|
XR Chest 1 View Frontal
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
CPT 71010
|
| Hospital Charge Code |
629716
|
| Min. Negotiated Rate |
$174.68 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Aetna Commercial |
$377.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.42
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$377.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.20
|
| Rate for Payer: Health EOS Commercial |
$361.27
|
| Rate for Payer: HFN Commercial |
$377.15
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$377.15
|
| Rate for Payer: Quartz Beloit One Network |
$174.68
|
| Rate for Payer: Quartz Commercial |
$226.29
|
| Rate for Payer: The Alliance Commercial |
$198.50
|
| Rate for Payer: WEA Trust Commercial |
$218.35
|
| Rate for Payer: WPS Commercial |
$294.06
|
|
|
XR Chest 1 View Frontal
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Aetna Commercial |
$459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$459.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$242.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.40
|
| Rate for Payer: Health EOS Commercial |
$440.44
|
| Rate for Payer: HFN Commercial |
$459.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.09
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Preferred Network Access Commercial |
$459.80
|
| Rate for Payer: Quartz Beloit One Network |
$212.96
|
| Rate for Payer: Quartz Commercial |
$275.88
|
| Rate for Payer: The Alliance Commercial |
$242.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
XR Chest 1 View Frontal
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| 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 |
$256.52
|
| 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 |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| 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 |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| 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 |
$266.20
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
XR Chest 1 View Frontal
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 71010
|
| Hospital Charge Code |
629716
|
| Min. Negotiated Rate |
$111.16 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Aetna Commercial |
$357.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.42
|
| Rate for Payer: Aetna Managed Medicare |
$111.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$258.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.41
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$365.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.16
|
| Rate for Payer: Health EOS Commercial |
$353.33
|
| Rate for Payer: HFN Commercial |
$365.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: NAPHCARE Commercial |
$238.20
|
| Rate for Payer: Preferred Network Access Commercial |
$365.24
|
| Rate for Payer: Quartz Beloit One Network |
$194.53
|
| Rate for Payer: Quartz Commercial |
$258.05
|
| Rate for Payer: Quartz Medicare Advantage |
$238.20
|
| Rate for Payer: The Alliance Commercial |
$1,588.00
|
| Rate for Payer: WEA Trust Commercial |
$218.35
|
| Rate for Payer: WPS Commercial |
$294.06
|
|
|
XR Chest 1 View Frontal
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 71010
|
| Hospital Charge Code |
629716
|
| Min. Negotiated Rate |
$194.53 |
| Max. Negotiated Rate |
$365.24 |
| Rate for Payer: Aetna Commercial |
$357.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.41
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$365.24
|
| Rate for Payer: Health EOS Commercial |
$353.33
|
| Rate for Payer: HFN Commercial |
$365.24
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: NAPHCARE Commercial |
$238.20
|
| Rate for Payer: Preferred Network Access Commercial |
$365.24
|
| Rate for Payer: Quartz Beloit One Network |
$194.53
|
| Rate for Payer: Quartz Commercial |
$238.20
|
| Rate for Payer: WEA Trust Commercial |
$218.35
|
| Rate for Payer: WPS Commercial |
$294.06
|
|
|
XR Chest 1 View Frontal
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
XR Chest 2 Views
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$234.22 |
| Max. Negotiated Rate |
$439.76 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.34
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$286.80
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$286.80
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
XR Chest 2 Views
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.70 |
| Max. Negotiated Rate |
$454.10 |
| Rate for Payer: Aetna Commercial |
$454.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$454.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.80
|
| Rate for Payer: Health EOS Commercial |
$434.98
|
| Rate for Payer: HFN Commercial |
$454.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.70
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.10
|
| Rate for Payer: Quartz Beloit One Network |
$210.32
|
| Rate for Payer: Quartz Commercial |
$272.46
|
| Rate for Payer: The Alliance Commercial |
$239.00
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
XR Chest 2 Views
