|
XR Shoulder Intern/Extern Rotation Right
|
Facility
OP
|
$671.00
|
|
|
Service Code
|
CPT 73030 RT,TC
|
| Hospital Charge Code |
1537302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$187.88 |
| Max. Negotiated Rate |
$2,684.00 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Aetna Managed Medicare |
$187.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.25
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$436.15
|
| Rate for Payer: Quartz Medicare Advantage |
$402.60
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Intern/Extern Rotation Right
|
Professional
|
$671.00
|
|
|
Service Code
|
CPT 73030 RT,TC
|
| Hospital Charge Code |
1537302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.24 |
| Max. Negotiated Rate |
$637.45 |
| Rate for Payer: Aetna Commercial |
$637.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$637.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.60
|
| Rate for Payer: Health EOS Commercial |
$610.61
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: Preferred Network Access Commercial |
$637.45
|
| Rate for Payer: Quartz Beloit One Network |
$295.24
|
| Rate for Payer: Quartz Commercial |
$382.47
|
| Rate for Payer: The Alliance Commercial |
$335.50
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Intern/Extern Rotation Right
|
Professional
|
$621.00
|
|
|
Service Code
|
CPT 73030
|
| Hospital Charge Code |
711794
|
| Min. Negotiated Rate |
$33.35 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna Commercial |
$589.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.35
|
| Rate for Payer: Anthem Medicare Advantage |
$33.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.35
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$589.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.35
|
| Rate for Payer: Health EOS Commercial |
$565.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.35
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$589.95
|
| Rate for Payer: Quartz Beloit One Network |
$273.24
|
| Rate for Payer: Quartz Commercial |
$353.97
|
| Rate for Payer: Quartz Medicare Advantage |
$33.35
|
| Rate for Payer: The Alliance Commercial |
$126.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.35
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$166.75
|
|
|
XR Shoulder Intern/Extern Rotation Right
|
Facility
IP
|
$671.00
|
|
|
Service Code
|
CPT 73030 RT,TC
|
| Hospital Charge Code |
1537302
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$328.79 |
| Max. Negotiated Rate |
$617.32 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$402.60
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
XR Shoulder Intern/Extern Rotation Right
|
Facility
IP
|
$646.00
|
|
|
Service Code
|
CPT 73030 TC,RT
|
| Hospital Charge Code |
2979995
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
XR Shoulder Therapeutic Injection Lt
|
Facility
IP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570658
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$432.67 |
| Max. Negotiated Rate |
$812.36 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$529.80
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Shoulder Therapeutic Injection Lt
|
Facility
OP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570658
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$247.24 |
| Max. Negotiated Rate |
$3,532.00 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Aetna Managed Medicare |
$247.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$441.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494.13
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$662.25
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$573.95
|
| Rate for Payer: Quartz Medicare Advantage |
$529.80
|
| Rate for Payer: The Alliance Commercial |
$3,532.00
|
| Rate for Payer: United Healthcare PPO |
$662.25
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Shoulder Therapeutic Injection Lt
|
Professional
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570658
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$388.52 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Aetna Commercial |
$838.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$838.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$441.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.80
|
| Rate for Payer: Health EOS Commercial |
$803.53
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$838.85
|
| Rate for Payer: Quartz Beloit One Network |
$388.52
|
| Rate for Payer: Quartz Commercial |
$503.31
|
| Rate for Payer: The Alliance Commercial |
$441.50
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Shoulder Therapeutic Injection Rt
|
Professional
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570664
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$388.52 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Quartz Beloit One Network |
$388.52
|
| Rate for Payer: Aetna Commercial |
$838.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$838.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$441.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.80
|
| Rate for Payer: Health EOS Commercial |
$803.53
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$838.85
|
| Rate for Payer: Quartz Commercial |
$503.31
|
| Rate for Payer: The Alliance Commercial |
$441.50
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Shoulder Therapeutic Injection Rt
|
Facility
OP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570664
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$247.24 |
| Max. Negotiated Rate |
$3,532.00 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Aetna Managed Medicare |
$247.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$441.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494.13
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$662.25
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$573.95
|
| Rate for Payer: Quartz Medicare Advantage |
$529.80
|
