$573.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$550.08
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.38
|
| 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 |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$1,054.32
|
| 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 |
$1,019.94
|
| Rate for Payer: HFN Commercial |
$1,054.32
|
| 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 |
$916.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,054.32
|
| Rate for Payer: Quartz Beloit One Network |
$561.54
|
| Rate for Payer: Quartz Commercial |
$744.90
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$1,918.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$630.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$848.84
|
|
|
XR Salivary Gland Calcus Bilateral
|
Professional
|
$1,146.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630180
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$1,088.70 |
| Rate for Payer: Aetna Commercial |
$1,088.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$985.56
|
| Rate for Payer: Aetna Managed Medicare |
$36.23
|
| Rate for Payer: Anthem Medicare Advantage |
$36.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.23
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$1,088.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$573.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.23
|
| Rate for Payer: Health EOS Commercial |
$1,042.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.23
|
| Rate for Payer: Multiplan Commercial |
$916.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.70
|
| Rate for Payer: Quartz Beloit One Network |
$504.24
|
| Rate for Payer: Quartz Commercial |
$653.22
|
| Rate for Payer: Quartz Medicare Advantage |
$36.23
|
| Rate for Payer: The Alliance Commercial |
$137.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.23
|
| Rate for Payer: WEA Trust Commercial |
$630.30
|
| Rate for Payer: WPS Commercial |
$181.15
|
|
|
XR Salivary Gland Calcus Bilateral
|
Facility
IP
|
$1,146.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630180
|
| Min. Negotiated Rate |
$561.54 |
| Max. Negotiated Rate |
$1,054.32 |
| Rate for Payer: Aetna Commercial |
$1,031.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.38
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$1,054.32
|
| Rate for Payer: Health EOS Commercial |
$1,019.94
|
| Rate for Payer: HFN Commercial |
$1,054.32
|
| Rate for Payer: Multiplan Commercial |
$916.80
|
| Rate for Payer: NAPHCARE Commercial |
$687.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,054.32
|
| Rate for Payer: Quartz Beloit One Network |
$561.54
|
| Rate for Payer: Quartz Commercial |
$687.60
|
| Rate for Payer: WEA Trust Commercial |
$630.30
|
| Rate for Payer: WPS Commercial |
$848.84
|
|
|
XR Salivary Gland Calcus Left
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630178
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,918.88 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$372.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.04
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| 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 |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| 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 |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| 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 |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$372.45
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$1,918.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
|
XR Salivary Gland Calcus Left
|
Facility
IP
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630178
|
| Min. Negotiated Rate |
$280.77 |
| Max. Negotiated Rate |
$527.16 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| Rate for Payer: Health EOS Commercial |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$343.80
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$343.80
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
|
XR Salivary Gland Calcus Left
|
Professional
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630178
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$544.35 |
| Rate for Payer: Aetna Commercial |
$544.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Aetna Managed Medicare |
$36.23
|
| Rate for Payer: Anthem Medicare Advantage |
$36.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.23
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$544.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.23
|
| Rate for Payer: Health EOS Commercial |
$521.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.23
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: Preferred Network Access Commercial |
$544.35
|
| Rate for Payer: Quartz Beloit One Network |
$252.12
|
| Rate for Payer: Quartz Commercial |
$326.61
|
| Rate for Payer: Quartz Medicare Advantage |
$36.23
|
| Rate for Payer: The Alliance Commercial |
$137.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.23
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$181.15
|
|
|
XR Salivary Gland Calcus Right
|
Facility
IP
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630174
|
| Min. Negotiated Rate |
$280.77 |
| Max. Negotiated Rate |
$527.16 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| Rate for Payer: Health EOS Commercial |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$343.80
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$343.80
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
|
XR Salivary Gland Calcus Right
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630174
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,918.88 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$372.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.04
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| 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 |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| 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 |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| 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 |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$372.45
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$1,918.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
|
XR Salivary Gland Calcus Right
|
Professional
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630174
|
| Min. Negotiated Rate |
$36.23 |
| Max. Negotiated Rate |
$544.35 |
| Rate for Payer: Aetna Commercial |
$544.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Aetna Managed Medicare |
$36.23
|
| Rate for Payer: Anthem Medicare Advantage |
$36.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.23
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$544.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.23
|
| Rate for Payer: Health EOS Commercial |
$521.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.23
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: Preferred Network Access Commercial |
$544.35
|
| Rate for Payer: Quartz Beloit One Network |
$252.12
|
| Rate for Payer: Quartz Commercial |
$326.61
|
| Rate for Payer: Quartz Medicare Advantage |
$36.23
|
| Rate for Payer: The Alliance Commercial |
$137.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.23
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$181.15
|
|
|
XR Scapula Bilateral
|
Facility
OP
|
$1,153.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630170
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$1,060.76 |
| Rate for Payer: Aetna Commercial |
$1,037.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.58
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$749.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$553.44
