|
XR Mandible Partial Less Than 4 Views
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 70100 TC
|
| Hospital Charge Code |
1537180
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$182.29
|
| 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 |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.33
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.28
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$390.62
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$423.18
|
| Rate for Payer: Quartz Medicare Advantage |
$390.62
|
| Rate for Payer: The Alliance Commercial |
$124.22
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
XR Mastoids < 3 Views Bilateral
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630335
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$678.76 |
| Rate for Payer: Aetna Commercial |
$678.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Aetna Managed Medicare |
$38.42
|
| Rate for Payer: Anthem Medicare Advantage |
$38.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.42
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$678.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$357.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.42
|
| Rate for Payer: Health EOS Commercial |
$650.18
|
| Rate for Payer: HFN Commercial |
$678.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.42
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: NAPHCARE Commercial |
$57.63
|
| Rate for Payer: Preferred Network Access Commercial |
$678.76
|
| Rate for Payer: Quartz Beloit One Network |
$314.37
|
| Rate for Payer: Quartz Commercial |
$407.25
|
| Rate for Payer: Quartz Medicare Advantage |
$38.42
|
| Rate for Payer: The Alliance Commercial |
$145.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.42
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$192.09
|
|
|
XR Mastoids < 3 Views Bilateral
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.63 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Aetna Commercial |
$353.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$353.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.39
|
| Rate for Payer: Health EOS Commercial |
$338.81
|
| Rate for Payer: HFN Commercial |
$353.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.63
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: Preferred Network Access Commercial |
$353.70
|
| Rate for Payer: Quartz Beloit One Network |
$163.82
|
| Rate for Payer: Quartz Commercial |
$212.22
|
| Rate for Payer: The Alliance Commercial |
$186.16
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
XR Mastoids < 3 Views Bilateral
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630335
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$657.32 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$428.69
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
XR Mastoids < 3 Views Bilateral
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630335
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$657.32 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.95
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| 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 |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| 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 |
$571.58
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$464.41
|
| 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 |
$392.96
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
XR Mastoids < 3 Views Bilateral
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.44 |
| Max. Negotiated Rate |
$342.53 |
| Rate for Payer: Aetna Commercial |
$335.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.33
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$342.53
|
| Rate for Payer: Health EOS Commercial |
$331.36
|
| Rate for Payer: HFN Commercial |
$342.53
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: Preferred Network Access Commercial |
$342.53
|
| Rate for Payer: Quartz Beloit One Network |
$182.44
|
| Rate for Payer: Quartz Commercial |
$223.39
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
XR Mastoids < 3 Views Bilateral
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537184
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$423.81 |
| Rate for Payer: Aetna Commercial |
$335.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Aetna Managed Medicare |
$104.25
|
| 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 |
$197.33
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$342.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.36
|
| Rate for Payer: Health EOS Commercial |
$331.36
|
| Rate for Payer: HFN Commercial |
$342.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.24
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: NAPHCARE Commercial |
$223.39
|
| Rate for Payer: Preferred Network Access Commercial |
$342.53
|
| Rate for Payer: Quartz Beloit One Network |
$182.44
|
| Rate for Payer: Quartz Commercial |
$242.01
|
| Rate for Payer: Quartz Medicare Advantage |
$223.39
|
| Rate for Payer: The Alliance Commercial |
$186.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
XR Mastoids < 3 Views Left
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537186
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$423.81 |
| Rate for Payer: Aetna Commercial |
$335.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Aetna Managed Medicare |
$104.25
|
| 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 |
$197.33
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$342.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.36
|
| Rate for Payer: Health EOS Commercial |
$331.36
|
| Rate for Payer: HFN Commercial |
$342.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.24
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: NAPHCARE Commercial |