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$259.21 |
| Max. Negotiated Rate |
$486.68 |
| Rate for Payer: Aetna Commercial |
$476.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.37
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$486.68
|
| Rate for Payer: Health EOS Commercial |
$470.81
|
| Rate for Payer: HFN Commercial |
$486.68
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: NAPHCARE Commercial |
$317.40
|
| Rate for Payer: Preferred Network Access Commercial |
$486.68
|
| Rate for Payer: Quartz Beloit One Network |
$259.21
|
| Rate for Payer: Quartz Commercial |
$317.40
|
| Rate for Payer: WEA Trust Commercial |
$290.95
|
| Rate for Payer: WPS Commercial |
$391.83
|
|
|
XR Chest 2 Views
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$486.68 |
| Rate for Payer: Aetna Commercial |
$476.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.94
|
| 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 |
$280.37
|
| 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 |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$486.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$470.81
|
| Rate for Payer: HFN Commercial |
$486.68
|
| 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 |
$423.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$486.68
|
| Rate for Payer: Quartz Beloit One Network |
$259.21
|
| Rate for Payer: Quartz Commercial |
$343.85
|
| 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 |
$290.95
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$391.83
|
|
|
XR Chest 2 Views
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$439.76 |
| Rate for Payer: Aetna Commercial |
$430.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| 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 |
$253.34
|
| 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 |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$439.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$425.42
|
| Rate for Payer: HFN Commercial |
$439.76
|
| 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 |
$382.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$439.76
|
| Rate for Payer: Quartz Beloit One Network |
$234.22
|
| Rate for Payer: Quartz Commercial |
$310.70
|
| 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 |
$262.90
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
XR Chest 2 Views
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$502.55 |
| Rate for Payer: Aetna Commercial |
$502.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.94
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$502.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$264.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$481.39
|
| Rate for Payer: HFN Commercial |
$502.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.95
|
| Rate for Payer: Multiplan Commercial |
$423.20
|
| Rate for Payer: Preferred Network Access Commercial |
$502.55
|
| Rate for Payer: Quartz Beloit One Network |
$232.76
|
| Rate for Payer: Quartz Commercial |
$301.53
|
| Rate for Payer: The Alliance Commercial |
$264.50
|
| Rate for Payer: WEA Trust Commercial |
$290.95
|
| Rate for Payer: WPS Commercial |
$391.83
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
CPT 71047 TC
|
| Hospital Charge Code |
1536917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$97.82 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Aetna Commercial |
$665.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.86
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$665.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$350.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.60
|
| Rate for Payer: Health EOS Commercial |
$637.91
|
| Rate for Payer: HFN Commercial |
$665.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.82
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: Preferred Network Access Commercial |
$665.95
|
| Rate for Payer: Quartz Beloit One Network |
$308.44
|
| Rate for Payer: Quartz Commercial |
$399.57
|
| Rate for Payer: The Alliance Commercial |
$350.50
|
| Rate for Payer: WEA Trust Commercial |
$385.55
|
| Rate for Payer: WPS Commercial |
$519.23
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 71047 TC
|
| Hospital Charge Code |
1536917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$644.92 |
| Rate for Payer: Aetna Commercial |
$630.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.86
|
| 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 |
$371.53
|
| 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 |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$644.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$623.89
|
| Rate for Payer: HFN Commercial |
$644.92
|
| 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 |
$560.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$644.92
|
| Rate for Payer: Quartz Beloit One Network |
$343.49
|
| Rate for Payer: Quartz Commercial |
$455.65
|
| 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 |
$385.55
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$519.23
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Professional
