|
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
|
|
|
XR Sinuses Paranasal Complete
|
Facility
OP
|
$671.00
|
|
|
Service Code
|
CPT 70220 TC
|
| Hospital Charge Code |
1537311
|
|
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 Sinuses Paranasal Complete
|
Facility
IP
|
$671.00
|
|
|
Service Code
|
CPT 70220 TC
|
| Hospital Charge Code |
1537311
|
|
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 Skull < 4 Views
|
Facility
OP
|
$586.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
630096
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$539.12 |
| Rate for Payer: Aetna Commercial |
$527.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.96
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$380.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$293.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$281.28
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.58
|
| 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 |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$539.12
|
| 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 |
$521.54
|
| Rate for Payer: HFN Commercial |
$539.12
|
| 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 |
$468.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$539.12
|
| Rate for Payer: Quartz Beloit One Network |
$287.14
|
| Rate for Payer: Quartz Commercial |
$380.90
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$267.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$322.30
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$434.05
|
|
|
XR Skull < 4 Views
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
5510675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.04 |
| Max. Negotiated Rate |
$2,272.00 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Aetna Managed Medicare |
$159.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.00
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$369.20
|
| Rate for Payer: Quartz Medicare Advantage |
$340.80
|
| Rate for Payer: The Alliance Commercial |
$2,272.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
XR Skull < 4 Views
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
1537313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.32 |
| Max. Negotiated Rate |
$522.56 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$340.80
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
XR Skull < 4 Views
|
Professional
|
$568.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
5510675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$539.60 |
| Rate for Payer: Aetna Commercial |
$539.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Aetna Managed Medicare |
$26.18
|
| Rate for Payer: Anthem Medicare Advantage |
$26.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.18
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$539.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.18
|
| Rate for Payer: Health EOS Commercial |
$516.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.18
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: Preferred Network Access Commercial |
$539.60
|
| Rate for Payer: Quartz Beloit One Network |
$249.92
|
| Rate for Payer: Quartz Commercial |
$323.76
|
| Rate for Payer: Quartz Medicare Advantage |
$26.18
|
| Rate for Payer: The Alliance Commercial |
$99.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.18
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$130.90
|
|
|
XR Skull < 4 Views
|
Facility
IP
|
$586.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
630096
|
| Min. Negotiated Rate |
$287.14 |
| Max. Negotiated Rate |
$539.12 |
| Rate for Payer: Aetna Commercial |
$527.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.58
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$539.12
|
| Rate for Payer: Health EOS Commercial |
$521.54
|
| Rate for Payer: HFN Commercial |
$539.12
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: NAPHCARE Commercial |
$351.60
|
| Rate for Payer: Preferred Network Access Commercial |
$539.12
|
| Rate for Payer: Quartz Beloit One Network |
$287.14
|
| Rate for Payer: Quartz Commercial |
$351.60
|
| Rate for Payer: WEA Trust Commercial |
$322.30
|
| Rate for Payer: WPS Commercial |
$434.05
|
|
|
XR Skull < 4 Views
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
1537313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.04 |
| Max. Negotiated Rate |
$2,272.00 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Aetna Managed Medicare |
$159.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.00
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$369.20
|
| Rate for Payer: Quartz Medicare Advantage |
$340.80
|
| Rate for Payer: The Alliance Commercial |
$2,272.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
XR Skull < 4 Views
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
5510675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.32 |
| Max. Negotiated Rate |
$522.56 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$340.80
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
XR Skull < 4 Views
|
Professional
|
$568.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
1537313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.18 |
| Max. Negotiated Rate |
$539.60 |
| Rate for Payer: Aetna Commercial |
$539.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Aetna Managed Medicare |
$26.18
|
| Rate for Payer: Anthem Medicare Advantage |
$26.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.18
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$539.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.18
|
| Rate for Payer: Health EOS Commercial |
$516.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.18
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: Preferred Network Access Commercial |
$539.60
|
| Rate for Payer: Quartz Beloit One Network |
$249.92
|
| Rate for Payer: Quartz Commercial |
$323.76
|
| Rate for Payer: Quartz Medicare Advantage |
$26.18
|
| Rate for Payer: The Alliance Commercial |
$99.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.18
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$130.90
