|
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 Nephrostomy Dilation Bilateral
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 LT,TC
|
| Hospital Charge Code |
2587238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,101.76 |
| Max. Negotiated Rate |
$2,068.60 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,349.09
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
XR Nephrostomy Dilation Bilateral
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 LT,TC
|
| Hospital Charge Code |
2587238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Aetna Managed Medicare |
$629.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,461.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,124.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,079.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,686.36
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,349.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,461.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,349.09
|
| Rate for Payer: The Alliance Commercial |
$1,124.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
XR Nephrostomy Dilation Bilateral
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 LT,TC
|
| Hospital Charge Code |
2587238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$683.21 |
| Max. Negotiated Rate |
$2,136.06 |
| Rate for Payer: Aetna Commercial |
$2,136.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,136.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$683.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.09
|
| Rate for Payer: Health EOS Commercial |
$2,046.12
|
| Rate for Payer: HFN Commercial |
$2,136.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,136.06
|
| Rate for Payer: Quartz Beloit One Network |
$989.33
|
| Rate for Payer: Quartz Commercial |
$1,281.63
|
| Rate for Payer: The Alliance Commercial |
$1,124.24
|
| Rate for Payer: United Healthcare Medicaid |
$683.21
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
XR Nephrostomy Dilation Left
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,LT
|
| Hospital Charge Code |
2587241
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,101.76 |
| Max. Negotiated Rate |
$2,068.60 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,349.09
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
XR Nephrostomy Dilation Left
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,LT
|
| Hospital Charge Code |
2587241
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Aetna Managed Medicare |
$629.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,461.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,124.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,079.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,686.36
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,349.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,461.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,349.09
|
| Rate for Payer: The Alliance Commercial |
$1,124.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
XR Nephrostomy Dilation Left
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,LT
|
| Hospital Charge Code |
2587241
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$683.21 |
| Max. Negotiated Rate |
$2,136.06 |
| Rate for Payer: Aetna Commercial |
$2,136.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,136.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$683.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.09
|
| Rate for Payer: Health EOS Commercial |
$2,046.12
|
| Rate for Payer: HFN Commercial |
$2,136.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,136.06
|
| Rate for Payer: Quartz Beloit One Network |
$989.33
|
| Rate for Payer: Quartz Commercial |
$1,281.63
|
| Rate for Payer: The Alliance Commercial |
$1,124.24
|
| Rate for Payer: United Healthcare Medicaid |
$683.21
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
XR Nephrostomy Dilation Right
|
Facility
|
IP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 RT,TC
|
| Hospital Charge Code |
2587244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,376.94 |
| Max. Negotiated Rate |
$2,585.27 |
| Rate for Payer: Aetna Commercial |
$2,529.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,489.34
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,585.27
|
| Rate for Payer: Health EOS Commercial |
$2,500.97
|
| Rate for Payer: HFN Commercial |
$2,585.27
|
| Rate for Payer: Multiplan Commercial |
$2,248.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,585.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,376.94
|
| Rate for Payer: Quartz Commercial |
$1,686.05
|
| Rate for Payer: WEA Trust Commercial |
$1,545.54
|
| Rate for Payer: WPS Commercial |
$2,081.35
|
|
|
XR Nephrostomy Dilation Right
|
Professional
|
Both
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 RT,TC
|
| Hospital Charge Code |
2587244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$683.21 |
| Max. Negotiated Rate |
$2,669.58 |
| Rate for Payer: Aetna Commercial |
$2,669.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.67
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,669.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$683.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,686.05
|
| Rate for Payer: Health EOS Commercial |
$2,557.17
|
| Rate for Payer: HFN Commercial |
$2,669.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$2,248.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,669.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,236.44
|
| Rate for Payer: Quartz Commercial |
$1,601.75
|
| Rate for Payer: The Alliance Commercial |
$1,405.04
|
| Rate for Payer: United Healthcare Medicaid |
$683.21
|
| Rate for Payer: WEA Trust Commercial |
$1,545.54
|
| Rate for Payer: WPS Commercial |
$2,081.35
|
|
|
XR Nephrostomy Dilation Right
|
Facility
|
OP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 RT,TC
|
| Hospital Charge Code |
2587244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,529.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,416.67
|
| Rate for Payer: Aetna Managed Medicare |
$786.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,826.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,405.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,348.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,489.34