|
Both
|
$674.00
|
|
|
Service Code
|
CPT 71021
|
| Hospital Charge Code |
629720
|
| Min. Negotiated Rate |
$296.56 |
| Max. Negotiated Rate |
$640.30 |
| Rate for Payer: Aetna Commercial |
$640.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$579.64
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$640.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$337.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.40
|
| Rate for Payer: Health EOS Commercial |
$613.34
|
| Rate for Payer: HFN Commercial |
$640.30
|
| Rate for Payer: Multiplan Commercial |
$539.20
|
| Rate for Payer: Preferred Network Access Commercial |
$640.30
|
| Rate for Payer: Quartz Beloit One Network |
$296.56
|
| Rate for Payer: Quartz Commercial |
$384.18
|
| Rate for Payer: The Alliance Commercial |
$337.00
|
| Rate for Payer: WEA Trust Commercial |
$370.70
|
| Rate for Payer: WPS Commercial |
$499.23
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Facility
|
IP
|
$701.00
|
|
|
Service Code
|
CPT 71047 TC
|
| Hospital Charge Code |
1536917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$343.49 |
| Max. Negotiated Rate |
$644.92 |
| Rate for Payer: Aetna Commercial |
$630.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.53
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$644.92
|
| Rate for Payer: Health EOS Commercial |
$623.89
|
| Rate for Payer: HFN Commercial |
$644.92
|
| Rate for Payer: Multiplan Commercial |
$560.80
|
| Rate for Payer: NAPHCARE Commercial |
$420.60
|
| Rate for Payer: Preferred Network Access Commercial |
$644.92
|
| Rate for Payer: Quartz Beloit One Network |
$343.49
|
| Rate for Payer: Quartz Commercial |
$420.60
|
| Rate for Payer: WEA Trust Commercial |
$385.55
|
| Rate for Payer: WPS Commercial |
$519.23
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 71021
|
| Hospital Charge Code |
629720
|
| Min. Negotiated Rate |
$330.26 |
| Max. Negotiated Rate |
$620.08 |
| Rate for Payer: Aetna Commercial |
$606.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$579.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.22
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$620.08
|
| Rate for Payer: Health EOS Commercial |
$599.86
|
| Rate for Payer: HFN Commercial |
$620.08
|
| Rate for Payer: Multiplan Commercial |
$539.20
|
| Rate for Payer: NAPHCARE Commercial |
$404.40
|
| Rate for Payer: Preferred Network Access Commercial |
$620.08
|
| Rate for Payer: Quartz Beloit One Network |
$330.26
|
| Rate for Payer: Quartz Commercial |
$404.40
|
| Rate for Payer: WEA Trust Commercial |
$370.70
|
| Rate for Payer: WPS Commercial |
$499.23
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Facility
|
OP
|
$674.00
|
|
|
Service Code
|
CPT 71021
|
| Hospital Charge Code |
629720
|
| Min. Negotiated Rate |
$188.72 |
| Max. Negotiated Rate |
$2,696.00 |
| Rate for Payer: Aetna Commercial |
$606.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$579.64
|
| Rate for Payer: Aetna Managed Medicare |
$188.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$438.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$323.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$357.22
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$620.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$377.17
|
| Rate for Payer: Health EOS Commercial |
$599.86
|
| Rate for Payer: HFN Commercial |
$620.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.50
|
| Rate for Payer: Multiplan Commercial |
$539.20
|
| Rate for Payer: NAPHCARE Commercial |
$404.40
|
| Rate for Payer: Preferred Network Access Commercial |
$620.08
|
| Rate for Payer: Quartz Beloit One Network |
$330.26
|
| Rate for Payer: Quartz Commercial |
$438.10
|
| Rate for Payer: Quartz Medicare Advantage |
$404.40
|
| Rate for Payer: The Alliance Commercial |
$2,696.00
|
| Rate for Payer: WEA Trust Commercial |
$370.70
|
| Rate for Payer: WPS Commercial |
$499.23
|
|
|
XR Chest 2 Views w/ Fluoroscopy
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629722
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,094.80 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$773.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$595.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$571.20
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.70
|
| 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 |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$665.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$1,059.10
|
| Rate for Payer: HFN Commercial |
$1,094.80
|
| 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 |
$952.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.80
|
| Rate for Payer: Quartz Beloit One Network |
$583.10
|
| Rate for Payer: Quartz Commercial |
$773.50
|
| 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: WEA Trust Commercial |
$654.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
XR Chest 2 Views w/ Fluoroscopy
|
Facility
|
OP
|
$1,237.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
1536919
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,138.04 |
