|
XR Chest Decubitus Right
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 71035
|
| Hospital Charge Code |
657590
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.24
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.25
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Chest Minimum 4 Views
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536930
|
|
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
|
|
|
XR Chest Minimum 4 Views
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$721.28 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| 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 |
$415.52
|
| 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 |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| 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 |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$509.60
|
| 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 |
$431.20
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
XR Chest Minimum 4 Views
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.16 |
| Max. Negotiated Rate |
$721.28 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$721.28
|
| Rate for Payer: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Multiplan Commercial |
$627.20
|
| Rate for Payer: NAPHCARE Commercial |
$470.40
|
| Rate for Payer: Preferred Network Access Commercial |
$721.28
|
| Rate for Payer: Quartz Beloit One Network |
$384.16
|
| Rate for Payer: Quartz Commercial |
$470.40
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
XR Chest Minimum 4 Views
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
629726
|
| Min. Negotiated Rate |
$154.93 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Aetna Commercial |
$716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$648.44
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$716.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$377.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.40
|
| Rate for Payer: Health EOS Commercial |
$686.14
|
| Rate for Payer: HFN Commercial |
$716.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$154.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.93
|
| Rate for Payer: Multiplan Commercial |
$603.20
|
| Rate for Payer: Preferred Network Access Commercial |
$716.30
|
| Rate for Payer: Quartz Beloit One Network |
$331.76
|
| Rate for Payer: Quartz Commercial |
$429.78
|
| Rate for Payer: The Alliance Commercial |
$377.00
|
| Rate for Payer: WEA Trust Commercial |
$414.70
|
| Rate for Payer: WPS Commercial |
$558.49
|
|
|
XR Chest Minimum 4 Views
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
629726
|
| Min. Negotiated Rate |
$369.46 |
| Max. Negotiated Rate |
$693.68 |
| Rate for Payer: Aetna Commercial |
$678.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$648.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.62
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$693.68
|
| Rate for Payer: Health EOS Commercial |
$671.06
|
| Rate for Payer: HFN Commercial |
$693.68
|
| Rate for Payer: Multiplan Commercial |
$603.20
|
| Rate for Payer: NAPHCARE Commercial |
$452.40
|
| Rate for Payer: Preferred Network Access Commercial |
$693.68
|
| Rate for Payer: Quartz Beloit One Network |
$369.46
|
| Rate for Payer: Quartz Commercial |
$452.40
|
| Rate for Payer: WEA Trust Commercial |
$414.70
|
| Rate for Payer: WPS Commercial |
$558.49
|
|
|
XR Chest Minimum 4 Views
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
629726
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$693.68 |
| Rate for Payer: Aetna Commercial |
$678.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$648.44
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$490.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$377.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$361.92
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.62
|
| 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 |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$693.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$671.06
|
| Rate for Payer: HFN Commercial |
$693.68
|
| 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 |
$603.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$693.68
|
| Rate for Payer: Quartz Beloit One Network |
$369.46
|
| Rate for Payer: Quartz Commercial |
$490.10
|
| 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 |
$414.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$558.49
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 71034
|
| Hospital Charge Code |
629728
|
| 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 Minimum 4 Views w/ Fluoroscopy
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
CPT 71034
|
| Hospital Charge Code |
629728
|
| Min. Negotiated Rate |
$523.60 |
| 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: 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: 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 Minimum 4 Views w/ Fluoroscopy
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536932
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.31 |
| Max. Negotiated Rate |
$1,176.10 |
| Rate for Payer: Aetna Commercial |
$1,176.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,176.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$619.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.80
|
| Rate for Payer: Health EOS Commercial |
$1,126.58
|
| Rate for Payer: HFN Commercial |
$1,176.10
|
| 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 |
$990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,176.10
|
| Rate for Payer: Quartz Beloit One Network |
$544.72
|
| Rate for Payer: Quartz Commercial |
$705.66
|
| Rate for Payer: The Alliance Commercial |
$619.00
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536932
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,138.96 |
| Rate for Payer: Aetna Commercial |
