|
XR Mastoids Complete Right
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,RT
|
| Hospital Charge Code |
2979984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$221.71 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna Commercial |
$666.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$666.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$351.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.20
|
| Rate for Payer: Health EOS Commercial |
$638.82
|
| Rate for Payer: HFN Commercial |
$666.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$221.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$221.71
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$666.90
|
| Rate for Payer: Quartz Beloit One Network |
$308.88
|
| Rate for Payer: Quartz Commercial |
$400.14
|
| Rate for Payer: The Alliance Commercial |
$351.00
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
XR Mastoids Complete Right
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630320
|
| Min. Negotiated Rate |
$330.73 |
| Max. Negotiated Rate |
$620.96 |
| Rate for Payer: Aetna Commercial |
$607.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.73
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$620.96
|
| Rate for Payer: Health EOS Commercial |
$600.71
|
| Rate for Payer: HFN Commercial |
$620.96
|
| Rate for Payer: Multiplan Commercial |
$539.97
|
| Rate for Payer: Preferred Network Access Commercial |
$620.96
|
| Rate for Payer: Quartz Beloit One Network |
$330.73
|
| Rate for Payer: Quartz Commercial |
$404.98
|
| Rate for Payer: WEA Trust Commercial |
$371.23
|
| Rate for Payer: WPS Commercial |
$499.92
|
|
|
XR Mastoids Complete Right
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630320
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$620.96 |
| Rate for Payer: Aetna Commercial |
$607.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.47
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$323.98
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$620.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$600.71
|
| Rate for Payer: HFN Commercial |
$620.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$539.97
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$620.96
|
| Rate for Payer: Quartz Beloit One Network |
$330.73
|
| Rate for Payer: Quartz Commercial |
$438.72
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$371.23
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$499.92
|
|
|
XR Mastoids Complete Right
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630320
|
| Min. Negotiated Rate |
$60.70 |
| Max. Negotiated Rate |
$641.21 |
| Rate for Payer: Aetna Commercial |
$641.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$580.47
|
| Rate for Payer: Aetna Managed Medicare |
$60.70
|
| Rate for Payer: Anthem Medicare Advantage |
$60.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cash Price |
$194.70
|
| Rate for Payer: Cigna Commercial |
$641.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$337.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.70
|
| Rate for Payer: Health EOS Commercial |
$614.21
|
| Rate for Payer: HFN Commercial |
$641.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$221.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$221.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.70
|
| Rate for Payer: Multiplan Commercial |
$539.97
|
| Rate for Payer: NAPHCARE Commercial |
$91.06
|
| Rate for Payer: Preferred Network Access Commercial |
$641.21
|
| Rate for Payer: Quartz Beloit One Network |
$296.98
|
| Rate for Payer: Quartz Commercial |
$384.73
|
| Rate for Payer: Quartz Medicare Advantage |
$60.70
|
| Rate for Payer: The Alliance Commercial |
$230.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.70
|
| Rate for Payer: WEA Trust Commercial |
$371.23
|
| Rate for Payer: WPS Commercial |
$303.52
|
|
|
XR Mastoids Complete Right
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,RT
|
| Hospital Charge Code |
2979984
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$202.50
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$421.20
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
XR Midline Catheter
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5551924
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$51.54 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$51.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$119.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.06
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$110.45
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$119.65
|
| Rate for Payer: Quartz Medicare Advantage |
$110.45
|
| Rate for Payer: The Alliance Commercial |
$92.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
XR Midline Catheter
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5551924
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$10.51 |
| Max. Negotiated Rate |
$174.88 |
| Rate for Payer: Aetna Commercial |
$174.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$174.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.45
|
| Rate for Payer: Health EOS Commercial |
$167.51
|
| Rate for Payer: HFN Commercial |
$174.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.27
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$174.88
|
| Rate for Payer: Quartz Beloit One Network |
$81.00
|
| Rate for Payer: Quartz Commercial |
$104.93
|
| Rate for Payer: The Alliance Commercial |
$92.04
|
| Rate for Payer: United Healthcare Medicaid |
$10.51
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
XR Midline Catheter
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 36410 TC
|
| Hospital Charge Code |
5551924
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$110.45
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
XR Myelography Cervical Spine
|
Facility
|
OP
|
$3,116.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3072715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.31 |
| Max. Negotiated Rate |
$3,086.46 |
| Rate for Payer: Aetna Commercial |
$2,916.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,786.95
|
| Rate for Payer: Aetna Managed Medicare |
$907.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,086.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,469.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,717.54
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$2,981.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,813.51
|
| Rate for Payer: Health EOS Commercial |
$2,884.17
|
| Rate for Payer: HFN Commercial |
$2,981.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,430.48
|
| Rate for Payer: Multiplan Commercial |