| Rate for Payer: The Alliance Commercial |
$3,532.00
|
| Rate for Payer: United Healthcare PPO |
$662.25
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Shoulder Therapeutic Injection Rt
|
Facility
IP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570664
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$432.67 |
| Max. Negotiated Rate |
$812.36 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$529.80
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Sialogram
|
Professional
|
$2,416.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
1537307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.28 |
| Max. Negotiated Rate |
$2,295.20 |
| Rate for Payer: Aetna Commercial |
$2,295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,077.76
|
| Rate for Payer: Aetna Managed Medicare |
$114.28
|
| Rate for Payer: Anthem Medicare Advantage |
$114.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.28
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$2,295.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,208.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.28
|
| Rate for Payer: Health EOS Commercial |
$2,198.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.28
|
| Rate for Payer: Multiplan Commercial |
$1,932.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,295.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.04
|
| Rate for Payer: Quartz Commercial |
$1,377.12
|
| Rate for Payer: Quartz Medicare Advantage |
$114.28
|
| Rate for Payer: The Alliance Commercial |
$434.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.28
|
| Rate for Payer: WEA Trust Commercial |
$1,328.80
|
| Rate for Payer: WPS Commercial |
$571.40
|
|
|
XR Sialogram
|
Facility
IP
|
$1,162.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
630110
|
| Min. Negotiated Rate |
$569.38 |
| Max. Negotiated Rate |
$1,069.04 |
| Rate for Payer: Aetna Commercial |
$1,045.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.86
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,069.04
|
| Rate for Payer: Health EOS Commercial |
$1,034.18
|
| Rate for Payer: HFN Commercial |
$1,069.04
|
| Rate for Payer: Multiplan Commercial |
$929.60
|
| Rate for Payer: NAPHCARE Commercial |
$697.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.04
|
| Rate for Payer: Quartz Beloit One Network |
$569.38
|
| Rate for Payer: Quartz Commercial |
$697.20
|
| Rate for Payer: WEA Trust Commercial |
$639.10
|
| Rate for Payer: WPS Commercial |
$860.69
|
|
|
XR Sialogram
|
Facility
IP
|
$2,416.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
1537307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,183.84 |
| Max. Negotiated Rate |
$2,222.72 |
| Rate for Payer: Aetna Commercial |
$2,174.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.48
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$2,222.72
|
| Rate for Payer: Health EOS Commercial |
$2,150.24
|
| Rate for Payer: HFN Commercial |
$2,222.72
|
| Rate for Payer: Multiplan Commercial |
$1,932.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,449.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,222.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,183.84
|
| Rate for Payer: Quartz Commercial |
$1,449.60
|
| Rate for Payer: WEA Trust Commercial |
$1,328.80
|
| Rate for Payer: WPS Commercial |
$1,789.53
|
|
|
XR Sialogram
|
Facility
OP
|
$2,416.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
1537307
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$2,222.72 |
| Rate for Payer: Aetna Commercial |
$2,174.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,077.76
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$908.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.27
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cash Price |
$724.80
|
| Rate for Payer: Cigna Commercial |
$2,222.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$2,150.24
|
| Rate for Payer: HFN Commercial |
$2,222.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$1,932.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,222.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,183.84
|
| Rate for Payer: Quartz Commercial |
$1,570.40
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$1,003.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,328.80
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,789.53
|
|
|
XR Sialogram
|
Professional
|
$1,162.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
630110
|
| Min. Negotiated Rate |
$114.28 |
| Max. Negotiated Rate |
$1,103.90 |
| Rate for Payer: Aetna Commercial |
$1,103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.32
|
| Rate for Payer: Aetna Managed Medicare |
$114.28
|
| Rate for Payer: Anthem Medicare Advantage |
$114.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.28
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,103.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$581.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.28
|
| Rate for Payer: Health EOS Commercial |
$1,057.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.28
|
| Rate for Payer: Multiplan Commercial |
$929.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.90
|
| Rate for Payer: Quartz Beloit One Network |
$511.28
|
| Rate for Payer: Quartz Commercial |
$662.34
|
| Rate for Payer: Quartz Medicare Advantage |
$114.28
|
| Rate for Payer: The Alliance Commercial |
$434.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.28
|
| Rate for Payer: WEA Trust Commercial |
$639.10
|
| Rate for Payer: WPS Commercial |
$571.40
|
|
|
XR Sialogram
|
Facility
OP
|
$1,162.00
|
|
|
Service Code
|
CPT 70390
|
| Hospital Charge Code |
630110
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,069.04 |
| Rate for Payer: Aetna Commercial |
$1,045.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.32
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$755.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$581.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$557.76