| Rate for Payer: Aetna Commercial |
$1,113.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,063.82
|
| 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 |
$655.61
|
| 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 |
$371.10
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cigna Commercial |
$1,138.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$1,100.93
|
| Rate for Payer: HFN Commercial |
$1,138.04
|
| 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 |
$989.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.04
|
| Rate for Payer: Quartz Beloit One Network |
$606.13
|
| Rate for Payer: Quartz Commercial |
$804.05
|
| 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 |
$680.35
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$916.25
|
|
|
XR Chest 2 Views w/ Fluoroscopy
|
Professional
|
Both
|
$1,237.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
1536919
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$1,175.15 |
| Rate for Payer: Aetna Commercial |
$1,175.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,063.82
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cigna Commercial |
$1,175.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$618.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.20
|
| Rate for Payer: Health EOS Commercial |
$1,125.67
|
| Rate for Payer: HFN Commercial |
$1,175.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.95
|
| Rate for Payer: Multiplan Commercial |
$989.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.15
|
| Rate for Payer: Quartz Beloit One Network |
$544.28
|
| Rate for Payer: Quartz Commercial |
$705.09
|
| Rate for Payer: The Alliance Commercial |
$618.50
|
| Rate for Payer: WEA Trust Commercial |
$680.35
|
| Rate for Payer: WPS Commercial |
$916.25
|
|
|
XR Chest 2 Views w/ Fluoroscopy
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629722
|
| Min. Negotiated Rate |
$583.10 |
| Max. Negotiated Rate |
$1,094.80 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$630.70
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,094.80
|
| Rate for Payer: Health EOS Commercial |
$1,059.10
|
| Rate for Payer: HFN Commercial |
$1,094.80
|
| Rate for Payer: Multiplan Commercial |
$952.00
|
| Rate for Payer: NAPHCARE Commercial |
$714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.80
|
| Rate for Payer: Quartz Beloit One Network |
$583.10
|
| Rate for Payer: Quartz Commercial |
$714.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
XR Chest 2 Views w/ Fluoroscopy
|
Facility
|
IP
|
$1,237.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
1536919
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$606.13 |
| Max. Negotiated Rate |
$1,138.04 |
| Rate for Payer: Aetna Commercial |
$1,113.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,063.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.61
|
| Rate for Payer: Cash Price |
$371.10
|
| Rate for Payer: Cigna Commercial |
$1,138.04
|
| Rate for Payer: Health EOS Commercial |
$1,100.93
|
| Rate for Payer: HFN Commercial |
$1,138.04
|
| Rate for Payer: Multiplan Commercial |
$989.60
|
| Rate for Payer: NAPHCARE Commercial |
$742.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.04
|
| Rate for Payer: Quartz Beloit One Network |
$606.13
|
| Rate for Payer: Quartz Commercial |
$742.20
|
| Rate for Payer: WEA Trust Commercial |
$680.35
|
| Rate for Payer: WPS Commercial |
$916.25
|
|
|
XR Chest 2 Views w/ Fluoroscopy
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629722
|
| Min. Negotiated Rate |
$113.70 |
| Max. Negotiated Rate |
$1,130.50 |
| Rate for Payer: Aetna Commercial |
$1,130.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,130.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$595.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.00
|
| Rate for Payer: Health EOS Commercial |
$1,082.90
|
| Rate for Payer: HFN Commercial |
$1,130.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.70
|
| Rate for Payer: Multiplan Commercial |
$952.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,130.50
|
| Rate for Payer: Quartz Beloit One Network |
$523.60
|
| Rate for Payer: Quartz Commercial |
$678.30
|
| Rate for Payer: The Alliance Commercial |
$595.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
XR Chest 2 Views w/ Obliques
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536921
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.31 |
| Max. Negotiated Rate |
$744.80 |
| Rate for Payer: Aetna Commercial |
$744.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$744.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$392.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$470.40
|
| Rate for Payer: Health EOS Commercial |
$713.44
|
| Rate for Payer: HFN Commercial |
$744.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.31
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: Preferred Network Access Commercial |
$744.80
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$446.88
|
| Rate for Payer: The Alliance Commercial |
$392.00
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