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,585.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,500.97
|
| Rate for Payer: HFN Commercial |
$2,585.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,107.56
|
| Rate for Payer: Multiplan Commercial |
$2,248.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,686.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,585.27
|
| Rate for Payer: Quartz Beloit One Network |
$1,376.94
|
| Rate for Payer: Quartz Commercial |
$1,826.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,686.05
|
| Rate for Payer: The Alliance Commercial |
$1,405.04
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,545.54
|
| Rate for Payer: WPS Commercial |
$2,081.35
|
|
|
XR Nephrostomy Dilation Right
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,RT
|
| Hospital Charge Code |
5430655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Aetna Managed Medicare |
$629.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,461.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,124.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,079.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,686.36
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,349.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,461.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,349.09
|
| Rate for Payer: The Alliance Commercial |
$1,124.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
XR Nephrostomy Dilation Right
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,RT
|
| Hospital Charge Code |
5430655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,101.76 |
| Max. Negotiated Rate |
$2,068.60 |
| Rate for Payer: Aetna Commercial |
$2,023.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,191.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,068.60
|
| Rate for Payer: Health EOS Commercial |
$2,001.15
|
| Rate for Payer: HFN Commercial |
$2,068.60
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,068.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,349.09
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
XR Nephrostomy Dilation Right
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,RT
|
| Hospital Charge Code |
5430655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$683.21 |
| Max. Negotiated Rate |
$2,136.06 |
| Rate for Payer: Aetna Commercial |
$2,136.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,933.69
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,136.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$683.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,349.09
|
| Rate for Payer: Health EOS Commercial |
$2,046.12
|
| Rate for Payer: HFN Commercial |
$2,136.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$714.75
|
| Rate for Payer: Multiplan Commercial |
$1,798.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,136.06
|
| Rate for Payer: Quartz Beloit One Network |
$989.33
|
| Rate for Payer: Quartz Commercial |
$1,281.63
|
| Rate for Payer: The Alliance Commercial |
$1,124.24
|
| Rate for Payer: United Healthcare Medicaid |
$683.21
|
| Rate for Payer: WEA Trust Commercial |
$1,236.66
|
| Rate for Payer: WPS Commercial |
$1,665.39
|
|
|
XR Optic Foramina Left
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630305
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: Aetna Commercial |
$457.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.54
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$467.88
|
| Rate for Payer: Health EOS Commercial |
$452.62
|
| Rate for Payer: HFN Commercial |
$467.88
|
| Rate for Payer: Multiplan Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$467.88
|
| Rate for Payer: Quartz Beloit One Network |
$249.19
|
| Rate for Payer: Quartz Commercial |
$305.14
|
| Rate for Payer: WEA Trust Commercial |
$279.71
|
| Rate for Payer: WPS Commercial |
$376.68
|
|
|
XR Optic Foramina Left
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
CPT 70190 LT,TC
|
| Hospital Charge Code |
1537210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.27 |
| Max. Negotiated Rate |
$502.89 |
| Rate for Payer: Aetna Commercial |
$502.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$502.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$264.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.62
|
| Rate for Payer: Health EOS Commercial |
$481.72
|
| Rate for Payer: HFN Commercial |
$502.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.27
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$502.89
|
| Rate for Payer: Quartz Beloit One Network |
$232.92
|
| Rate for Payer: Quartz Commercial |
$301.74
|
| Rate for Payer: The Alliance Commercial |
$264.68
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
XR Optic Foramina Left
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 70190 LT,TC
|
| Hospital Charge Code |
1537210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.22 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Aetna Managed Medicare |
$148.22
|
| 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 |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$397.02
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: NAPHCARE Commercial |
$317.62
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$344.08
|
| Rate for Payer: Quartz Medicare Advantage |
$317.62
|
| Rate for Payer: The Alliance Commercial |
$264.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
XR Optic Foramina Left
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 70190 LT,TC
|
| Hospital Charge Code |
1537210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.39 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$317.62
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
XR Optic Foramina Left
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630305
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: Aetna Commercial |
$457.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.11
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.54
|
| 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 |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$467.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$452.62