$1,114.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| 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 |
$656.14
|
| 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 |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,138.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,101.82
|
| Rate for Payer: HFN Commercial |
$1,138.96
|
| 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 |
$990.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.96
|
| Rate for Payer: Quartz Beloit One Network |
$606.62
|
| Rate for Payer: Quartz Commercial |
$804.70
|
| 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 |
$680.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536932
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$606.62 |
| Max. Negotiated Rate |
$1,138.96 |
| Rate for Payer: Aetna Commercial |
$1,114.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.14
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,138.96
|
| Rate for Payer: Health EOS Commercial |
$1,101.82
|
| Rate for Payer: HFN Commercial |
$1,138.96
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: NAPHCARE Commercial |
$742.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.96
|
| Rate for Payer: Quartz Beloit One Network |
$606.62
|
| Rate for Payer: Quartz Commercial |
$742.80
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
CPT 71034
|
| Hospital Charge Code |
629728
|
| Min. Negotiated Rate |
$333.20 |
| Max. Negotiated Rate |
$4,760.00 |
| Rate for Payer: Aetna Commercial |
$1,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,023.40
|
| Rate for Payer: Aetna Managed Medicare |
$333.20
|
| 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: 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: Dean Health DHI/DHP/ASO |
$665.92
|
| 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 |
$892.50
|
| 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 |
$773.50
|
| Rate for Payer: Quartz Medicare Advantage |
$714.00
|
| Rate for Payer: The Alliance Commercial |
$4,760.00
|
| Rate for Payer: WEA Trust Commercial |
$654.50
|
| Rate for Payer: WPS Commercial |
$881.43
|
|
|
XR Chest Special Views
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536934
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Aetna Commercial |
$493.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$493.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.40
|
| Rate for Payer: Health EOS Commercial |
$472.29
|
| Rate for Payer: HFN Commercial |
$493.05
|
| 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 |
$415.20
|
| Rate for Payer: Preferred Network Access Commercial |
$493.05
|
| Rate for Payer: Quartz Beloit One Network |
$228.36
|
| Rate for Payer: Quartz Commercial |
$295.83
|
| Rate for Payer: The Alliance Commercial |
$259.50
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
XR Chest Special Views
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 71035
|
| Hospital Charge Code |
629730
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Chest Special Views
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 71035
|
| Hospital Charge Code |
629730
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$324.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.24
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$374.25
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Chest Special Views
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536934
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.31 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$311.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$311.40
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
XR Chest Special Views
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536934
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$477.48 |
| Rate for Payer: Aetna Commercial |
$467.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| 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 |
$275.07
|
| 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 |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$477.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$461.91
|
| Rate for Payer: HFN Commercial |
$477.48
|
| 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 |
$415.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$477.48
|
| Rate for Payer: Quartz Beloit One Network |
$254.31
|
| Rate for Payer: Quartz Commercial |
$337.35
|
| 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 |
$285.45
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
XR Chest Special Views
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 71035
|
| Hospital Charge Code |
629730
|
| Min. Negotiated Rate |
$219.56 |
| Max. Negotiated Rate |
$474.05 |
| Rate for Payer: Aetna Commercial |
$474.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$474.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.40
|
| Rate for Payer: Health EOS Commercial |
$454.09
|
| Rate for Payer: HFN Commercial |
$474.05
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$474.05
|
| Rate for Payer: Quartz Beloit One Network |
$219.56
|
| Rate for Payer: Quartz Commercial |
$284.43
|
| Rate for Payer: The Alliance Commercial |
$249.50
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
XR Cholangiogram Or w/ Existing Catheter
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 47505 TC
|
| Hospital Charge Code |
3072711
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$402.92 |
| Max. Negotiated Rate |
$5,756.00 |
| Rate for Payer: Aetna Commercial |
$1,295.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,237.54
|
| Rate for Payer: Aetna Managed Medicare |
$402.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$935.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$719.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.67
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,323.88
|
| Rate for Payer: Health EOS Commercial |
$1,280.71
|