$2,592.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,944.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,981.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,587.91
|
| Rate for Payer: Quartz Commercial |
$2,106.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,944.38
|
| Rate for Payer: The Alliance Commercial |
$273.31
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,782.35
|
| Rate for Payer: WPS Commercial |
$2,400.25
|
|
|
XR Myelography Cervical Spine
|
Facility
|
IP
|
$3,116.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3072715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,587.91 |
| Max. Negotiated Rate |
$2,981.39 |
| Rate for Payer: Aetna Commercial |
$2,916.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,786.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,717.54
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$2,981.39
|
| Rate for Payer: Health EOS Commercial |
$2,884.17
|
| Rate for Payer: HFN Commercial |
$2,981.39
|
| Rate for Payer: Multiplan Commercial |
$2,592.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,981.39
|
| Rate for Payer: Quartz Beloit One Network |
$1,587.91
|
| Rate for Payer: Quartz Commercial |
$1,944.38
|
| Rate for Payer: WEA Trust Commercial |
$1,782.35
|
| Rate for Payer: WPS Commercial |
$2,400.25
|
|
|
XR Myelography Cervical Spine
|
Professional
|
Both
|
$3,116.00
|
|
|
Service Code
|
CPT 72240 TC
|
| Hospital Charge Code |
3072715
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$68.33 |
| Max. Negotiated Rate |
$3,078.61 |
| Rate for Payer: Aetna Commercial |
$3,078.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,786.95
|
| Rate for Payer: Aetna Managed Medicare |
$68.33
|
| Rate for Payer: Anthem Medicare Advantage |
$68.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.33
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cash Price |
$934.80
|
| Rate for Payer: Cigna Commercial |
$3,078.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,620.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.33
|
| Rate for Payer: Health EOS Commercial |
$2,948.98
|
| Rate for Payer: HFN Commercial |
$3,078.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$252.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.33
|
| Rate for Payer: Multiplan Commercial |
$2,592.51
|
| Rate for Payer: NAPHCARE Commercial |
$102.49
|
| Rate for Payer: Preferred Network Access Commercial |
$3,078.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,425.88
|
| Rate for Payer: Quartz Commercial |
$1,847.16
|
| Rate for Payer: Quartz Medicare Advantage |
$68.33
|
| Rate for Payer: The Alliance Commercial |
$259.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.33
|
| Rate for Payer: WEA Trust Commercial |
$1,782.35
|
| Rate for Payer: WPS Commercial |
$341.64
|
|
|
XR Myelography Lumbosacral
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3072716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$894.86 |
| Max. Negotiated Rate |
$1,680.14 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,095.74
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
XR Myelography Lumbosacral
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3072716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.64 |
| Max. Negotiated Rate |
$3,086.46 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Aetna Managed Medicare |
$511.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,086.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,469.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,021.99
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,369.68
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,095.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,187.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,095.74
|
| Rate for Payer: The Alliance Commercial |
$278.64
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
XR Myelography Lumbosacral
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3072716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$69.66 |
| Max. Negotiated Rate |
$1,734.93 |
| Rate for Payer: Aetna Commercial |
$1,734.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Aetna Managed Medicare |
$69.66
|
| Rate for Payer: Anthem Medicare Advantage |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.66
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,734.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$913.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.66
|
| Rate for Payer: Health EOS Commercial |
$1,661.88
|
| Rate for Payer: HFN Commercial |
$1,734.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.66
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: NAPHCARE Commercial |
$104.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,734.93
|
| Rate for Payer: Quartz Beloit One Network |
$803.55
|
| Rate for Payer: Quartz Commercial |
$1,040.96
|
| Rate for Payer: Quartz Medicare Advantage |
$69.66
|
| Rate for Payer: The Alliance Commercial |
$264.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.66
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$348.30
|
|
|
XR Myelography Spine 2 Or More Areas
|
Facility
|
OP
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.95 |
| Max. Negotiated Rate |
$3,930.53 |
| Rate for Payer: Aetna Commercial |
$3,845.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,674.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,196.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,086.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,469.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,264.33
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$3,930.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,390.86
|
| Rate for Payer: Health EOS Commercial |
$3,802.36
|
| Rate for Payer: HFN Commercial |
$3,930.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,204.24
|
| Rate for Payer: Multiplan Commercial |
$3,417.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,563.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,930.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,093.44
|
| Rate for Payer: Quartz Commercial |
$2,777.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,563.39
|
| Rate for Payer: The Alliance Commercial |
$291.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,349.78
|
| Rate for Payer: WPS Commercial |
$3,164.39
|
|
|
XR Myelography Spine 2 Or More Areas
|
Professional
|
Both
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.99 |
| Max. Negotiated Rate |
$4,058.70 |
| Rate for Payer: Aetna Commercial |
$4,058.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,674.20
|
| Rate for Payer: Aetna Managed Medicare |
