|
XR Calcaneous Right
|
Facility
OP
|
$316.00
|
|
|
Service Code
|
CPT 73650 TC,RT
|
| Hospital Charge Code |
2980068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.48 |
| Max. Negotiated Rate |
$1,264.00 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$88.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$205.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$151.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.00
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$205.40
|
| Rate for Payer: Quartz Medicare Advantage |
$189.60
|
| Rate for Payer: The Alliance Commercial |
$1,264.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
XR Calcaneous Right
|
Professional
|
$316.00
|
|
|
Service Code
|
CPT 73650 RT,TC
|
| Hospital Charge Code |
1536911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.04 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.60
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: The Alliance Commercial |
$158.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
XR Calcaneous Right
|
Professional
|
$316.00
|
|
|
Service Code
|
CPT 73650 TC,RT
|
| Hospital Charge Code |
2980068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.04 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.60
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: The Alliance Commercial |
$158.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
XR Calcaneous Right
|
Facility
OP
|
$316.00
|
|
|
Service Code
|
CPT 73650 RT,TC
|
| Hospital Charge Code |
1536911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$88.48 |
| Max. Negotiated Rate |
$1,264.00 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$88.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$205.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$151.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.00
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$205.40
|
| Rate for Payer: Quartz Medicare Advantage |
$189.60
|
| Rate for Payer: The Alliance Commercial |
$1,264.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
XR Calcaneous Right
|
Facility
IP
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629620
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Chest 1 View, Abdomen 1 View
|
Facility
IP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
6210073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| 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 1 View, Abdomen 1 View
|
Professional
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
6210073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Aetna Commercial |
$459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$16.52
|
| Rate for Payer: Anthem Medicare Advantage |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.52
|
| 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 |
$16.52
|
| Rate for Payer: Health EOS Commercial |
$440.44
|
| 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: Independent Care Health Plan Medicare |
$16.52
|
| 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: Quartz Medicare Advantage |
$16.52
|
| Rate for Payer: The Alliance Commercial |
$62.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.52
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$82.60
|
|
|
XR Chest 1 View, Abdomen 1 View
|
Facility
OP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
6210073
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| 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: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| 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 |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| 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: 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: 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
|
Professional
|
$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: 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
|
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: 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 1 View Frontal
|
Facility
OP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| 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: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| 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 |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
XR Chest 1 View Frontal
|
Professional
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536915
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Aetna Commercial |
$459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$16.52
|
| Rate for Payer: Anthem Medicare Advantage |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.52
|
| 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 |
$16.52
|
| Rate for Payer: Health EOS Commercial |
$440.44
|
| 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: Independent Care Health Plan Medicare |
$16.52
|
| 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: Quartz Medicare Advantage |
$16.52
|
| Rate for Payer: The Alliance Commercial |
$62.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.52
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$82.60
|
|
|
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: 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 2 Views
|
Professional
|
$478.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.46 |
| Max. Negotiated Rate |
$454.10 |
| Rate for Payer: Aetna Commercial |
$454.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Aetna Managed Medicare |
$32.46
|
| Rate for Payer: Anthem Medicare Advantage |
$32.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.46
|
| 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 |
$32.46
|
| Rate for Payer: Health EOS Commercial |
$434.98
|
| 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: Independent Care Health Plan Medicare |
$32.46
|
| 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: Quartz Medicare Advantage |
$32.46
|
| Rate for Payer: The Alliance Commercial |
$123.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.46
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$162.30
|
|
|
XR Chest 2 Views
|
Professional
|
$529.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$502.55 |
| Rate for Payer: Aetna Commercial |
$502.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.94
|
| Rate for Payer: Aetna Managed Medicare |
$22.32
|
| Rate for Payer: Anthem Medicare Advantage |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.32
|
| 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 |
$22.32
|
| Rate for Payer: Health EOS Commercial |
$481.39
|
| 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: Independent Care Health Plan Medicare |
$22.32
|
| 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: Quartz Medicare Advantage |
$22.32
|
| Rate for Payer: The Alliance Commercial |
$84.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.32
|
| Rate for Payer: WEA Trust Commercial |
$290.95
|
| Rate for Payer: WPS Commercial |
$111.60
|
|
|
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 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 |
$396.80
|
| 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
|
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: 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
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: 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
|
Facility
OP
|
$529.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.12 |
| Max. Negotiated Rate |
$2,116.00 |
| Rate for Payer: Aetna Commercial |
$476.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.94
|
| Rate for Payer: Aetna Managed Medicare |
$148.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$343.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$264.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$253.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.37
|
| 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: Health EOS Commercial |
$470.81
|
| Rate for Payer: HFN Commercial |
$486.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.75
|
| 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 |
$343.85
|
| Rate for Payer: Quartz Medicare Advantage |
$317.40
|
| Rate for Payer: The Alliance Commercial |
$2,116.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$290.95
|
| Rate for Payer: WPS Commercial |
$391.83
|
|
|
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: 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: 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
|
Professional
|
$701.00
|
|
|
Service Code
|
CPT 71047 TC
|
| Hospital Charge Code |
1536917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$665.95 |
| Rate for Payer: Aetna Commercial |
$665.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.11
|
| Rate for Payer: Anthem Medicare Advantage |
$28.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.11
|
| 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 |
$28.11
|
| Rate for Payer: Health EOS Commercial |
$637.91
|
| 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: Independent Care Health Plan Medicare |
$28.11
|
| 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: Quartz Medicare Advantage |
$28.11
|
| Rate for Payer: The Alliance Commercial |
$106.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.11
|
| Rate for Payer: WEA Trust Commercial |
$385.55
|
| Rate for Payer: WPS Commercial |
$140.55
|
|
|
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 |
$196.28 |
| Max. Negotiated Rate |
$2,804.00 |
| Rate for Payer: Aetna Commercial |
$630.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.86
|
| Rate for Payer: Aetna Managed Medicare |
$196.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$455.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$350.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.53
|
| 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: Health EOS Commercial |
$623.89
|
| Rate for Payer: HFN Commercial |
$644.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.75
|
| 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 |
$455.65
|
| Rate for Payer: Quartz Medicare Advantage |
$420.60
|
| Rate for Payer: The Alliance Commercial |
$2,804.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$385.55
|
| Rate for Payer: WPS Commercial |
$519.23
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Professional
|
$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: 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
|
|
