|
XR Abdomen AP Obliques Cone Views
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 74019 TC
|
| Hospital Charge Code |
1536805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.70 |
| Max. Negotiated Rate |
$487.60 |
| Rate for Payer: Aetna Commercial |
$477.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.90
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$487.60
|
| Rate for Payer: Health EOS Commercial |
$471.70
|
| Rate for Payer: HFN Commercial |
$487.60
|
| Rate for Payer: Multiplan Commercial |
$424.00
|
| Rate for Payer: NAPHCARE Commercial |
$318.00
|
| Rate for Payer: Preferred Network Access Commercial |
$487.60
|
| Rate for Payer: Quartz Beloit One Network |
$259.70
|
| Rate for Payer: Quartz Commercial |
$318.00
|
| Rate for Payer: WEA Trust Commercial |
$291.50
|
| Rate for Payer: WPS Commercial |
$392.57
|
|
|
XR Abdomen AP Obliques Cone Views
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 74019 TC
|
| Hospital Charge Code |
1536805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$487.60 |
| Rate for Payer: Aetna Commercial |
$477.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.80
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$487.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$471.70
|
| Rate for Payer: HFN Commercial |
$487.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$424.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$487.60
|
| Rate for Payer: Quartz Beloit One Network |
$259.70
|
| Rate for Payer: Quartz Commercial |
$344.50
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$291.50
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$392.57
|
|
|
XR Abdomen AP Obliques Cone Views
|
Professional
|
Both
|
$530.00
|
|
|
Service Code
|
CPT 74019 TC
|
| Hospital Charge Code |
1536805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$503.50 |
| Rate for Payer: Aetna Commercial |
$503.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.80
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$503.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.00
|
| Rate for Payer: Health EOS Commercial |
$482.30
|
| Rate for Payer: HFN Commercial |
$503.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$424.00
|
| Rate for Payer: Preferred Network Access Commercial |
$503.50
|
| Rate for Payer: Quartz Beloit One Network |
$233.20
|
| Rate for Payer: Quartz Commercial |
$302.10
|
| Rate for Payer: The Alliance Commercial |
$265.00
|
| Rate for Payer: WEA Trust Commercial |
$291.50
|
| Rate for Payer: WPS Commercial |
$392.57
|
|
|
XR Abdomen AP Obliques Cone Views
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 74010
|
| Hospital Charge Code |
625616
|
| Min. Negotiated Rate |
$142.80 |
| Max. Negotiated Rate |
$2,040.00 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Aetna Managed Medicare |
$142.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.30
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.40
|
| Rate for Payer: Health EOS Commercial |
$453.90
|
| Rate for Payer: HFN Commercial |
$469.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.50
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: NAPHCARE Commercial |
$306.00
|
| Rate for Payer: Preferred Network Access Commercial |
$469.20
|
| Rate for Payer: Quartz Beloit One Network |
$249.90
|
| Rate for Payer: Quartz Commercial |
$331.50
|
| Rate for Payer: Quartz Medicare Advantage |
$306.00
|
| Rate for Payer: The Alliance Commercial |
$2,040.00
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
CPT 74021 TC
|
| Hospital Charge Code |
1536807
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.15 |
| Max. Negotiated Rate |
$579.50 |
| Rate for Payer: Aetna Commercial |
$579.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$579.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$305.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.00
|
| Rate for Payer: Health EOS Commercial |
$555.10
|
| Rate for Payer: HFN Commercial |
$579.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.15
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Preferred Network Access Commercial |
$579.50
|
| Rate for Payer: Quartz Beloit One Network |
$268.40
|
| Rate for Payer: Quartz Commercial |
$347.70
|
| Rate for Payer: The Alliance Commercial |
$305.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 74021 TC
|
| Hospital Charge Code |
1536807
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$561.20 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$341.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$396.50
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 74020
|
| Hospital Charge Code |
625618
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Aetna Managed Medicare |
$158.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.17
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.75
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$367.25
|
| Rate for Payer: Quartz Medicare Advantage |
$339.00
|
| Rate for Payer: The Alliance Commercial |
$2,260.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 74021 TC
|
| Hospital Charge Code |
1536807
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$561.20 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 74020
|
| Hospital Charge Code |
625618
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Abdomen Complete w/ Decub/Erect
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
CPT 74020
|
| Hospital Charge Code |
625618
|
| Min. Negotiated Rate |
$248.60 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Aetna Commercial |
$536.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$536.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.00
|
| Rate for Payer: Health EOS Commercial |
$514.15
|
| Rate for Payer: HFN Commercial |
$536.75
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Preferred Network Access Commercial |
$536.75
|
| Rate for Payer: Quartz Beloit One Network |
$248.60
|
| Rate for Payer: Quartz Commercial |
$322.05
|
| Rate for Payer: The Alliance Commercial |
$282.50
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Facility
|
IP
|
$945.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
625630
|
| Min. Negotiated Rate |
$463.05 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Aetna Commercial |
$850.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$812.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.85
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$869.40
|
| Rate for Payer: Health EOS Commercial |
$841.05
|
| Rate for Payer: HFN Commercial |
$869.40
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: NAPHCARE Commercial |
$567.00
|
| Rate for Payer: Preferred Network Access Commercial |
$869.40
|
| Rate for Payer: Quartz Beloit One Network |
$463.05
|
| Rate for Payer: Quartz Commercial |
$567.00
|
| Rate for Payer: WEA Trust Commercial |
$519.75
|
| Rate for Payer: WPS Commercial |
$699.96
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
1536809
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
1536809
