|
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
|
$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
|
|
|
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: 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
|
$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: 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
|
$1,439.00
|
|
|
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
|
$1,043.00
|
|
|
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: 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 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 |
$4,840.40 |
| 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: 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: 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 |
$4,840.40
|
| 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 Perc Transhepatic
|
Professional
|
$2,098.00
|
|
|
Service Code
|
CPT 74320 TC
|
| Hospital Charge Code |
3072712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$923.12 |
| Max. Negotiated Rate |
$1,993.10 |
| Rate for Payer: Aetna Commercial |
$1,993.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,804.28
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$1,993.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,049.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,258.80
|
| Rate for Payer: Health EOS Commercial |
$1,909.18
|
| Rate for Payer: Multiplan Commercial |
$1,678.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,993.10
|
| Rate for Payer: Quartz Beloit One Network |
$923.12
|
| Rate for Payer: Quartz Commercial |
$1,195.86
|
| Rate for Payer: The Alliance Commercial |
$1,049.00
|
| Rate for Payer: WEA Trust Commercial |
$1,153.90
|
| Rate for Payer: WPS Commercial |
$1,553.99
|
|
|
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: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$1,930.16
|
| 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
|
|
|
XR Cholangiogram Perc Transhepatic
|
Facility
IP
|
$2,098.00
|
|
|
Service Code
|
CPT 74320 TC
|
| Hospital Charge Code |
3072712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,028.02 |
| Max. Negotiated Rate |
$1,930.16 |
| Rate for Payer: Aetna Commercial |
$1,888.20
|
| 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: Cigna Commercial |
$1,930.16
|
| Rate for Payer: Health EOS Commercial |
$1,867.22
|
| Rate for Payer: HFN Commercial |
$1,930.16
|
| 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 |
$1,258.80
|
| Rate for Payer: WEA Trust Commercial |
$1,153.90
|
| Rate for Payer: WPS Commercial |
$1,553.99
|
|
|
XR Cisternography
|
Professional
|
$1,350.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
1536948
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.40 |
| Max. Negotiated Rate |
$1,282.50 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.00
|
| Rate for Payer: Aetna Managed Medicare |
$163.40
|
| Rate for Payer: Anthem Medicare Advantage |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$163.40
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,282.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$675.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.40
|
| Rate for Payer: Health EOS Commercial |
$1,228.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$580.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$580.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$163.40
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,282.50
|
| Rate for Payer: Quartz Beloit One Network |
$594.00
|
| Rate for Payer: Quartz Commercial |
$769.50
|
| Rate for Payer: Quartz Medicare Advantage |
$163.40
|
| Rate for Payer: The Alliance Commercial |
$620.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$163.40
|
| Rate for Payer: WEA Trust Commercial |
$742.50
|
| Rate for Payer: WPS Commercial |
$817.00
|
|
|
XR Cisternography
|
Facility
IP
|
$1,298.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
629746
|
| Min. Negotiated Rate |
$636.02 |
| Max. Negotiated Rate |
$1,194.16 |
| Rate for Payer: Aetna Commercial |
$1,168.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$687.94
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,194.16
|
| Rate for Payer: Health EOS Commercial |
$1,155.22
|
| Rate for Payer: HFN Commercial |
$1,194.16
|
| Rate for Payer: Multiplan Commercial |
$1,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,194.16
|
| Rate for Payer: Quartz Beloit One Network |
$636.02
|
| Rate for Payer: Quartz Commercial |
$778.80
|
| Rate for Payer: WEA Trust Commercial |
$713.90
|
| Rate for Payer: WPS Commercial |
$961.43
|
|
|
XR Cisternography
|
Professional
|
$1,298.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
629746
|
| Min. Negotiated Rate |
$163.40 |
| Max. Negotiated Rate |
$1,233.10 |
| Rate for Payer: Aetna Commercial |
$1,233.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,116.28
|
| Rate for Payer: Aetna Managed Medicare |
$163.40
|
| Rate for Payer: Anthem Medicare Advantage |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$163.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,233.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$649.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.40
|
| Rate for Payer: Health EOS Commercial |
$1,181.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$580.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$580.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$163.40
|
| Rate for Payer: Multiplan Commercial |
$1,038.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,233.10
|
| Rate for Payer: Quartz Beloit One Network |
$571.12
|
| Rate for Payer: Quartz Commercial |
$739.86
|
| Rate for Payer: Quartz Medicare Advantage |
$163.40
|
| Rate for Payer: The Alliance Commercial |
$620.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$163.40
|
| Rate for Payer: WEA Trust Commercial |
$713.90
|
| Rate for Payer: WPS Commercial |
$817.00
|
|
|
XR Cisternography
|
Facility
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
1536948
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$2,967.75 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.00
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,967.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,374.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,255.49
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,242.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$1,201.50
|
| Rate for Payer: HFN Commercial |
$1,242.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.00
|
| Rate for Payer: Quartz Beloit One Network |
$661.50
|
| Rate for Payer: Quartz Commercial |
$877.50
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$581.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$742.50
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$999.94
|
|
|
XR Cisternography
|
Facility
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
1536948
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$1,242.00 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.50
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,242.00
|
| Rate for Payer: Health EOS Commercial |
$1,201.50
|
| Rate for Payer: HFN Commercial |
$1,242.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: NAPHCARE Commercial |
$810.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.00
|
| Rate for Payer: Quartz Beloit One Network |
$661.50
|
| Rate for Payer: Quartz Commercial |
$810.00
|
| Rate for Payer: WEA Trust Commercial |
$742.50
|
| Rate for Payer: WPS Commercial |
$999.94
|
|
|
XR Cisternography
|
Facility
OP
|
$1,298.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
629746
|
| Min. Negotiated Rate |
$581.44 |
| Max. Negotiated Rate |
$2,944.01 |
| Rate for Payer: Aetna Commercial |
$1,168.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,116.28
|
| Rate for Payer: Aetna Managed Medicare |
