|
XR Salivary Gland Calculus Left
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 70380 LT
|
| Hospital Charge Code |
1537272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$371.90
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Salivary Gland Calculus Left
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 70380 LT
|
| Hospital Charge Code |
1537272
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Health EOS Commercial |
$564.05
|
| Rate for Payer: HFN Commercial |
$588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.35
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$588.85
|
| Rate for Payer: Quartz Beloit One Network |
$272.73
|
| Rate for Payer: Quartz Commercial |
$353.31
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Salivary Gland Calculus Right
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 70380 TC,RT
|
| Hospital Charge Code |
2979986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Health EOS Commercial |
$564.05
|
| Rate for Payer: HFN Commercial |
$588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.35
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$588.85
|
| Rate for Payer: Quartz Beloit One Network |
$272.73
|
| Rate for Payer: Quartz Commercial |
$353.31
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Salivary Gland Calculus Right
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 70380 RT
|
| Hospital Charge Code |
1537274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$371.90
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Salivary Gland Calculus Right
|
Professional
|
Both
|
$596.00
|
|
|
Service Code
|
CPT 70380 RT
|
| Hospital Charge Code |
1537274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.35 |
| Max. Negotiated Rate |
$588.85 |
| Rate for Payer: Aetna Commercial |
$588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.90
|
| Rate for Payer: Health EOS Commercial |
$564.05
|
| Rate for Payer: HFN Commercial |
$588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.35
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$588.85
|
| Rate for Payer: Quartz Beloit One Network |
$272.73
|
| Rate for Payer: Quartz Commercial |
$353.31
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Salivary Gland Calculus Right
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 70380 RT
|
| Hospital Charge Code |
1537274
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Aetna Managed Medicare |
$173.56
|
| 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 |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.87
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: NAPHCARE Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$402.90
|
| Rate for Payer: Quartz Medicare Advantage |
$371.90
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Salivary Gland Calculus Right
|
Facility
|
IP
|
$596.00
|
|
|
Service Code
|
CPT 70380 TC,RT
|
| Hospital Charge Code |
2979986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$371.90
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Salivary Gland Calculus Right
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 70380 TC,RT
|
| Hospital Charge Code |
2979986
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Aetna Managed Medicare |
$173.56
|
| 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 |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.87
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: NAPHCARE Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$402.90
|
| Rate for Payer: Quartz Medicare Advantage |
$371.90
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Salivary Gland Calcus Bilateral
|
Professional
|
Both
|
$1,146.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630180
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$1,132.25 |
| Rate for Payer: Aetna Commercial |
$1,132.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.98
|
| Rate for Payer: Aetna Managed Medicare |
$36.40
|
| Rate for Payer: Anthem Medicare Advantage |
$36.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.40
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$1,132.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$595.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.40
|
| Rate for Payer: Health EOS Commercial |
$1,084.57
|
| Rate for Payer: HFN Commercial |
$1,132.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$953.47
|
| Rate for Payer: NAPHCARE Commercial |
$54.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,132.25
|
| Rate for Payer: Quartz Beloit One Network |
$524.41
|
| Rate for Payer: Quartz Commercial |
$679.35
|
| Rate for Payer: Quartz Medicare Advantage |
$36.40
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$655.51
|
| Rate for Payer: WPS Commercial |
$182.00
|
|
|
XR Salivary Gland Calcus Bilateral
|
Facility
|
OP
|
$1,146.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630180
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,096.49 |
| Rate for Payer: Aetna Commercial |
$1,072.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.98
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$774.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$595.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$572.08
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$1,096.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$666.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,060.74
|
| Rate for Payer: HFN Commercial |
$1,096.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$953.47
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,096.49
|
| Rate for Payer: Quartz Beloit One Network |
$584.00
|