|
|
|
XR Skull < 4 Views
|
Professional
|
$586.00
|
|
|
Service Code
|
CPT 70250
|
| Hospital Charge Code |
630096
|
| Min. Negotiated Rate |
$34.64 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna Commercial |
$556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.96
|
| Rate for Payer: Aetna Managed Medicare |
$34.64
|
| Rate for Payer: Anthem Medicare Advantage |
$34.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.64
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$556.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$293.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.64
|
| Rate for Payer: Health EOS Commercial |
$533.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.64
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$556.70
|
| Rate for Payer: Quartz Beloit One Network |
$257.84
|
| Rate for Payer: Quartz Commercial |
$334.02
|
| Rate for Payer: Quartz Medicare Advantage |
$34.64
|
| Rate for Payer: The Alliance Commercial |
$131.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.64
|
| Rate for Payer: WEA Trust Commercial |
$322.30
|
| Rate for Payer: WPS Commercial |
$173.20
|
|
|
XR Skull Complete
|
Facility
IP
|
$687.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
630092
|
| Min. Negotiated Rate |
$336.63 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$412.20
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
XR Skull Complete
|
Facility
IP
|
$743.00
|
|
|
Service Code
|
CPT 70260 TC
|
| Hospital Charge Code |
1537315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$364.07 |
| Max. Negotiated Rate |
$683.56 |
| Rate for Payer: Aetna Commercial |
$668.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.79
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$683.56
|
| Rate for Payer: Health EOS Commercial |
$661.27
|
| Rate for Payer: HFN Commercial |
$683.56
|
| Rate for Payer: Multiplan Commercial |
$594.40
|
| Rate for Payer: NAPHCARE Commercial |
$445.80
|
| Rate for Payer: Preferred Network Access Commercial |
$683.56
|
| Rate for Payer: Quartz Beloit One Network |
$364.07
|
| Rate for Payer: Quartz Commercial |
$445.80
|
| Rate for Payer: WEA Trust Commercial |
$408.65
|
| Rate for Payer: WPS Commercial |
$550.34
|
|
|
XR Skull Complete
|
Professional
|
$743.00
|
|
|
Service Code
|
CPT 70260 TC
|
| Hospital Charge Code |
1537315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.05 |
| Max. Negotiated Rate |
$705.85 |
| Rate for Payer: Aetna Commercial |
$705.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.98
|
| Rate for Payer: Aetna Managed Medicare |
$30.05
|
| Rate for Payer: Anthem Medicare Advantage |
$30.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.05
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$705.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$371.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.05
|
| Rate for Payer: Health EOS Commercial |
$676.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$104.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.05
|
| Rate for Payer: Multiplan Commercial |
$594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$705.85
|
| Rate for Payer: Quartz Beloit One Network |
$326.92
|
| Rate for Payer: Quartz Commercial |
$423.51
|
| Rate for Payer: Quartz Medicare Advantage |
$30.05
|
| Rate for Payer: The Alliance Commercial |
$114.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.05
|
| Rate for Payer: WEA Trust Commercial |
$408.65
|
| Rate for Payer: WPS Commercial |
$150.25
|
|
|
XR Skull Complete
|
Facility
OP
|
$743.00
|
|
|
Service Code
|
CPT 70260 TC
|
| Hospital Charge Code |
1537315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$208.04 |
| Max. Negotiated Rate |
$2,972.00 |
| Rate for Payer: Aetna Commercial |
$668.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.98
|
| Rate for Payer: Aetna Managed Medicare |
$208.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$356.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.79
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$683.56
|
| Rate for Payer: Health EOS Commercial |
$661.27
|
| Rate for Payer: HFN Commercial |
$683.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$557.25
|
| Rate for Payer: Multiplan Commercial |
$594.40
|
| Rate for Payer: NAPHCARE Commercial |
$445.80
|
| Rate for Payer: Preferred Network Access Commercial |
$683.56
|
| Rate for Payer: Quartz Beloit One Network |
$364.07
|
| Rate for Payer: Quartz Commercial |
$482.95
|
| Rate for Payer: Quartz Medicare Advantage |
$445.80
|
| Rate for Payer: The Alliance Commercial |
$2,972.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$408.65
|
| Rate for Payer: WPS Commercial |
$550.34
|
|
|
XR Skull Complete
|
Facility
OP
|
$687.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
630092
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$446.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$343.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$329.76
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$446.55
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$121.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
XR Skull Complete
|
Professional
|
$687.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
630092
|
| Min. Negotiated Rate |
$43.18 |
| Max. Negotiated Rate |
$652.65 |
| Rate for Payer: Aetna Commercial |
$652.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Aetna Managed Medicare |
$43.18
|
| Rate for Payer: Anthem Medicare Advantage |
$43.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.18
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$652.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$343.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.18
|
| Rate for Payer: Health EOS Commercial |
$625.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$152.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.18
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$652.65
|
| Rate for Payer: Quartz Beloit One Network |
$302.28
|
| Rate for Payer: Quartz Commercial |
$391.59
|
| Rate for Payer: Quartz Medicare Advantage |