$791.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$843.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$623.04
|
| Rate for Payer: Anthem Medicare Advantage |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$687.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$791.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$791.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,194.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$791.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$1,155.22
|
| Rate for Payer: HFN Commercial |
$1,194.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,944.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$791.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$791.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$791.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$791.40
|
| Rate for Payer: Multiplan Commercial |
$1,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,187.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,194.16
|
| Rate for Payer: Quartz Beloit One Network |
$636.02
|
| Rate for Payer: Quartz Commercial |
$843.70
|
| Rate for Payer: Quartz Medicare Advantage |
$791.40
|
| Rate for Payer: The Alliance Commercial |
$581.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$713.90
|
| Rate for Payer: Wellcare Medicare |
$791.40
|
| Rate for Payer: WPS Commercial |
$961.43
|
|
|
XR Clavicle Bilateral
|
Facility
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629750
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$1,012.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$946.00
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$715.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$550.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$528.00
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$583.00
|
| 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 |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,012.00
|
| 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 |
$979.00
|
| Rate for Payer: HFN Commercial |
$1,012.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.00
|
| Rate for Payer: Quartz Beloit One Network |
$539.00
|
| Rate for Payer: Quartz Commercial |
$715.00
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$159.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$605.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$814.77
|
|
|
XR Clavicle Bilateral
|
Facility
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629750
|
| Min. Negotiated Rate |
$539.00 |
| Max. Negotiated Rate |
$1,012.00 |
| Rate for Payer: Aetna Commercial |
$990.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$583.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,012.00
|
| Rate for Payer: Health EOS Commercial |
$979.00
|
| Rate for Payer: HFN Commercial |
$1,012.00
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: NAPHCARE Commercial |
$660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,012.00
|
| Rate for Payer: Quartz Beloit One Network |
$539.00
|
| Rate for Payer: Quartz Commercial |
$660.00
|
| Rate for Payer: WEA Trust Commercial |
$605.00
|
| Rate for Payer: WPS Commercial |
$814.77
|
|
|
XR Clavicle Bilateral
|
Professional
|
$1,100.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629750
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$1,045.00 |
| Rate for Payer: Aetna Commercial |
$1,045.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$946.00
|
| Rate for Payer: Aetna Managed Medicare |
$31.07
|
| Rate for Payer: Anthem Medicare Advantage |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.07
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,045.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$550.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.07
|
| Rate for Payer: Health EOS Commercial |
$1,001.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.07
|
| Rate for Payer: Multiplan Commercial |
$880.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.00
|
| Rate for Payer: Quartz Beloit One Network |
$484.00
|
| Rate for Payer: Quartz Commercial |
$627.00
|
| Rate for Payer: Quartz Medicare Advantage |
$31.07
|
| Rate for Payer: The Alliance Commercial |
$118.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.07
|
| Rate for Payer: WEA Trust Commercial |
$605.00
|
| Rate for Payer: WPS Commercial |
$155.35
|
|
|
XR Clavicle Bilateral
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536950
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Aetna Managed Medicare |
$156.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$268.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$364.00
|
| Rate for Payer: Quartz Medicare Advantage |
$336.00
|
| Rate for Payer: The Alliance Commercial |
$2,240.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Clavicle Bilateral
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536950
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Clavicle Bilateral
|
Professional
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536950
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.40 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.00
|
| Rate for Payer: Health EOS Commercial |
$509.60
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$532.00
|
| Rate for Payer: Quartz Beloit One Network |
$246.40
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Clavicle Left
|
Facility
OP
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629752
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$357.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.00
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| 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 |
$489.50
|
| Rate for Payer: HFN Commercial |
$506.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$506.00
|
| Rate for Payer: Quartz Beloit One Network |
$269.50
|
| Rate for Payer: Quartz Commercial |
$357.50
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$159.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
XR Clavicle Left
|
Facility
IP
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629752
|
| Min. Negotiated Rate |
$269.50 |
| Max. Negotiated Rate |
$506.00 |
| Rate for Payer: Aetna Commercial |
$495.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.50
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$506.00
|
| Rate for Payer: Health EOS Commercial |
$489.50
|
| Rate for Payer: HFN Commercial |
$506.00
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: NAPHCARE Commercial |
$330.00
|
| Rate for Payer: Preferred Network Access Commercial |
$506.00
|
| Rate for Payer: Quartz Beloit One Network |
$269.50
|
| Rate for Payer: Quartz Commercial |
$330.00
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: WPS Commercial |
$407.38
|
|
|
XR Clavicle Left
|
Professional
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629752
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$522.50 |
| Rate for Payer: Aetna Commercial |
$522.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.00
|
| Rate for Payer: Aetna Managed Medicare |
$31.07
|
| Rate for Payer: Anthem Medicare Advantage |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.07
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$522.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.07
|
| Rate for Payer: Health EOS Commercial |
$500.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.07
|
| Rate for Payer: Multiplan Commercial |
$440.00
|
| Rate for Payer: Preferred Network Access Commercial |
$522.50
|
| Rate for Payer: Quartz Beloit One Network |
$242.00
|
| Rate for Payer: Quartz Commercial |
$313.50
|
| Rate for Payer: Quartz Medicare Advantage |
$31.07
|
| Rate for Payer: The Alliance Commercial |
$118.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.07
|
| Rate for Payer: WEA Trust Commercial |
$302.50
|
| Rate for Payer: WPS Commercial |
$155.35
|
|
