|
XR Chest Decubitus Right
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT 71045 TC,RT
|
| Hospital Charge Code |
2979990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.31 |
| Max. Negotiated Rate |
$569.48 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$371.40
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
XR Chest Decubitus Right
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT 71045 RT,TC
|
| Hospital Charge Code |
1536928
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.31 |
| Max. Negotiated Rate |
$569.48 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$371.40
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
XR Chest Decubitus Right
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT 71045 RT,TC
|
| Hospital Charge Code |
1536928
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.32 |
| Max. Negotiated Rate |
$2,476.00 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Aetna Managed Medicare |
$173.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$402.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.25
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$402.35
|
| Rate for Payer: Quartz Medicare Advantage |
$371.40
|
| Rate for Payer: The Alliance Commercial |
$2,476.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
XR Chest Decubitus Right
|
Professional
|
$619.00
|
|
|
Service Code
|
CPT 71045 RT,TC
|
| Hospital Charge Code |
1536928
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.36 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: The Alliance Commercial |
$309.50
|
| Rate for Payer: Aetna Commercial |
$588.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$588.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.40
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$588.05
|
| Rate for Payer: Quartz Beloit One Network |
$272.36
|
| Rate for Payer: Quartz Commercial |
$352.83
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
XR Chest Decubitus Right
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT 71045 TC,RT
|
| Hospital Charge Code |
2979990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$173.32 |
| Max. Negotiated Rate |
$2,476.00 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Aetna Managed Medicare |
$173.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$402.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.25
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$402.35
|
| Rate for Payer: Quartz Medicare Advantage |
$371.40
|
| Rate for Payer: The Alliance Commercial |
$2,476.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
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: 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: 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 Decubitus Right
|
Facility
IP
|
$499.00
|
|
|
Service Code
|
CPT 71035
|
| Hospital Charge Code |
657590
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| 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 Decubitus Right
|
Professional
|
$619.00
|
|
|
Service Code
|
CPT 71045 TC,RT
|
| Hospital Charge Code |
2979990
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$272.36 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Aetna Commercial |
$588.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$588.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.40
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$588.05
|
| Rate for Payer: Quartz Beloit One Network |
$272.36
|
| Rate for Payer: Quartz Commercial |
$352.83
|
| Rate for Payer: The Alliance Commercial |
$309.50
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
XR Chest Decubitus Right
|
Professional
|
$499.00
|
|
|
Service Code
|
CPT 71035
|
| Hospital Charge Code |
657590
|
| 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: 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 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: 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
|
Facility
OP
|
$784.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.52 |
| Max. Negotiated Rate |
$3,136.00 |
| Rate for Payer: Aetna Commercial |
$705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Aetna Managed Medicare |
$219.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.52
|
| 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: Health EOS Commercial |
$697.76
|
| Rate for Payer: HFN Commercial |
$721.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.00
|
| 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 |
$509.60
|
| Rate for Payer: Quartz Medicare Advantage |
$470.40
|
| Rate for Payer: The Alliance Commercial |
$3,136.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$580.71
|
|
|
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 |
$1,272.40 |
| 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 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 |
$1,272.40
|
| 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
|
Professional
|
$784.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.37 |
| Max. Negotiated Rate |
$744.80 |
| Rate for Payer: Aetna Commercial |
$744.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.24
|
| Rate for Payer: Aetna Managed Medicare |
$30.37
|
| Rate for Payer: Anthem Medicare Advantage |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.37
|
| 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 |
$30.37
|
| Rate for Payer: Health EOS Commercial |
$713.44
|
| 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: Independent Care Health Plan Medicare |
$30.37
|
| 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: Quartz Medicare Advantage |
$30.37
|
| Rate for Payer: The Alliance Commercial |
$115.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.37
|
| Rate for Payer: WEA Trust Commercial |
$431.20
|
| Rate for Payer: WPS Commercial |
$151.85
|
|
|
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: 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
|
Professional
|
$754.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
629726
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$716.30 |
| Rate for Payer: Aetna Commercial |
$716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$648.44
|
| Rate for Payer: Aetna Managed Medicare |
$44.84
|
| Rate for Payer: Anthem Medicare Advantage |
$44.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.84
|
| 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 |
$44.84
|
| Rate for Payer: Health EOS Commercial |
$686.14
|
| 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: Independent Care Health Plan Medicare |
$44.84
|
| 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: Quartz Medicare Advantage |
$44.84
|
| Rate for Payer: The Alliance Commercial |
$170.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.84
|
| Rate for Payer: WEA Trust Commercial |
$414.70
|
| Rate for Payer: WPS Commercial |
$224.20
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Professional
|
$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: 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
|
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: 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: 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 Minimum 4 Views w/ Fluoroscopy
|
Professional
|
$1,238.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536932
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.37 |
| 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: Aetna Managed Medicare |
$30.37
|
| Rate for Payer: Anthem Medicare Advantage |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.37
|
| 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 |
$30.37
|
| Rate for Payer: Health EOS Commercial |
$1,126.58
|
| 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: Independent Care Health Plan Medicare |
$30.37
|
| 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: Quartz Medicare Advantage |
$30.37
|
| Rate for Payer: The Alliance Commercial |
$115.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.37
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$151.85
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$4,952.00 |
| Rate for Payer: Aetna Commercial |
$1,114.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Aetna Managed Medicare |
$346.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$804.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$619.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$656.14
|
| 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: Health EOS Commercial |
$1,101.82
|
| Rate for Payer: HFN Commercial |
$1,138.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$928.50
|
| 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 |
$804.70
|
| Rate for Payer: Quartz Medicare Advantage |
$742.80
|
| Rate for Payer: The Alliance Commercial |
$4,952.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| 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: 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
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: 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 Special Views
|
Professional
|
$519.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536934
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Aetna Commercial |
$493.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| 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 |
$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 |
$16.52
|
| Rate for Payer: Health EOS Commercial |
$472.29
|
| 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 |
$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: 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 |
$285.45
|
| Rate for Payer: WPS Commercial |
$82.60
|
|
|
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: 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
|
Professional
|
$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: 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 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: 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
|
|