| Rate for Payer: Quartz Commercial |
$774.70
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$655.51
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$882.76
|
|
|
XR Salivary Gland Calcus Bilateral
|
Facility
|
IP
|
$1,146.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630180
|
| Min. Negotiated Rate |
$584.00 |
| Max. Negotiated Rate |
$1,096.49 |
| Rate for Payer: Aetna Commercial |
$1,072.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,024.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$631.68
|
| Rate for Payer: Cash Price |
$343.80
|
| Rate for Payer: Cigna Commercial |
$1,096.49
|
| Rate for Payer: Health EOS Commercial |
$1,060.74
|
| Rate for Payer: HFN Commercial |
$1,096.49
|
| Rate for Payer: Multiplan Commercial |
$953.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,096.49
|
| Rate for Payer: Quartz Beloit One Network |
$584.00
|
| Rate for Payer: Quartz Commercial |
$715.10
|
| Rate for Payer: WEA Trust Commercial |
$655.51
|
| Rate for Payer: WPS Commercial |
$882.76
|
|
|
XR Salivary Gland Calcus Left
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630178
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.04
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$387.35
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
XR Salivary Gland Calcus Left
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630178
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$566.12 |
| Rate for Payer: Aetna Commercial |
$566.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Aetna Managed Medicare |
$36.40
|
| Rate for Payer: Anthem Medicare Advantage |
$36.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.40
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$566.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.40
|
| Rate for Payer: Health EOS Commercial |
$542.29
|
| Rate for Payer: HFN Commercial |
$566.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: NAPHCARE Commercial |
$54.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.12
|
| Rate for Payer: Quartz Beloit One Network |
$262.20
|
| Rate for Payer: Quartz Commercial |
$339.67
|
| Rate for Payer: Quartz Medicare Advantage |
$36.40
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$182.00
|
|
|
XR Salivary Gland Calcus Left
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630178
|
| Min. Negotiated Rate |
$292.00 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.84
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$357.55
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
XR Salivary Gland Calcus Right
|
Facility
|
OP
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630174
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.04
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$387.35
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
XR Salivary Gland Calcus Right
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630174
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$566.12 |
| Rate for Payer: Aetna Commercial |
$566.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Aetna Managed Medicare |
$36.40
|
| Rate for Payer: Anthem Medicare Advantage |
$36.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.40
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$566.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.40
|
| Rate for Payer: Health EOS Commercial |
$542.29
|
| Rate for Payer: HFN Commercial |
$566.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.40
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: NAPHCARE Commercial |
$54.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.12
|
| Rate for Payer: Quartz Beloit One Network |
$262.20
|
| Rate for Payer: Quartz Commercial |
$339.67
|
| Rate for Payer: Quartz Medicare Advantage |
$36.40
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$182.00
|
|
|
XR Salivary Gland Calcus Right
|
Facility
|
IP
|
$573.00
|
|
|
Service Code
|
CPT 70380
|
| Hospital Charge Code |
630174
|
| Min. Negotiated Rate |
$292.00 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.84
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$357.55
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
XR Scapula Bilateral
|
Professional
|
Both
|
$1,153.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630170
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$1,139.16 |
| Rate for Payer: Aetna Commercial |
$1,139.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.24
|
| Rate for Payer: Aetna Managed Medicare |
$24.75
|
| Rate for Payer: Anthem Medicare Advantage |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.75
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,139.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$599.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.75
|
| Rate for Payer: Health EOS Commercial |
$1,091.20
|
| Rate for Payer: HFN Commercial |
$1,139.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$959.30
|
| Rate for Payer: NAPHCARE Commercial |
$37.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,139.16
|
| Rate for Payer: Quartz Beloit One Network |
$527.61
|
| Rate for Payer: Quartz Commercial |
$683.50
|
| Rate for Payer: Quartz Medicare Advantage |
$24.75
|
| Rate for Payer: The Alliance Commercial |
$94.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.75
|
| Rate for Payer: WEA Trust Commercial |
$659.52
|
| Rate for Payer: WPS Commercial |
$123.76
|
|
|
XR Scapula Bilateral
|
Professional
|
Both
|
$600.00
|
|
|
Service Code
|
CPT 73010 LT,TC
|
| Hospital Charge Code |
1537276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$82.86 |
| Max. Negotiated Rate |
$592.80 |
