|
XR Fluoro Guidance Venous Access
|
Professional
|
Both
|
$1,231.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
3511537
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$347.99 |
| Max. Negotiated Rate |
$1,169.45 |
| Rate for Payer: Aetna Commercial |
$1,169.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,058.66
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,169.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$615.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.60
|
| Rate for Payer: Health EOS Commercial |
$1,120.21
|
| Rate for Payer: HFN Commercial |
$1,169.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$347.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.99
|
| Rate for Payer: Multiplan Commercial |
$984.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,169.45
|
| Rate for Payer: Quartz Beloit One Network |
$541.64
|
| Rate for Payer: Quartz Commercial |
$701.67
|
| Rate for Payer: The Alliance Commercial |
$615.50
|
| Rate for Payer: WEA Trust Commercial |
$677.05
|
| Rate for Payer: WPS Commercial |
$911.80
|
|
|
XR Fluoro Guided Midline
|
Facility
|
OP
|
$1,082.00
|
|
|
Service Code
|
CPT 77001 TC
|
| Hospital Charge Code |
5552126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,328.00 |
| Rate for Payer: Aetna Commercial |
$973.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.52
|
| Rate for Payer: Aetna Managed Medicare |
$302.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$703.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$541.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$519.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.46
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$995.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$605.49
|
| Rate for Payer: Health EOS Commercial |
$962.98
|
| Rate for Payer: HFN Commercial |
$995.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$811.50
|
| Rate for Payer: Multiplan Commercial |
$865.60
|
| Rate for Payer: NAPHCARE Commercial |
$649.20
|
| Rate for Payer: Preferred Network Access Commercial |
$995.44
|
| Rate for Payer: Quartz Beloit One Network |
$530.18
|
| Rate for Payer: Quartz Commercial |
$703.30
|
| Rate for Payer: Quartz Medicare Advantage |
$649.20
|
| Rate for Payer: The Alliance Commercial |
$4,328.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$595.10
|
| Rate for Payer: WPS Commercial |
$801.44
|
|
|
XR Fluoro Guided Midline
|
Facility
|
IP
|
$1,082.00
|
|
|
Service Code
|
CPT 77001 TC
|
| Hospital Charge Code |
5552126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$530.18 |
| Max. Negotiated Rate |
$995.44 |
| Rate for Payer: Aetna Commercial |
$973.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$573.46
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$995.44
|
| Rate for Payer: Health EOS Commercial |
$962.98
|
| Rate for Payer: HFN Commercial |
$995.44
|
| Rate for Payer: Multiplan Commercial |
$865.60
|
| Rate for Payer: NAPHCARE Commercial |
$649.20
|
| Rate for Payer: Preferred Network Access Commercial |
$995.44
|
| Rate for Payer: Quartz Beloit One Network |
$530.18
|
| Rate for Payer: Quartz Commercial |
$649.20
|
| Rate for Payer: WEA Trust Commercial |
$595.10
|
| Rate for Payer: WPS Commercial |
$801.44
|
|
|
XR Fluoro Guided Midline
|
Professional
|
Both
|
$1,082.00
|
|
|
Service Code
|
CPT 77001 TC
|
| Hospital Charge Code |
5552126
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.79 |
| Max. Negotiated Rate |
$1,027.90 |
| Rate for Payer: Aetna Commercial |
$1,027.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$930.52
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cash Price |
$324.60
|
| Rate for Payer: Cigna Commercial |
$1,027.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$541.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$649.20
|
| Rate for Payer: Health EOS Commercial |
$984.62
|
| Rate for Payer: HFN Commercial |
$1,027.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$285.79
|
| Rate for Payer: Multiplan Commercial |
$865.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,027.90
|
| Rate for Payer: Quartz Beloit One Network |
$476.08
|
| Rate for Payer: Quartz Commercial |
$616.74
|
| Rate for Payer: The Alliance Commercial |
$541.00
|
| Rate for Payer: WEA Trust Commercial |
$595.10
|
| Rate for Payer: WPS Commercial |
$801.44
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$968.80 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$908.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.27
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Professional
|
Both
|
$1,020.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537054
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$969.00 |
| Rate for Payer: Aetna Commercial |
$969.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$969.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$510.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$612.00
|
| Rate for Payer: Health EOS Commercial |
$928.20
|
| Rate for Payer: HFN Commercial |
$969.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.21
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: Preferred Network Access Commercial |
$969.00
|
| Rate for Payer: Quartz Beloit One Network |
$448.80
|
| Rate for Payer: Quartz Commercial |
$581.40
|
| Rate for Payer: The Alliance Commercial |
$510.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Facility
|
IP
|
$1,319.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630583
|
| Min. Negotiated Rate |
$646.31 |
| Max. Negotiated Rate |
$1,213.48 |
| Rate for Payer: Aetna Commercial |
$1,187.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.07
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,213.48
|
| Rate for Payer: Health EOS Commercial |
$1,173.91
|
| Rate for Payer: HFN Commercial |
$1,213.48
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$791.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,213.48
|
| Rate for Payer: Quartz Beloit One Network |
$646.31
|
| Rate for Payer: Quartz Commercial |
$791.40
|
| Rate for Payer: WEA Trust Commercial |
$725.45
|
| Rate for Payer: WPS Commercial |
$976.98
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Professional
|
Both
|
$1,319.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630583
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$1,253.05 |
| Rate for Payer: Aetna Commercial |