| Rate for Payer: HFN Commercial |
$1,323.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,079.25
|
| Rate for Payer: Multiplan Commercial |
$1,151.20
|
| Rate for Payer: NAPHCARE Commercial |
$863.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.88
|
| Rate for Payer: Quartz Beloit One Network |
$705.11
|
| Rate for Payer: Quartz Commercial |
$935.35
|
| Rate for Payer: Quartz Medicare Advantage |
$863.40
|
| Rate for Payer: The Alliance Commercial |
$5,756.00
|
| Rate for Payer: WEA Trust Commercial |
$791.45
|
| Rate for Payer: WPS Commercial |
$1,065.87
|
|
|
XR Cholangiogram Or w/ Existing Catheter
|
Facility
|
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 47505 TC
|
| Hospital Charge Code |
3072711
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$705.11 |
| Max. Negotiated Rate |
$1,323.88 |
| Rate for Payer: Aetna Commercial |
$1,295.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,237.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.67
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,323.88
|
| Rate for Payer: Health EOS Commercial |
$1,280.71
|
| Rate for Payer: HFN Commercial |
$1,323.88
|
| Rate for Payer: Multiplan Commercial |
$1,151.20
|
| Rate for Payer: NAPHCARE Commercial |
$863.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.88
|
| Rate for Payer: Quartz Beloit One Network |
$705.11
|
| Rate for Payer: Quartz Commercial |
$863.40
|
| Rate for Payer: WEA Trust Commercial |
$791.45
|
| Rate for Payer: WPS Commercial |
$1,065.87
|
|
|
XR Cholangiogram Or w/ Existing Catheter
|
Professional
|
Both
|
$1,439.00
|
|
|
Service Code
|
CPT 47505 TC
|
| Hospital Charge Code |
3072711
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$633.16 |
| Max. Negotiated Rate |
$1,367.05 |
| Rate for Payer: Aetna Commercial |
$1,367.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,237.54
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,367.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$719.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$863.40
|
| Rate for Payer: Health EOS Commercial |
$1,309.49
|
| Rate for Payer: HFN Commercial |
$1,367.05
|
| Rate for Payer: Multiplan Commercial |
$1,151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,367.05
|
| Rate for Payer: Quartz Beloit One Network |
$633.16
|
| Rate for Payer: Quartz Commercial |
$820.23
|
| Rate for Payer: The Alliance Commercial |
$719.50
|
| Rate for Payer: WEA Trust Commercial |
$791.45
|
| Rate for Payer: WPS Commercial |
$1,065.87
|
|
|
XR Cholangiogram OR w/ Existing Catheter
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1536938
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$292.04 |
| Max. Negotiated Rate |
$4,172.00 |
| Rate for Payer: Aetna Commercial |
$938.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| Rate for Payer: Aetna Managed Medicare |
$292.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$677.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$521.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$500.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.79
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$959.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.66
|
| Rate for Payer: Health EOS Commercial |
$928.27
|
| Rate for Payer: HFN Commercial |
$959.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.25
|
| Rate for Payer: Multiplan Commercial |
$834.40
|
| Rate for Payer: NAPHCARE Commercial |
$625.80
|
| Rate for Payer: Preferred Network Access Commercial |
$959.56
|
| Rate for Payer: Quartz Beloit One Network |
$511.07
|
| Rate for Payer: Quartz Commercial |
$677.95
|
| Rate for Payer: Quartz Medicare Advantage |
$625.80
|
| Rate for Payer: The Alliance Commercial |
$4,172.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
XR Cholangiogram OR w/ Existing Catheter
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1536938
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$511.07 |
| Max. Negotiated Rate |
$959.56 |
| Rate for Payer: Aetna Commercial |
$938.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.79
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$959.56
|
| Rate for Payer: Health EOS Commercial |
$928.27
|
| Rate for Payer: HFN Commercial |
$959.56
|
| Rate for Payer: Multiplan Commercial |
$834.40
|
| Rate for Payer: NAPHCARE Commercial |
$625.80
|
| Rate for Payer: Preferred Network Access Commercial |
$959.56
|
| Rate for Payer: Quartz Beloit One Network |
$511.07
|
| Rate for Payer: Quartz Commercial |
$625.80
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
XR Cholangiogram Perc Transhepatic
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
CPT 74320 TC
|
| Hospital Charge Code |
3072712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,392.00 |
| Rate for Payer: Aetna Commercial |
$1,888.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,804.28
|
| Rate for Payer: Aetna Managed Medicare |
$587.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,363.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,049.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,007.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,111.94
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$1,930.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,174.04
|
| Rate for Payer: Health EOS Commercial |
$1,867.22
|
| Rate for Payer: HFN Commercial |
$1,930.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,573.50
|
| Rate for Payer: Multiplan Commercial |
$1,678.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,258.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,930.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,028.02
|
| Rate for Payer: Quartz Commercial |
$1,363.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,258.80
|
| Rate for Payer: The Alliance Commercial |
$8,392.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,153.90
|
| Rate for Payer: WPS Commercial |
$1,553.99
|
|