$223.39
|
| Rate for Payer: Preferred Network Access Commercial |
$342.53
|
| Rate for Payer: Quartz Beloit One Network |
$182.44
|
| Rate for Payer: Quartz Commercial |
$242.01
|
| Rate for Payer: Quartz Medicare Advantage |
$223.39
|
| Rate for Payer: The Alliance Commercial |
$186.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
XR Mastoids < 3 Views Left
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537186
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.44 |
| Max. Negotiated Rate |
$342.53 |
| Rate for Payer: Aetna Commercial |
$335.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.33
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$342.53
|
| Rate for Payer: Health EOS Commercial |
$331.36
|
| Rate for Payer: HFN Commercial |
$342.53
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: Preferred Network Access Commercial |
$342.53
|
| Rate for Payer: Quartz Beloit One Network |
$182.44
|
| Rate for Payer: Quartz Commercial |
$223.39
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
XR Mastoids < 3 Views Left
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
CPT 70120 LT,TC
|
| Hospital Charge Code |
1537186
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.63 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Aetna Commercial |
$353.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$353.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.39
|
| Rate for Payer: Health EOS Commercial |
$338.81
|
| Rate for Payer: HFN Commercial |
$353.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.63
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: Preferred Network Access Commercial |
$353.70
|
| Rate for Payer: Quartz Beloit One Network |
$163.82
|
| Rate for Payer: Quartz Commercial |
$212.22
|
| Rate for Payer: The Alliance Commercial |
$186.16
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
XR Mastoids < 3 Views Left
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630333
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$329.14 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$214.66
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
XR Mastoids < 3 Views Left
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630333
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$339.87 |
| Rate for Payer: Aetna Commercial |
$339.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Aetna Managed Medicare |
$38.42
|
| Rate for Payer: Anthem Medicare Advantage |
$38.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.42
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$339.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$178.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.42
|
| Rate for Payer: Health EOS Commercial |
$325.56
|
| Rate for Payer: HFN Commercial |
$339.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.42
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: NAPHCARE Commercial |
$57.63
|
| Rate for Payer: Preferred Network Access Commercial |
$339.87
|
| Rate for Payer: Quartz Beloit One Network |
$157.41
|
| Rate for Payer: Quartz Commercial |
$203.92
|
| Rate for Payer: Quartz Medicare Advantage |
$38.42
|
| Rate for Payer: The Alliance Commercial |
$145.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.42
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$192.09
|
|
|
XR Mastoids < 3 Views Left
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630333
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$440.09 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$232.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.72
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| 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 |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| 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 |
$286.21
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$232.54
|
| 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 |
$196.77
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
XR Mastoids < 3 Views Right
|
Professional
|
Both
|
$358.00
|
|
|
Service Code
|
CPT 70120 TC,RT
|
| Hospital Charge Code |
2979983
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.63 |
| Max. Negotiated Rate |
$353.70 |
| Rate for Payer: Aetna Commercial |
$353.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$353.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.39
|
| Rate for Payer: Health EOS Commercial |
$338.81
|
| Rate for Payer: HFN Commercial |
$353.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.63
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: Preferred Network Access Commercial |
$353.70
|
| Rate for Payer: Quartz Beloit One Network |
$163.82
|
| Rate for Payer: Quartz Commercial |
$212.22
|
| Rate for Payer: The Alliance Commercial |
$186.16
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
XR Mastoids < 3 Views Right
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 70120 TC,RT
|
| Hospital Charge Code |
2979983
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$104.25 |
| Max. Negotiated Rate |
$423.81 |
| Rate for Payer: Aetna Commercial |
$335.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Aetna Managed Medicare |
$104.25
|
| 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 |
$197.33
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$342.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.36
|
| Rate for Payer: Health EOS Commercial |
$331.36
|
| Rate for Payer: HFN Commercial |
$342.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.24
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: NAPHCARE Commercial |
$223.39
|
| Rate for Payer: Preferred Network Access Commercial |
$342.53
|
| Rate for Payer: Quartz Beloit One Network |
$182.44
|
| Rate for Payer: Quartz Commercial |
