|
XR Myelography Lumbosacral
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3072716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$894.86 |
| Max. Negotiated Rate |
$1,680.14 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,095.74
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
XR Myelography Lumbosacral
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 72265 TC
|
| Hospital Charge Code |
3072716
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.64 |
| Max. Negotiated Rate |
$3,086.46 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Aetna Managed Medicare |
$511.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,086.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,469.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,021.99
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,369.68
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: NAPHCARE Commercial |
$1,095.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,187.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,095.74
|
| Rate for Payer: The Alliance Commercial |
$278.64
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
XR Myelography Spine 2 Or More Areas
|
Facility
|
IP
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,093.44 |
| Max. Negotiated Rate |
$3,930.53 |
| Rate for Payer: Aetna Commercial |
$3,845.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,674.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,264.33
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$3,930.53
|
| Rate for Payer: Health EOS Commercial |
$3,802.36
|
| Rate for Payer: HFN Commercial |
$3,930.53
|
| Rate for Payer: Multiplan Commercial |
$3,417.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,930.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,093.44
|
| Rate for Payer: Quartz Commercial |
$2,563.39
|
| Rate for Payer: WEA Trust Commercial |
$2,349.78
|
| Rate for Payer: WPS Commercial |
$3,164.39
|
|
|
XR Myelography Spine 2 Or More Areas
|
Facility
|
OP
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.95 |
| Max. Negotiated Rate |
$3,930.53 |
| Rate for Payer: Aetna Commercial |
$3,845.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,674.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,196.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,086.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,469.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,264.33
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$3,930.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,390.86
|
| Rate for Payer: Health EOS Commercial |
$3,802.36
|
| Rate for Payer: HFN Commercial |
$3,930.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,204.24
|
| Rate for Payer: Multiplan Commercial |
$3,417.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,563.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,930.53
|
| Rate for Payer: Quartz Beloit One Network |
$2,093.44
|
| Rate for Payer: Quartz Commercial |
$2,777.01
|
| Rate for Payer: Quartz Medicare Advantage |
$2,563.39
|
| Rate for Payer: The Alliance Commercial |
$291.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,349.78
|
| Rate for Payer: WPS Commercial |
$3,164.39
|
|
|
XR Myelography Spine 2 Or More Areas
|
Professional
|
Both
|
$4,108.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.99 |
| Max. Negotiated Rate |
$4,058.70 |
| Rate for Payer: Aetna Commercial |
$4,058.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,674.20
|
| Rate for Payer: Aetna Managed Medicare |
$72.99
|
| Rate for Payer: Anthem Medicare Advantage |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.99
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cash Price |
$1,232.40
|
| Rate for Payer: Cigna Commercial |
$4,058.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,136.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.99
|
| Rate for Payer: Health EOS Commercial |
$3,887.81
|
| Rate for Payer: HFN Commercial |
$4,058.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.99
|
| Rate for Payer: Multiplan Commercial |
$3,417.86
|
| Rate for Payer: NAPHCARE Commercial |
$109.48
|
| Rate for Payer: Preferred Network Access Commercial |
$4,058.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.82
|
| Rate for Payer: Quartz Commercial |
$2,435.22
|
| Rate for Payer: Quartz Medicare Advantage |
$72.99
|
| Rate for Payer: The Alliance Commercial |
$277.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.99
|
| Rate for Payer: WEA Trust Commercial |
$2,349.78
|
| Rate for Payer: WPS Commercial |
$364.94
|
|
|
XR Myelography Thoracic Spine
|
Facility
|
IP
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,478.35 |
| Max. Negotiated Rate |
$2,775.68 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,810.22
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
|
XR Myelography Thoracic Spine
|
Facility
|
OP
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.95 |
| Max. Negotiated Rate |
$3,086.46 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Aetna Managed Medicare |
$844.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,086.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,469.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.38
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,262.78
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,961.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.22
|
| Rate for Payer: The Alliance Commercial |
$291.95
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
|
XR Myelography Thoracic Spine
|
Professional
|
Both
|
$2,901.00
|
|
|
Service Code
|
CPT 72270 TC
|
| Hospital Charge Code |
3072717
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$72.99 |
| Max. Negotiated Rate |
$2,866.19 |
