|
XR Mastoids Complete Bilateral
|
Facility
|
OP
|
$1,298.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630325
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,241.93 |
| Rate for Payer: Aetna Commercial |
$1,214.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.93
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$877.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$674.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$647.96
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.46
|
| 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 |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,241.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$755.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,201.43
|
| Rate for Payer: HFN Commercial |
$1,241.93
|
| 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 |
$1,079.94
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,241.93
|
| Rate for Payer: Quartz Beloit One Network |
$661.46
|
| Rate for Payer: Quartz Commercial |
$877.45
|
| 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 |
$742.46
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$999.85
|
|
|
XR Mastoids Complete Bilateral
|
Facility
|
IP
|
$1,298.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630325
|
| Min. Negotiated Rate |
$661.46 |
| Max. Negotiated Rate |
$1,241.93 |
| Rate for Payer: Aetna Commercial |
$1,214.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.46
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,241.93
|
| Rate for Payer: Health EOS Commercial |
$1,201.43
|
| Rate for Payer: HFN Commercial |
$1,241.93
|
| Rate for Payer: Multiplan Commercial |
$1,079.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,241.93
|
| Rate for Payer: Quartz Beloit One Network |
$661.46
|
| Rate for Payer: Quartz Commercial |
$809.95
|
| Rate for Payer: WEA Trust Commercial |
$742.46
|
| Rate for Payer: WPS Commercial |
$999.85
|
|
|
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
|
|
|
XR Mastoids Complete Left
|
Facility
|
IP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537192
|
|
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 Left
|
Facility
|
IP
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630323
|
| 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 Left
|
Professional
|
Both
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630323
|
| 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 Left
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537192
|
|
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 Left
|
Facility
|
OP
|
$649.00
|
|
|
Service Code
|
CPT 70130
|
| Hospital Charge Code |
630323
|
| 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 Left
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,LT
|
| Hospital Charge Code |
1537192
|
|
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
|
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 RT,TC
|
| Hospital Charge Code |
1537194
|
|
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 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 Mastoids Complete Right
|
Professional
|
Both
|
$675.00
|
|
|
Service Code
|
CPT 70130 RT,TC
|
| Hospital Charge Code |
1537194
|
|
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
|
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
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 70130 TC,RT
|
| Hospital Charge Code |
2979984
|
|
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 Right
|
Facility
|
OP
|
$675.00
|
|
|
Service Code
|
CPT 70130 RT,TC
|
| Hospital Charge Code |
1537194
|
|
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 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 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 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 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 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 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
|
|