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.25 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$969.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$969.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$510.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$612.00
|
| Rate for Payer: Health EOS Commercial |
$928.20
|
| Rate for Payer: HFN Commercial |
$969.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.25
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Preferred Network Access Commercial |
$969.00
|
| Rate for Payer: Quartz Beloit One Network |
$448.80
|
| Rate for Payer: Quartz Commercial |
$581.40
|
| Rate for Payer: The Alliance Commercial |
$510.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Facility
|
OP
|
$945.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
625630
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$869.40 |
| Rate for Payer: Aetna Commercial |
$850.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$812.70
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$614.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$472.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$453.60
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$869.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$528.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$841.05
|
| Rate for Payer: HFN Commercial |
$869.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$869.40
|
| Rate for Payer: Quartz Beloit One Network |
$463.05
|
| Rate for Payer: Quartz Commercial |
$614.25
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$519.75
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$699.96
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 74022 TC
|
| Hospital Charge Code |
1536809
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
XR Abdomen Series w/ Chest 1 View
|
Professional
|
Both
|
$945.00
|
|
|
Service Code
|
CPT 74022
|
| Hospital Charge Code |
625630
|
| Min. Negotiated Rate |
$168.95 |
| Max. Negotiated Rate |
$897.75 |
| Rate for Payer: Aetna Commercial |
$897.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$812.70
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cash Price |
$283.50
|
| Rate for Payer: Cigna Commercial |
$897.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$472.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$567.00
|
| Rate for Payer: Health EOS Commercial |
$859.95
|
| Rate for Payer: HFN Commercial |
$897.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.95
|
| Rate for Payer: Multiplan Commercial |
$756.00
|
| Rate for Payer: Preferred Network Access Commercial |
$897.75
|
| Rate for Payer: Quartz Beloit One Network |
$415.80
|
| Rate for Payer: Quartz Commercial |
$538.65
|
| Rate for Payer: The Alliance Commercial |
$472.50
|
| Rate for Payer: WEA Trust Commercial |
$519.75
|
| Rate for Payer: WPS Commercial |
$699.96
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$522.50 |
| Rate for Payer: Aetna Commercial |
$522.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$522.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.00
|
| Rate for Payer: Health EOS Commercial |
$500.50
|
| Rate for Payer: HFN Commercial |
$522.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.18
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$522.50
|
| Rate for Payer: Quartz Beloit One Network |
$242.00
|
| Rate for Payer: Quartz Commercial |
$313.50
|
| Rate for Payer: The Alliance Commercial |
$275.00
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.50
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Health EOS Commercial |
$489.50
|
| Rate for Payer: HFN Commercial |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: NAPHCARE Commercial |
$330.00
|
| Rate for Payer: Preferred Network Access Commercial |
$506.00
|
| Rate for Payer: Quartz Beloit One Network |
$269.50
|
| Rate for Payer: Quartz Commercial |
$330.00
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$291.06 |
| Max. Negotiated Rate |
$546.48 |
| Rate for Payer: Aetna Commercial |
$534.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.82
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$546.48
|
| Rate for Payer: Health EOS Commercial |
$528.66
|
| Rate for Payer: HFN Commercial |
$546.48
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: NAPHCARE Commercial |
$356.40
|
| Rate for Payer: Preferred Network Access Commercial |
$546.48
|
| Rate for Payer: Quartz Beloit One Network |
$291.06
|
| Rate for Payer: Quartz Commercial |
$356.40
|
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: WPS Commercial |
$439.98
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.84
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$564.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$356.40
|
| Rate for Payer: Health EOS Commercial |
$540.54
|
| Rate for Payer: HFN Commercial |
$564.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.18
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$564.30
|
| Rate for Payer: Quartz Beloit One Network |
$261.36
|
| Rate for Payer: Quartz Commercial |
$338.58
|
| Rate for Payer: The Alliance Commercial |
$297.00
|
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: WPS Commercial |
$439.98
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625648
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$489.50
|
| Rate for Payer: HFN Commercial |
$506.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$506.00
|
| Rate for Payer: Quartz Beloit One Network |
$269.50
|
| Rate for Payer: Quartz Commercial |
$357.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
XR AC Joints Bilateral w/ + w/o wts
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536799
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$546.48 |
| Rate for Payer: Aetna Commercial |
$534.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.84
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$546.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$528.66
|
| Rate for Payer: HFN Commercial |
$546.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$546.48
|
| Rate for Payer: Quartz Beloit One Network |
$291.06
|
| Rate for Payer: Quartz Commercial |
$386.10
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$439.98
|
|
|
XR AC Joints Bilateral w/ wts
|
Facility
|
IP
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$343.20
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
XR AC Joints Bilateral w/ wts
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
625646
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.20
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.18
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: The Alliance Commercial |
$286.00
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
|
XR AC Joints Bilateral w/ wts
|
Professional
|
Both
|
$572.00
|
|
|
Service Code
|
CPT 73050 TC
|
| Hospital Charge Code |
1536801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.18 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cash Price |
$171.60
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.20
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.18
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: The Alliance Commercial |
$286.00
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.68
|
|