| Rate for Payer: Aetna Commercial |
$2,866.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Aetna Managed Medicare |
$72.99
|
| Rate for Payer: Anthem Medicare Advantage |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.99
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,866.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,508.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.99
|
| Rate for Payer: Health EOS Commercial |
$2,745.51
|
| Rate for Payer: HFN Commercial |
$2,866.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.99
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: NAPHCARE Commercial |
$109.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,866.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,327.50
|
| Rate for Payer: Quartz Commercial |
$1,719.71
|
| Rate for Payer: Quartz Medicare Advantage |
$72.99
|
| Rate for Payer: The Alliance Commercial |
$277.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.99
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$364.94
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$114.90 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$120.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.37
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.14
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$257.71
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$279.19
|
| Rate for Payer: Quartz Medicare Advantage |
$257.71
|
| Rate for Payer: The Alliance Commercial |
$114.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$195.18 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$238.99
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
XR Nasal Bones Minimum 3 Views
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.72 |
| Max. Negotiated Rate |
$408.04 |
| Rate for Payer: Aetna Commercial |
$408.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Aetna Managed Medicare |
$28.72
|
| Rate for Payer: Anthem Medicare Advantage |
$28.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.72
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$408.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$214.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.72
|
| Rate for Payer: Health EOS Commercial |
$390.86
|
| Rate for Payer: HFN Commercial |
$408.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.72
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: NAPHCARE Commercial |
$43.09
|
| Rate for Payer: Preferred Network Access Commercial |
$408.04
|
| Rate for Payer: Quartz Beloit One Network |
$188.99
|
| Rate for Payer: Quartz Commercial |
$244.83
|
| Rate for Payer: Quartz Medicare Advantage |
$28.72
|
| Rate for Payer: The Alliance Commercial |
$109.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.72
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$143.62
|
|
|
XR Nasal Bones Minimum 3 Views
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$37.07 |
| Max. Negotiated Rate |
$378.40 |
| Rate for Payer: Quartz Commercial |
$227.04
|
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$37.07
|
| Rate for Payer: Anthem Medicare Advantage |
$37.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.07
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.07
|
| Rate for Payer: Health EOS Commercial |
$362.47
|
| Rate for Payer: HFN Commercial |
$378.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.07
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$55.60
|
| Rate for Payer: Preferred Network Access Commercial |
$378.40
|
| Rate for Payer: Quartz Beloit One Network |
$175.26
|
| Rate for Payer: Quartz Medicare Advantage |
$37.07
|
| Rate for Payer: The Alliance Commercial |
$140.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.07
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$185.33
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 70160 TC
|
| Hospital Charge Code |
1537206
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.46 |
| Max. Negotiated Rate |
$395.16 |
| Rate for Payer: Aetna Commercial |
$386.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.65
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$395.16
|
| Rate for Payer: Health EOS Commercial |
$382.27
|
| Rate for Payer: HFN Commercial |
$395.16
|
| Rate for Payer: Multiplan Commercial |
$343.62
|
| Rate for Payer: Preferred Network Access Commercial |
$395.16
|
| Rate for Payer: Quartz Beloit One Network |
$210.46
|
| Rate for Payer: Quartz Commercial |
$257.71
|
| Rate for Payer: WEA Trust Commercial |
$236.24
|
| Rate for Payer: WPS Commercial |
$318.13
|
|
|
XR Nasal Bones Minimum 3 Views
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 70160
|
| Hospital Charge Code |
630309
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$258.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.19
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| 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 |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| 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 |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$258.91
|
| 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 |
$219.08
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
XR Neck Soft Tissue
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 70360 TC
|
| Hospital Charge Code |
1537208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$255.82 |
| Max. Negotiated Rate |
$480.31 |
| Rate for Payer: Aetna Commercial |
$469.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.70
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$480.31
|
| Rate for Payer: Health EOS Commercial |
$464.65
|
| Rate for Payer: HFN Commercial |
$480.31
|
| Rate for Payer: Multiplan Commercial |
$417.66
|