$72.99
|
| Rate for Payer: Anthem Medicare Advantage |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.99
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$4,058.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,136.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.99
|
| Rate for Payer: Health EOS Commercial |
$3,887.81
|
| Rate for Payer: HFN Commercial |
$4,058.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.99
|
| Rate for Payer: Multiplan Commercial |
$3,417.86
|
| Rate for Payer: NAPHCARE Commercial |
$109.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,058.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.82
|
| Rate for Payer: Quartz Commercial |
$2,435.22
|
| Rate for Payer: Quartz Medicare Advantage |
$72.99
|
| Rate for Payer: The Alliance Commercial |
$277.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.99
|
| Rate for Payer: WEA Trust Commercial |
$2,349.78
|
| Rate for Payer: WPS Commercial |
$364.94
|
|
|
XR Myelography Spine 2 Or More Areas
|
Facility
|
IP
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,093.44 |
| Max. Negotiated Rate |
$3,930.53 |
| Rate for Payer: Aetna Commercial |
$3,845.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,674.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,264.33
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$3,930.53
|
| Rate for Payer: Health EOS Commercial |
$3,802.36
|
| Rate for Payer: HFN Commercial |
$3,930.53
|
| Rate for Payer: Multiplan Commercial |
$3,417.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,930.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,093.44
|
| Rate for Payer: Quartz Commercial |
$2,563.39
|
| Rate for Payer: WEA Trust Commercial |
$2,349.78
|
| Rate for Payer: WPS Commercial |
$3,164.39
|
|
|
XR Myelography Thoracic Spine
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,478.35 |
| Max. Negotiated Rate |
$2,775.68 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,810.22
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
|
XR Myelography Thoracic Spine
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.95 |
| Max. Negotiated Rate |
$3,086.46 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Aetna Managed Medicare |
$844.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,086.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,469.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.38
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,262.78
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,961.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.22
|
| Rate for Payer: The Alliance Commercial |
$291.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
|
XR Myelography Thoracic Spine
|
Professional
|
Both
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.99 |
| Max. Negotiated Rate |
$2,866.19 |
| Rate for Payer: Aetna Commercial |
$2,866.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Aetna Managed Medicare |
$72.99
|
| Rate for Payer: Anthem Medicare Advantage |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.99
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,866.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,508.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.99
|
| Rate for Payer: Health EOS Commercial |
$2,745.51
|
| Rate for Payer: HFN Commercial |
$2,866.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.99
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: NAPHCARE Commercial |
$109.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,866.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,327.50
|
| Rate for Payer: Quartz Commercial |
$1,719.71
|
| Rate for Payer: Quartz Medicare Advantage |
$72.99
|
| Rate for Payer: The Alliance Commercial |
$277.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.99
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$364.94
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$195.18 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$238.99
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
XR Nasal Bones Minimum 3 Views
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$408.04 |
| Rate for Payer: Aetna Commercial |
$408.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$28.72
|
| Rate for Payer: Anthem Medicare Advantage |
$28.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.72
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$408.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$214.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.72
|
| Rate for Payer: Health EOS Commercial |
$390.86
|
| Rate for Payer: HFN Commercial |
$408.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.72
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$43.09
|
| Rate for Payer: Preferred Network Access Commercial |
$408.04
|
| Rate for Payer: Quartz Beloit One Network |
$188.99
|
| Rate for Payer: Quartz Commercial |
$244.83
|
| Rate for Payer: Quartz Medicare Advantage |
$28.72
|
| Rate for Payer: The Alliance Commercial |
$109.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.72
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$143.62
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$120.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.37
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.14
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$257.71
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$279.19
|
| Rate for Payer: Quartz Medicare Advantage |
$257.71
|
| Rate for Payer: The Alliance Commercial |
$114.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.46 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$257.71
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
XR Nasal Bones Minimum 3 Views
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$37.07 |
| Max. Negotiated Rate |
$378.40 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$37.07
|
| Rate for Payer: Anthem Medicare Advantage |
$37.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.07
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.07
|
| Rate for Payer: Health EOS Commercial |
$362.47
|
| Rate for Payer: HFN Commercial |
$378.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.07
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$55.60
|
| Rate for Payer: Preferred Network Access Commercial |
$378.40
|
| Rate for Payer: Quartz Beloit One Network |
$175.26
|
| Rate for Payer: Quartz Commercial |
$227.04
|
| Rate for Payer: Quartz Medicare Advantage |
$37.07
|
| Rate for Payer: The Alliance Commercial |
$140.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.07
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$185.33
|
|