|
| Rate for Payer: HFN Commercial |
$467.88
|
| 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 |
$406.85
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$467.88
|
| Rate for Payer: Quartz Beloit One Network |
$249.19
|
| Rate for Payer: Quartz Commercial |
$330.56
|
| 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 |
$279.71
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$376.68
|
|
|
XR Optic Foramina Left
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630305
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$483.13 |
| Rate for Payer: Aetna Commercial |
$483.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Aetna Managed Medicare |
$36.44
|
| Rate for Payer: Anthem Medicare Advantage |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.44
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$483.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.44
|
| Rate for Payer: Health EOS Commercial |
$462.79
|
| Rate for Payer: HFN Commercial |
$483.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.44
|
| Rate for Payer: Multiplan Commercial |
$406.85
|
| Rate for Payer: NAPHCARE Commercial |
$54.66
|
| Rate for Payer: Preferred Network Access Commercial |
$483.13
|
| Rate for Payer: Quartz Beloit One Network |
$223.77
|
| Rate for Payer: Quartz Commercial |
$289.88
|
| Rate for Payer: Quartz Medicare Advantage |
$36.44
|
| Rate for Payer: The Alliance Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.44
|
| Rate for Payer: WEA Trust Commercial |
$279.71
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
XR Optic Foramina Right
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 70190 RT,TC
|
| Hospital Charge Code |
1537212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.22 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Aetna Managed Medicare |
$148.22
|
| 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 |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$397.02
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: NAPHCARE Commercial |
$317.62
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$344.08
|
| Rate for Payer: Quartz Medicare Advantage |
$317.62
|
| Rate for Payer: The Alliance Commercial |
$264.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
XR Optic Foramina Right
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
CPT 70190 RT,TC
|
| Hospital Charge Code |
1537212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$136.27 |
| Max. Negotiated Rate |
$502.89 |
| Rate for Payer: Aetna Commercial |
$502.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$502.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$264.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.62
|
| Rate for Payer: Health EOS Commercial |
$481.72
|
| Rate for Payer: HFN Commercial |
$502.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.27
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$502.89
|
| Rate for Payer: Quartz Beloit One Network |
$232.92
|
| Rate for Payer: Quartz Commercial |
$301.74
|
| Rate for Payer: The Alliance Commercial |
$264.68
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
XR Optic Foramina Right
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630303
|
| Min. Negotiated Rate |
$249.19 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: Aetna Commercial |
$457.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.54
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$467.88
|
| Rate for Payer: Health EOS Commercial |
$452.62
|
| Rate for Payer: HFN Commercial |
$467.88
|
| Rate for Payer: Multiplan Commercial |
$406.85
|
| Rate for Payer: Preferred Network Access Commercial |
$467.88
|
| Rate for Payer: Quartz Beloit One Network |
$249.19
|
| Rate for Payer: Quartz Commercial |
$305.14
|
| Rate for Payer: WEA Trust Commercial |
$279.71
|
| Rate for Payer: WPS Commercial |
$376.68
|
|
|
XR Optic Foramina Right
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630303
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$467.88 |
| Rate for Payer: Aetna Commercial |
$457.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.11
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.54
|
| 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 |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$467.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$452.62
|
| Rate for Payer: HFN Commercial |
$467.88
|
| 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 |
$406.85
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$467.88
|
| Rate for Payer: Quartz Beloit One Network |
$249.19
|
| Rate for Payer: Quartz Commercial |
$330.56
|
| 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 |
$279.71
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$376.68
|
|
|
XR Optic Foramina Right
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630303
|
| Min. Negotiated Rate |
$36.44 |
| Max. Negotiated Rate |
$483.13 |
| Rate for Payer: Aetna Commercial |
$483.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.36
|
| Rate for Payer: Aetna Managed Medicare |
$36.44
|
| Rate for Payer: Anthem Medicare Advantage |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.44
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$483.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.44
|
| Rate for Payer: Health EOS Commercial |
$462.79
|
| Rate for Payer: HFN Commercial |
$483.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.44
|
| Rate for Payer: Multiplan Commercial |
$406.85
|
| Rate for Payer: NAPHCARE Commercial |
$54.66
|
| Rate for Payer: Preferred Network Access Commercial |
$483.13
|
| Rate for Payer: Quartz Beloit One Network |
$223.77
|
| Rate for Payer: Quartz Commercial |
$289.88
|
| Rate for Payer: Quartz Medicare Advantage |
$36.44
|
| Rate for Payer: The Alliance Commercial |
$138.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.44
|
| Rate for Payer: WEA Trust Commercial |
$279.71
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
XR Optic Foramina Right
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 70190 RT,TC
|
| Hospital Charge Code |
1537212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.39 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$317.62
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