| Rate for Payer: Preferred Network Access Commercial |
$480.31
|
| Rate for Payer: Quartz Beloit One Network |
$255.82
|
| Rate for Payer: Quartz Commercial |
$313.25
|
| Rate for Payer: WEA Trust Commercial |
$287.14
|
| Rate for Payer: WPS Commercial |
$386.69
|
|
|
XR Neck Soft Tissue
|
Facility
|
OP
|
$465.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
630307
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna Commercial |
$435.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.90
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$241.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.13
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.31
|
| 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 |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$444.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$430.40
|
| Rate for Payer: HFN Commercial |
$444.91
|
| 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 |
$386.88
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$444.91
|
| Rate for Payer: Quartz Beloit One Network |
$236.96
|
| Rate for Payer: Quartz Commercial |
$314.34
|
| 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 |
$265.98
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$358.19
|
|
|
XR Neck Soft Tissue
|
Professional
|
Both
|
$502.00
|
|
|
Service Code
|
CPT 70360 TC
|
| Hospital Charge Code |
1537208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.07 |
| Max. Negotiated Rate |
$495.98 |
| Rate for Payer: Aetna Commercial |
$495.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.99
|
| Rate for Payer: Aetna Managed Medicare |
$22.07
|
| Rate for Payer: Anthem Medicare Advantage |
$22.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.07
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$495.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.07
|
| Rate for Payer: Health EOS Commercial |
$475.09
|
| Rate for Payer: HFN Commercial |
$495.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.07
|
| Rate for Payer: Multiplan Commercial |
$417.66
|
| Rate for Payer: NAPHCARE Commercial |
$33.10
|
| Rate for Payer: Preferred Network Access Commercial |
$495.98
|
| Rate for Payer: Quartz Beloit One Network |
$229.72
|
| Rate for Payer: Quartz Commercial |
$297.59
|
| Rate for Payer: Quartz Medicare Advantage |
$22.07
|
| Rate for Payer: The Alliance Commercial |
$83.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.07
|
| Rate for Payer: WEA Trust Commercial |
$287.14
|
| Rate for Payer: WPS Commercial |
$110.34
|
|
|
XR Neck Soft Tissue
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 70360 TC
|
| Hospital Charge Code |
1537208
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.28 |
| Max. Negotiated Rate |
$480.31 |
| Rate for Payer: Aetna Commercial |
$469.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.99
|
| Rate for Payer: Aetna Managed Medicare |
$146.18
|
| 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 |
$276.70
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$480.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.16
|
| Rate for Payer: Health EOS Commercial |
$464.65
|
| Rate for Payer: HFN Commercial |
$480.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$391.56
|
| Rate for Payer: Multiplan Commercial |
$417.66
|
| Rate for Payer: NAPHCARE Commercial |
$313.25
|
| Rate for Payer: Preferred Network Access Commercial |
$480.31
|
| Rate for Payer: Quartz Beloit One Network |
$255.82
|
| Rate for Payer: Quartz Commercial |
$339.35
|
| Rate for Payer: Quartz Medicare Advantage |
$313.25
|
| Rate for Payer: The Alliance Commercial |
$88.28
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$287.14
|
| Rate for Payer: WPS Commercial |
$386.69
|
|
|
XR Neck Soft Tissue
|
Professional
|
Both
|
$465.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
630307
|
| Min. Negotiated Rate |
$30.76 |
| Max. Negotiated Rate |
$459.42 |
| Rate for Payer: Aetna Commercial |
$459.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.90
|
| Rate for Payer: Aetna Managed Medicare |
$30.76
|
| Rate for Payer: Anthem Medicare Advantage |
$30.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.76
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$459.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.76
|
| Rate for Payer: Health EOS Commercial |
$440.08
|
| Rate for Payer: HFN Commercial |
$459.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.76
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: NAPHCARE Commercial |
$46.14
|
| Rate for Payer: Preferred Network Access Commercial |
$459.42
|
| Rate for Payer: Quartz Beloit One Network |
$212.78
|
| Rate for Payer: Quartz Commercial |
$275.65
|
| Rate for Payer: Quartz Medicare Advantage |
$30.76
|
| Rate for Payer: The Alliance Commercial |
$116.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.76
|
| Rate for Payer: WEA Trust Commercial |
$265.98
|
| Rate for Payer: WPS Commercial |
$153.82
|
|
|
XR Neck Soft Tissue
|
Facility
|
IP
|
$465.00
|
|
|
Service Code
|
CPT 70360
|
| Hospital Charge Code |
630307
|
| Min. Negotiated Rate |
$236.96 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna Commercial |
$435.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.31
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$444.91
|
| Rate for Payer: Health EOS Commercial |
$430.40
|
| Rate for Payer: HFN Commercial |
$444.91
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: Preferred Network Access Commercial |
$444.91
|
| Rate for Payer: Quartz Beloit One Network |
$236.96
|
| Rate for Payer: Quartz Commercial |
$290.16
|
| Rate for Payer: WEA Trust Commercial |
$265.98
|
| Rate for Payer: WPS Commercial |
$358.19
|
|
|
XR Neph Exchange Percutaneous
|
Facility
|
IP
|