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.09
|
| 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 |
$345.90
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,060.76
|
| 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 |
$1,026.17
|
| Rate for Payer: HFN Commercial |
$1,060.76
|
| 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 |
$922.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,060.76
|
| Rate for Payer: Quartz Beloit One Network |
$564.97
|
| Rate for Payer: Quartz Commercial |
$749.45
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$100.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$634.15
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$854.03
|
|
|
XR Scapula Bilateral
|
Professional
|
$600.00
|
|
|
Service Code
|
CPT 73010 LT,TC
|
| Hospital Charge Code |
1537276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.00 |
| Max. Negotiated Rate |
$570.00 |
| Rate for Payer: Aetna Commercial |
$570.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$570.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.00
|
| Rate for Payer: Health EOS Commercial |
$546.00
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.00
|
| Rate for Payer: Quartz Beloit One Network |
$264.00
|
| Rate for Payer: Quartz Commercial |
$342.00
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: WEA Trust Commercial |
$330.00
|
| Rate for Payer: WPS Commercial |
$444.42
|
|
|
XR Scapula Bilateral
|
Facility
OP
|
$600.00
|
|
|
Service Code
|
CPT 73010 LT,TC
|
| Hospital Charge Code |
1537276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$168.00 |
| Max. Negotiated Rate |
$2,400.00 |
| Rate for Payer: Aetna Commercial |
$540.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.00
|
| Rate for Payer: Aetna Managed Medicare |
$168.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$300.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$552.00
|
| Rate for Payer: Health EOS Commercial |
$534.00
|
| Rate for Payer: HFN Commercial |
$552.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.00
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: NAPHCARE Commercial |
$360.00
|
| Rate for Payer: Preferred Network Access Commercial |
$552.00
|
| Rate for Payer: Quartz Beloit One Network |
$294.00
|
| Rate for Payer: Quartz Commercial |
$390.00
|
| Rate for Payer: Quartz Medicare Advantage |
$360.00
|
| Rate for Payer: The Alliance Commercial |
$2,400.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$330.00
|
| Rate for Payer: WPS Commercial |
$444.42
|
|
|
XR Scapula Bilateral
|
Professional
|
$1,153.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630170
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$1,095.35 |
| Rate for Payer: Aetna Commercial |
$1,095.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.58
|
| Rate for Payer: Aetna Managed Medicare |
$22.71
|
| Rate for Payer: Anthem Medicare Advantage |
$22.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.71
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,095.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$576.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.71
|
| Rate for Payer: Health EOS Commercial |
$1,049.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.71
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,095.35
|
| Rate for Payer: Quartz Beloit One Network |
$507.32
|
| Rate for Payer: Quartz Commercial |
$657.21
|
| Rate for Payer: Quartz Medicare Advantage |
$22.71
|
| Rate for Payer: The Alliance Commercial |
$86.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.71
|
| Rate for Payer: WEA Trust Commercial |
$634.15
|
| Rate for Payer: WPS Commercial |
$113.55
|
|
|
XR Scapula Bilateral
|
Facility
IP
|
$600.00
|
|
|
Service Code
|
CPT 73010 LT,TC
|
| Hospital Charge Code |
1537276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.00 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$540.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$552.00
|
| Rate for Payer: Health EOS Commercial |
$534.00
|
| Rate for Payer: HFN Commercial |
$552.00
|
| Rate for Payer: Multiplan Commercial |
$480.00
|
| Rate for Payer: NAPHCARE Commercial |
$360.00
|
| Rate for Payer: Preferred Network Access Commercial |
$552.00
|
| Rate for Payer: Quartz Beloit One Network |
$294.00
|
| Rate for Payer: Quartz Commercial |
$360.00
|
| Rate for Payer: WEA Trust Commercial |
$330.00
|
| Rate for Payer: WPS Commercial |
$444.42
|
|
|
XR Scapula Bilateral
|
Facility
IP
|
$1,153.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630170
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$1,060.76 |
| Rate for Payer: Aetna Commercial |
$1,037.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.09
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,060.76
|
| Rate for Payer: Health EOS Commercial |
$1,026.17
|
| Rate for Payer: HFN Commercial |
$1,060.76
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: NAPHCARE Commercial |
$691.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,060.76
|
| Rate for Payer: Quartz Beloit One Network |
$564.97
|
| Rate for Payer: Quartz Commercial |
$691.80
|
| Rate for Payer: WEA Trust Commercial |
$634.15
|
| Rate for Payer: WPS Commercial |
$854.03
|
|
|
XR Scapula Left
|
Facility
OP
|
$577.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630165
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$530.84 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.22
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$288.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.96
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.81
|
| 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 |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$530.84
|
| 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 |
$513.53
|
| Rate for Payer: HFN Commercial |
$530.84
|
| 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 |
$461.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$530.84
|
| Rate for Payer: Quartz Beloit One Network |
$282.73
|
| Rate for Payer: Quartz Commercial |
$375.05
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$100.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
XR Scapula Left
|
Facility
OP
|
$596.00
|
|
|
Service Code
|
CPT 73010 LT,TC
|
| Hospital Charge Code |
1537278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
XR Scapula Left
|
Facility
IP
|
$577.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630165
|
| Min. Negotiated Rate |
$282.73 |
| Max. Negotiated Rate |
$530.84 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.81
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$530.84
|
| Rate for Payer: Health EOS Commercial |
$513.53
|
| Rate for Payer: HFN Commercial |
$530.84
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: NAPHCARE Commercial |
$346.20
|
| Rate for Payer: Preferred Network Access Commercial |
$530.84
|
| Rate for Payer: Quartz Beloit One Network |
$282.73
|
| Rate for Payer: Quartz Commercial |
$346.20
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
XR Scapula Left
|
Professional
|
$596.00
|
|
|
Service Code
|
CPT 73010 LT,TC
|
| Hospital Charge Code |
1537278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.24 |
| Max. Negotiated Rate |
$566.20 |
| Rate for Payer: Aetna Commercial |
$566.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$566.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$298.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.60
|
| Rate for Payer: Health EOS Commercial |
$542.36
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$566.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.24
|
| Rate for Payer: Quartz Commercial |
$339.72
|
| Rate for Payer: The Alliance Commercial |
$298.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