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,069.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,034.18
|
| Rate for Payer: HFN Commercial |
$1,069.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$929.60
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.04
|
| Rate for Payer: Quartz Beloit One Network |
$569.38
|
| Rate for Payer: Quartz Commercial |
$755.30
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$1,003.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: WEA Trust Commercial |
$639.10
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$860.69
|
|
|
XR Sinuses Paranasal < 3 Views
|
Facility
OP
|
$373.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
630105
|
| Min. Negotiated Rate |
$69.96 |
| Max. Negotiated Rate |
$343.16 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.04
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| 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 |
$111.90
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| 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 |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| 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 |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$242.45
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$69.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
XR Sinuses Paranasal < 3 Views
|
Facility
IP
|
$404.00
|
|
|
Service Code
|
CPT 70210 TC
|
| Hospital Charge Code |
1537309
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$371.68 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$242.40
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
XR Sinuses Paranasal < 3 Views
|
Facility
OP
|
$404.00
|
|
|
Service Code
|
CPT 70210 TC
|
| Hospital Charge Code |
1537309
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$1,616.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$113.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.00
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$242.40
|
| Rate for Payer: The Alliance Commercial |
$1,616.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
XR Sinuses Paranasal < 3 Views
|
Professional
|
$404.00
|
|
|
Service Code
|
CPT 70210 TC
|
| Hospital Charge Code |
1537309
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$383.80 |
| Rate for Payer: Aetna Commercial |
$383.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Medicare Advantage |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.96
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$383.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$202.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$367.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.80
|
| Rate for Payer: Quartz Beloit One Network |
$177.76
|
| Rate for Payer: Quartz Commercial |
$230.28
|
| Rate for Payer: Quartz Medicare Advantage |
$22.96
|
| Rate for Payer: The Alliance Commercial |
$87.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.96
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$114.80
|
|
|
XR Sinuses Paranasal < 3 Views
|
Professional
|
$373.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
630105
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$354.35 |
| Rate for Payer: Aetna Commercial |
$354.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Medicare Advantage |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.08
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$354.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.08
|
| Rate for Payer: Health EOS Commercial |
$339.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.08
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: Preferred Network Access Commercial |
$354.35
|
| Rate for Payer: Quartz Beloit One Network |
$164.12
|
| Rate for Payer: Quartz Commercial |
$212.61
|
| Rate for Payer: Quartz Medicare Advantage |
$31.08
|
| Rate for Payer: The Alliance Commercial |
$118.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.08
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$155.40
|
|
|
XR Sinuses Paranasal < 3 Views
|
Facility
IP
|
$373.00
|
|
|
Service Code
|
CPT 70210
|
| Hospital Charge Code |
630105
|
| Min. Negotiated Rate |
$182.77 |
| Max. Negotiated Rate |
$343.16 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| Rate for Payer: Health EOS Commercial |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$223.80
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$223.80
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
XR Sinuses Paranasal Complete
|
Facility
OP
|
$538.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
630100
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.24
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| 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 |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| 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 |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$349.70
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$12.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
XR Sinuses Paranasal Complete
|
Professional
|
$538.00
|
|
|
Service Code
|
CPT 70220
|
| Hospital Charge Code |
630100
|
| Min. Negotiated Rate |
$36.32 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$36.32
|
| Rate for Payer: Anthem Medicare Advantage |
$36.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.32
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$511.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.32
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.32
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$511.10
|
| Rate for Payer: Quartz Beloit One Network |
$236.72
|
| Rate for Payer: Quartz Commercial |
$306.66
|
| Rate for Payer: Quartz Medicare Advantage |
$36.32
|
| Rate for Payer: The Alliance Commercial |
$138.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.32
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$181.60
|
|