| Rate for Payer: Aetna Commercial |
$592.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$592.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$312.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$374.40
|
| Rate for Payer: Health EOS Commercial |
$567.84
|
| Rate for Payer: HFN Commercial |
$592.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.86
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$592.80
|
| Rate for Payer: Quartz Beloit One Network |
$274.56
|
| Rate for Payer: Quartz Commercial |
$355.68
|
| Rate for Payer: The Alliance Commercial |
$312.00
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.18
|
|
|
XR Scapula Bilateral
|
Facility
|
OP
|
$1,153.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630170
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,103.19 |
| Rate for Payer: Aetna Commercial |
$1,079.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.24
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$779.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$599.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$575.58
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.53
|
| 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 |
$345.90
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,103.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$671.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,067.22
|
| Rate for Payer: HFN Commercial |
$1,103.19
|
| 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 |
$959.30
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.19
|
| Rate for Payer: Quartz Beloit One Network |
$587.57
|
| Rate for Payer: Quartz Commercial |
$779.43
|
| 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 |
$659.52
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$888.16
|
|
|
XR Scapula Bilateral
|
Facility
|
IP
|
$600.00
|
|
|
Service Code
|
CPT 73010 LT,TC
|
| Hospital Charge Code |
1537276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$305.76 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$374.40
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.18
|
|
|
XR Scapula Bilateral
|
Facility
|
OP
|
$600.00
|
|
|
Service Code
|
CPT 73010 LT,TC
|
| Hospital Charge Code |
1537276
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Aetna Managed Medicare |
$174.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cash Price |
$180.00
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.20
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: NAPHCARE Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$405.60
|
| Rate for Payer: Quartz Medicare Advantage |
$374.40
|
| Rate for Payer: The Alliance Commercial |
$312.00
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.18
|
|
|
XR Scapula Bilateral
|
Facility
|
IP
|
$1,153.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630170
|
| Min. Negotiated Rate |
$587.57 |
| Max. Negotiated Rate |
$1,103.19 |
| Rate for Payer: Aetna Commercial |
$1,079.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.53
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,103.19
|
| Rate for Payer: Health EOS Commercial |
$1,067.22
|
| Rate for Payer: HFN Commercial |
$1,103.19
|
| Rate for Payer: Multiplan Commercial |
$959.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.19
|
| Rate for Payer: Quartz Beloit One Network |
$587.57
|
| Rate for Payer: Quartz Commercial |
$719.47
|
| Rate for Payer: WEA Trust Commercial |
$659.52
|
| Rate for Payer: WPS Commercial |
$888.16
|
|
|
XR Scapula Left
|
Facility
|
OP
|
$596.00
|
|
|
Service Code
|
CPT 73010 LT,TC
|
| Hospital Charge Code |
1537278
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.56 |
| Max. Negotiated Rate |
$570.25 |
| Rate for Payer: Aetna Commercial |
$557.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.06
|
| Rate for Payer: Aetna Managed Medicare |
$173.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.52
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$570.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.87
|
| Rate for Payer: Health EOS Commercial |
$551.66
|
| Rate for Payer: HFN Commercial |
$570.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.88
|
| Rate for Payer: Multiplan Commercial |
$495.87
|
| Rate for Payer: NAPHCARE Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$570.25
|
| Rate for Payer: Quartz Beloit One Network |
$303.72
|
| Rate for Payer: Quartz Commercial |
$402.90
|
| Rate for Payer: Quartz Medicare Advantage |
$371.90
|
| Rate for Payer: The Alliance Commercial |
$309.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$340.91
|
| Rate for Payer: WPS Commercial |
$459.10
|
|
|
XR Scapula Left
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
CPT 73010
|
| Hospital Charge Code |
630165
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna Commercial |
$570.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$24.75
|
| Rate for Payer: Anthem Medicare Advantage |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.75
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$570.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.75
|
| Rate for Payer: Health EOS Commercial |
$546.07
|
| Rate for Payer: HFN Commercial |
$570.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$37.13
|
| Rate for Payer: Preferred Network Access Commercial |
$570.08
|
| Rate for Payer: Quartz Beloit One Network |
$264.04
|
| Rate for Payer: Quartz Commercial |
$342.05
|
| Rate for Payer: Quartz Medicare Advantage |
$24.75
|
| Rate for Payer: The Alliance Commercial |
$94.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.75
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$123.76
|
|