$43.18
|
| Rate for Payer: The Alliance Commercial |
$164.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.18
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$215.90
|
|
|
XR Small Bowel
|
Facility
IP
|
$912.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
5609775
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$446.88 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.36
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$839.04
|
| Rate for Payer: Health EOS Commercial |
$811.68
|
| Rate for Payer: HFN Commercial |
$839.04
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: NAPHCARE Commercial |
$547.20
|
| Rate for Payer: Preferred Network Access Commercial |
$839.04
|
| Rate for Payer: Quartz Beloit One Network |
$446.88
|
| Rate for Payer: Quartz Commercial |
$547.20
|
| Rate for Payer: WEA Trust Commercial |
$501.60
|
| Rate for Payer: WPS Commercial |
$675.52
|
|
|
XR Small Bowel
|
Facility
OP
|
$912.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
5609775
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1.04 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$784.32
|
| Rate for Payer: Aetna Managed Medicare |
$255.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$592.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$437.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.36
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$839.04
|
| Rate for Payer: Health EOS Commercial |
$811.68
|
| Rate for Payer: HFN Commercial |
$839.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$684.00
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: NAPHCARE Commercial |
$547.20
|
| Rate for Payer: Preferred Network Access Commercial |
$839.04
|
| Rate for Payer: Quartz Beloit One Network |
$446.88
|
| Rate for Payer: Quartz Commercial |
$592.80
|
| Rate for Payer: Quartz Medicare Advantage |
$547.20
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$501.60
|
| Rate for Payer: WPS Commercial |
$675.52
|
|
|
XR Small Bowel
|
Professional
|
$912.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
5609775
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$80.91 |
| Max. Negotiated Rate |
$866.40 |
| Rate for Payer: Aetna Commercial |
$866.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$784.32
|
| Rate for Payer: Aetna Managed Medicare |
$80.91
|
| Rate for Payer: Anthem Medicare Advantage |
$80.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.91
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$866.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$456.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.91
|
| Rate for Payer: Health EOS Commercial |
$829.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$290.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$290.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.91
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$866.40
|
| Rate for Payer: Quartz Beloit One Network |
$401.28
|
| Rate for Payer: Quartz Commercial |
$519.84
|
| Rate for Payer: Quartz Medicare Advantage |
$80.91
|
| Rate for Payer: The Alliance Commercial |
$307.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.91
|
| Rate for Payer: WEA Trust Commercial |
$501.60
|
| Rate for Payer: WPS Commercial |
$404.55
|
|
|
XR Small Bowel w/ Serial Films
|
Professional
|
$985.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
1537319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$935.75 |
| Rate for Payer: Aetna Commercial |
$935.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.10
|
| Rate for Payer: Aetna Managed Medicare |
$120.05
|
| Rate for Payer: Anthem Medicare Advantage |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.05
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$935.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$492.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.05
|
| Rate for Payer: Health EOS Commercial |
$896.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.05
|
| Rate for Payer: Multiplan Commercial |
$788.00
|
| Rate for Payer: Preferred Network Access Commercial |
$935.75
|
| Rate for Payer: Quartz Beloit One Network |
$433.40
|
| Rate for Payer: Quartz Commercial |
$561.45
|
| Rate for Payer: Quartz Medicare Advantage |
$120.05
|
| Rate for Payer: The Alliance Commercial |
$456.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.05
|
| Rate for Payer: WEA Trust Commercial |
$541.75
|
| Rate for Payer: WPS Commercial |
$600.25
|
|
|
XR Small Bowel w/ Serial Films
|
Facility
IP
|
$912.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
630084
|
| Min. Negotiated Rate |
$446.88 |
| Max. Negotiated Rate |
$839.04 |
| Rate for Payer: Aetna Commercial |
$820.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$483.36
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$839.04
|
| Rate for Payer: Health EOS Commercial |
$811.68
|
| Rate for Payer: HFN Commercial |
$839.04
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: NAPHCARE Commercial |
$547.20
|
| Rate for Payer: Preferred Network Access Commercial |
$839.04
|
| Rate for Payer: Quartz Beloit One Network |
$446.88
|
| Rate for Payer: Quartz Commercial |
$547.20
|
| Rate for Payer: WEA Trust Commercial |
$501.60
|
| Rate for Payer: WPS Commercial |
$675.52
|
|
|
XR Small Bowel w/ Serial Films
|
Facility
IP
|
$985.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
1537319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$482.65 |
| Max. Negotiated Rate |
$906.20 |
| Rate for Payer: Aetna Commercial |
$886.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.05
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$906.20
|
| Rate for Payer: Health EOS Commercial |
$876.65
|
| Rate for Payer: HFN Commercial |
$906.20
|
| Rate for Payer: Multiplan Commercial |
$788.00
|
| Rate for Payer: NAPHCARE Commercial |
$591.00
|
| Rate for Payer: Preferred Network Access Commercial |
$906.20
|
| Rate for Payer: Quartz Beloit One Network |
$482.65
|
| Rate for Payer: Quartz Commercial |
$591.00
|
| Rate for Payer: WEA Trust Commercial |
$541.75
|
| Rate for Payer: WPS Commercial |
$729.59
|
|