$1,253.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.34
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,253.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$659.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$791.40
|
| Rate for Payer: Health EOS Commercial |
$1,200.29
|
| Rate for Payer: HFN Commercial |
$1,253.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.21
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,253.05
|
| Rate for Payer: Quartz Beloit One Network |
$580.36
|
| Rate for Payer: Quartz Commercial |
$751.83
|
| Rate for Payer: The Alliance Commercial |
$659.50
|
| Rate for Payer: WEA Trust Commercial |
$725.45
|
| Rate for Payer: WPS Commercial |
$976.98
|
|
|
XR Fluoroscopy Over 1 Hour Non-Rad
|
Facility
|
OP
|
$1,319.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630583
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,213.48 |
| Rate for Payer: Aetna Commercial |
$1,187.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.34
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$857.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$659.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.12
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cash Price |
$395.70
|
| Rate for Payer: Cigna Commercial |
$1,213.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,173.91
|
| Rate for Payer: HFN Commercial |
$1,213.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$1,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,213.48
|
| Rate for Payer: Quartz Beloit One Network |
$646.31
|
| Rate for Payer: Quartz Commercial |
$857.35
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: WEA Trust Commercial |
$725.45
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$976.98
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
|
IP
|
$981.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630569
|
| Min. Negotiated Rate |
$480.69 |
| Max. Negotiated Rate |
$902.52 |
| Rate for Payer: Aetna Commercial |
$882.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$843.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$519.93
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna Commercial |
$902.52
|
| Rate for Payer: Health EOS Commercial |
$873.09
|
| Rate for Payer: HFN Commercial |
$902.52
|
| Rate for Payer: Multiplan Commercial |
$784.80
|
| Rate for Payer: NAPHCARE Commercial |
$588.60
|
| Rate for Payer: Preferred Network Access Commercial |
$902.52
|
| Rate for Payer: Quartz Beloit One Network |
$480.69
|
| Rate for Payer: Quartz Commercial |
$588.60
|
| Rate for Payer: WEA Trust Commercial |
$539.55
|
| Rate for Payer: WPS Commercial |
$726.63
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Professional
|
Both
|
$981.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630569
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$931.95 |
| Rate for Payer: Aetna Commercial |
$931.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$843.66
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna Commercial |
$931.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$490.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.60
|
| Rate for Payer: Health EOS Commercial |
$892.71
|
| Rate for Payer: HFN Commercial |
$931.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.21
|
| Rate for Payer: Multiplan Commercial |
$784.80
|
| Rate for Payer: Preferred Network Access Commercial |
$931.95
|
| Rate for Payer: Quartz Beloit One Network |
$431.64
|
| Rate for Payer: Quartz Commercial |
$559.17
|
| Rate for Payer: The Alliance Commercial |
$490.50
|
| Rate for Payer: WEA Trust Commercial |
$539.55
|
| Rate for Payer: WPS Commercial |
$726.63
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.21 |
| Max. Negotiated Rate |
$1,007.00 |
| Rate for Payer: Aetna Commercial |
$1,007.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$911.60
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,007.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$530.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.00
|
| Rate for Payer: Health EOS Commercial |
$964.60
|
| Rate for Payer: HFN Commercial |
$1,007.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.21
|
| Rate for Payer: Multiplan Commercial |
$848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,007.00
|
| Rate for Payer: Quartz Beloit One Network |
$466.40
|
| Rate for Payer: Quartz Commercial |
$604.20
|
| Rate for Payer: The Alliance Commercial |
$530.00
|
| Rate for Payer: WEA Trust Commercial |
$583.00
|
| Rate for Payer: WPS Commercial |
$785.14
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$975.20 |
| Rate for Payer: Aetna Commercial |
$954.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$911.60
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$908.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$690.27
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$561.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$975.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$943.40
|
| Rate for Payer: HFN Commercial |
$975.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$848.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$975.20
|
| Rate for Payer: Quartz Beloit One Network |
$519.40
|
| Rate for Payer: Quartz Commercial |
$689.00
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$583.00
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$785.14
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
1537058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$519.40 |
| Max. Negotiated Rate |
$975.20 |
| Rate for Payer: Aetna Commercial |
$954.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$911.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$561.80
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$975.20
|
| Rate for Payer: Health EOS Commercial |
$943.40
|
| Rate for Payer: HFN Commercial |
$975.20
|
| Rate for Payer: Multiplan Commercial |
$848.00
|
| Rate for Payer: NAPHCARE Commercial |
$636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$975.20
|
| Rate for Payer: Quartz Beloit One Network |
$519.40
|
| Rate for Payer: Quartz Commercial |
$636.00
|
| Rate for Payer: WEA Trust Commercial |
$583.00
|
| Rate for Payer: WPS Commercial |
$785.14
|
|
|
XR Fluoroscopy Up to 1 Hour
|
Facility
|
OP
|
$981.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