$242.01
|
| Rate for Payer: Quartz Medicare Advantage |
$223.39
|
| Rate for Payer: The Alliance Commercial |
$186.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
XR Mastoids < 3 Views Right
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 70120 RT,TC
|
| Hospital Charge Code |
1537188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$231.50
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
XR Mastoids < 3 Views Right
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 70120 RT,TC
|
| Hospital Charge Code |
1537188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$423.81 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.04
|
| 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 |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.92
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.38
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$231.50
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: Quartz Medicare Advantage |
$231.50
|
| Rate for Payer: The Alliance Commercial |
$192.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
XR Mastoids < 3 Views Right
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630327
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$329.14 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$214.66
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
XR Mastoids < 3 Views Right
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630327
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$339.87 |
| Rate for Payer: Aetna Commercial |
$339.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Aetna Managed Medicare |
$38.42
|
| Rate for Payer: Anthem Medicare Advantage |
$38.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.42
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$339.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$178.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.42
|
| Rate for Payer: Health EOS Commercial |
$325.56
|
| Rate for Payer: HFN Commercial |
$339.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.42
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: NAPHCARE Commercial |
$57.63
|
| Rate for Payer: Preferred Network Access Commercial |
$339.87
|
| Rate for Payer: Quartz Beloit One Network |
$157.41
|
| Rate for Payer: Quartz Commercial |
$203.92
|
| Rate for Payer: Quartz Medicare Advantage |
$38.42
|
| Rate for Payer: The Alliance Commercial |
$145.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.42
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$192.09
|
|
|
XR Mastoids < 3 Views Right
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 70120
|
| Hospital Charge Code |
630327
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$440.09 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$232.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.72
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| 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 |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| 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 |
$286.21
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$232.54
|
| 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 |
$196.77
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
XR Mastoids < 3 Views Right
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
CPT 70120 RT,TC
|
| Hospital Charge Code |
1537188
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.63 |
| Max. Negotiated Rate |
$366.55 |
| Rate for Payer: Aetna Commercial |
$366.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$366.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.50
|
| Rate for Payer: Health EOS Commercial |
$351.11
|
| Rate for Payer: HFN Commercial |
$366.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.63
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$366.55
|
| Rate for Payer: Quartz Beloit One Network |
$169.77
|
| Rate for Payer: Quartz Commercial |
$219.93
|
| Rate for Payer: The Alliance Commercial |
$192.92
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
XR Mastoids < 3 Views Right
|
Facility
|
IP
|
$358.00
|
|
|
Service Code
|
CPT 70120 TC,RT
|
| Hospital Charge Code |
2979983
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.44 |
| Max. Negotiated Rate |
$342.53 |
| Rate for Payer: Aetna Commercial |
$335.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.33
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$342.53
|
| Rate for Payer: Health EOS Commercial |
$331.36
|
| Rate for Payer: HFN Commercial |
$342.53
|
| Rate for Payer: Multiplan Commercial |
$297.86
|
| Rate for Payer: Preferred Network Access Commercial |
$342.53
|
| Rate for Payer: Quartz Beloit One Network |
$182.44
|
| Rate for Payer: Quartz Commercial |
$223.39
|
| Rate for Payer: WEA Trust Commercial |
$204.78
|
| Rate for Payer: WPS Commercial |
$275.77
|
|
|
XR Mastoids Complete Bilateral
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537190
|
|
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 Mastoids Complete Bilateral
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$196.56 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Aetna Managed Medicare |
$196.56
|
| 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 |
$372.06
|
| 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 |
$645.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.85
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.50
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$456.30
|
| Rate for Payer: Quartz Medicare Advantage |
$421.20
|
| Rate for Payer: The Alliance Commercial |
$351.00
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.95
|
|
|
XR Mastoids Complete Bilateral
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537190
|
|
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
|
|