$3,505.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
4600648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,786.15 |
| Max. Negotiated Rate |
$3,353.58 |
| Rate for Payer: Aetna Commercial |
$3,280.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,134.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,931.96
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,353.58
|
| Rate for Payer: Health EOS Commercial |
$3,244.23
|
| Rate for Payer: HFN Commercial |
$3,353.58
|
| Rate for Payer: Multiplan Commercial |
$2,916.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,353.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,786.15
|
| Rate for Payer: Quartz Commercial |
$2,187.12
|
| Rate for Payer: WEA Trust Commercial |
$2,004.86
|
| Rate for Payer: WPS Commercial |
$2,699.90
|
|
|
XR Neph Exchange Percutaneous
|
Professional
|
Both
|
$3,505.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
4600648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$85.59 |
| Max. Negotiated Rate |
$3,462.94 |
| Rate for Payer: Aetna Commercial |
$3,462.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,134.87
|
| Rate for Payer: Aetna Managed Medicare |
$85.59
|
| Rate for Payer: Anthem Medicare Advantage |
$85.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.59
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,462.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$381.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.59
|
| Rate for Payer: Health EOS Commercial |
$3,317.13
|
| Rate for Payer: HFN Commercial |
$3,462.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$346.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$346.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.59
|
| Rate for Payer: Multiplan Commercial |
$2,916.16
|
| Rate for Payer: NAPHCARE Commercial |
$128.39
|
| Rate for Payer: Preferred Network Access Commercial |
$3,462.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,603.89
|
| Rate for Payer: Quartz Commercial |
$2,077.76
|
| Rate for Payer: Quartz Medicare Advantage |
$85.59
|
| Rate for Payer: The Alliance Commercial |
$363.77
|
| Rate for Payer: United Healthcare Medicaid |
$381.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.59
|
| Rate for Payer: WEA Trust Commercial |
$2,004.86
|
| Rate for Payer: WPS Commercial |
$385.16
|
|
|
XR Neph Exchange Percutaneous
|
Facility
|
OP
|
$3,505.00
|
|
|
Service Code
|
CPT 50435
|
| Hospital Charge Code |
4600648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Commercial |
$3,280.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,134.87
|
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,369.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,822.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,749.70
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,931.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cash Price |
$1,051.50
|
| Rate for Payer: Cigna Commercial |
$3,353.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Health EOS Commercial |
$3,244.23
|
| Rate for Payer: HFN Commercial |
$3,353.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: Multiplan Commercial |
$2,916.16
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Preferred Network Access Commercial |
$3,353.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,786.15
|
| Rate for Payer: Quartz Commercial |
$2,369.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,004.86
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
| Rate for Payer: WPS Commercial |
$2,699.90
|
|
|
XR Nephrostogram
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2587235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$786.45 |
| Rate for Payer: Aetna Commercial |
$786.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.94
|
| Rate for Payer: Aetna Managed Medicare |
$133.28
|
| Rate for Payer: Anthem Medicare Advantage |
$133.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$133.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$133.28
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$786.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$413.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.28
|
| Rate for Payer: Health EOS Commercial |
$753.33
|
| Rate for Payer: HFN Commercial |
$786.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$492.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$492.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$133.28
|
| Rate for Payer: Multiplan Commercial |
$662.27
|
| Rate for Payer: NAPHCARE Commercial |
$199.91
|
| Rate for Payer: Preferred Network Access Commercial |
$786.45
|
| Rate for Payer: Quartz Beloit One Network |
$364.25
|
| Rate for Payer: Quartz Commercial |
$471.87
|
| Rate for Payer: Quartz Medicare Advantage |
$133.28
|
| Rate for Payer: The Alliance Commercial |
$506.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.28
|
| Rate for Payer: WEA Trust Commercial |
$455.31
|
| Rate for Payer: WPS Commercial |
$666.38
|
|
|
XR Nephrostogram
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2587235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$405.64 |
| Max. Negotiated Rate |
$761.61 |
| Rate for Payer: Aetna Commercial |
$745.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.76
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$761.61
|
| Rate for Payer: Health EOS Commercial |
$736.78
|
| Rate for Payer: HFN Commercial |
$761.61
|
| Rate for Payer: Multiplan Commercial |
$662.27
|
| Rate for Payer: Preferred Network Access Commercial |
$761.61
|
| Rate for Payer: Quartz Beloit One Network |
$405.64
|
| Rate for Payer: Quartz Commercial |
$496.70
|
| Rate for Payer: WEA Trust Commercial |
$455.31
|
| Rate for Payer: WPS Commercial |
$613.16
|
|