630569
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$968.80 |
| Rate for Payer: Aetna Commercial |
$882.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$843.66
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$637.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$490.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$470.88
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$519.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna Commercial |
$902.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$548.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$873.09
|
| Rate for Payer: HFN Commercial |
$902.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$784.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$902.52
|
| Rate for Payer: Quartz Beloit One Network |
$480.69
|
| Rate for Payer: Quartz Commercial |
$637.65
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: WEA Trust Commercial |
$539.55
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$726.63
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
OP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.86
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$585.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.48
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$585.65
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
XR Foot 2 Views Bilateral
|
Professional
|
Both
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$855.95 |
| Rate for Payer: Aetna Commercial |
$855.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.86
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$855.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$450.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$540.60
|
| Rate for Payer: Health EOS Commercial |
$819.91
|
| Rate for Payer: HFN Commercial |
$855.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.84
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: Preferred Network Access Commercial |
$855.95
|
| Rate for Payer: Quartz Beloit One Network |
$396.44
|
| Rate for Payer: Quartz Commercial |
$513.57
|
| Rate for Payer: The Alliance Commercial |
$450.50
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
OP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| 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 |
$257.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| 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 |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$315.90
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
IP
|
$901.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630565
|
| Min. Negotiated Rate |
$441.49 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$540.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$540.60
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
XR Foot 2 Views Bilateral
|
Facility
|
IP
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$238.14 |
| Max. Negotiated Rate |
$447.12 |
| Rate for Payer: Aetna Commercial |
$437.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.58
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$432.54
|
| Rate for Payer: HFN Commercial |
$447.12
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: NAPHCARE Commercial |
$291.60
|
| Rate for Payer: Preferred Network Access Commercial |
$447.12
|
| Rate for Payer: Quartz Beloit One Network |
$238.14
|
| Rate for Payer: Quartz Commercial |
$291.60
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Bilateral
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537060
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$461.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$243.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.60
|
| Rate for Payer: Health EOS Commercial |
$442.26
|
| Rate for Payer: HFN Commercial |
$461.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.84
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Preferred Network Access Commercial |
$461.70
|
| Rate for Payer: Quartz Beloit One Network |
$213.84
|
| Rate for Payer: Quartz Commercial |
$277.02
|
| Rate for Payer: The Alliance Commercial |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
|
XR Foot 2 Views Left
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$427.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.00
|
| Rate for Payer: Health EOS Commercial |
$409.50
|
| Rate for Payer: HFN Commercial |
$427.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.84
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Preferred Network Access Commercial |
$427.50
|
| Rate for Payer: Quartz Beloit One Network |
$198.00
|
| Rate for Payer: Quartz Commercial |
$256.50
|
| Rate for Payer: The Alliance Commercial |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
XR Foot 2 Views Left
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 73620
|
| Hospital Charge Code |
630559
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.50
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: Health EOS Commercial |
$400.50
|
| Rate for Payer: HFN Commercial |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: NAPHCARE Commercial |
$270.00
|
| Rate for Payer: Preferred Network Access Commercial |
$414.00
|
| Rate for Payer: Quartz Beloit One Network |
$220.50
|
| Rate for Payer: Quartz Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
XR Foot 2 Views Left
|
Professional
|
Both
|
$486.00
|
|
|
Service Code
|
CPT 73620 LT,TC
|
| Hospital Charge Code |
1537062
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.84 |
| Max. Negotiated Rate |
$461.70 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.96
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cash Price |
$145.80
|
| Rate for Payer: Cigna Commercial |
$461.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$243.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.60
|
| Rate for Payer: Health EOS Commercial |
$442.26
|
| Rate for Payer: HFN Commercial |
$461.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.84
|
| Rate for Payer: Multiplan Commercial |
$388.80
|
| Rate for Payer: Preferred Network Access Commercial |
$461.70
|
| Rate for Payer: Quartz Beloit One Network |
$213.84
|
| Rate for Payer: Quartz Commercial |
$277.02
|
| Rate for Payer: The Alliance Commercial |
$243.00
|
| Rate for Payer: WEA Trust Commercial |
$267.30
|
| Rate for Payer: WPS Commercial |
$359.98
|
|
