|
X-RAY Pelvis Complete Minimum 3 Views 72190
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
4568644
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$265.77 |
| Rate for Payer: Aetna Commercial |
$265.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$42.93
|
| Rate for Payer: Anthem Medicare Advantage |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.93
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$265.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.93
|
| Rate for Payer: Health EOS Commercial |
$254.58
|
| Rate for Payer: HFN Commercial |
$265.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.93
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$64.40
|
| Rate for Payer: Preferred Network Access Commercial |
$265.77
|
| Rate for Payer: Quartz Beloit One Network |
$123.09
|
| Rate for Payer: Quartz Commercial |
$159.46
|
| Rate for Payer: Quartz Medicare Advantage |
$42.93
|
| Rate for Payer: The Alliance Commercial |
$163.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.93
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$214.66
|
|
|
X-RAY Pelvis Complete Minimum 3 Views 7219026
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
CPT 72190 26
|
| Hospital Charge Code |
4616760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$265.77 |
| Rate for Payer: Aetna Commercial |
$265.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$12.21
|
| Rate for Payer: Anthem Medicare Advantage |
$12.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.21
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$265.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.21
|
| Rate for Payer: Health EOS Commercial |
$254.58
|
| Rate for Payer: HFN Commercial |
$265.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$18.31
|
| Rate for Payer: Preferred Network Access Commercial |
$265.77
|
| Rate for Payer: Quartz Beloit One Network |
$123.09
|
| Rate for Payer: Quartz Commercial |
$159.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12.21
|
| Rate for Payer: The Alliance Commercial |
$46.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.21
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$61.05
|
|
|
X-RAY Sacrum & Coccyx 2 View 72220
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
3209626
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$158.70 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Medicare Advantage |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.74
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.74
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.74
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$47.61
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.74
|
| Rate for Payer: The Alliance Commercial |
$120.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.74
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$158.70
|
|
|
X-RAY Sacrum & Coccyx 2 View 7222026
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
CPT 72220 26
|
| Hospital Charge Code |
3209631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$157.09 |
| Rate for Payer: Aetna Commercial |
$157.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$157.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$150.48
|
| Rate for Payer: HFN Commercial |
$157.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$157.09
|
| Rate for Payer: Quartz Beloit One Network |
$72.76
|
| Rate for Payer: Quartz Commercial |
$94.26
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$41.70
|
|
|
X-RAY Shoulder 1 View 7302026
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
CPT 73020 26
|
| Hospital Charge Code |
3209642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$58.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Aetna Managed Medicare |
$7.31
|
| Rate for Payer: Anthem Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.31
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$58.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.31
|
| Rate for Payer: Health EOS Commercial |
$55.84
|
| Rate for Payer: HFN Commercial |
$58.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$10.97
|
| Rate for Payer: Preferred Network Access Commercial |
$58.29
|
| Rate for Payer: Quartz Beloit One Network |
$27.00
|
| Rate for Payer: Quartz Commercial |
$34.98
|
| Rate for Payer: Quartz Medicare Advantage |
$7.31
|
| Rate for Payer: The Alliance Commercial |
$27.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.31
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$36.56
|
|
|
X-Ray Spine Scoliosis Study Standing 72081
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
5294616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$464.36 |
| Rate for Payer: Aetna Commercial |
$464.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$43.62
|
| Rate for Payer: Anthem Medicare Advantage |
$43.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.62
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$464.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.62
|
| Rate for Payer: Health EOS Commercial |
$444.81
|
| Rate for Payer: HFN Commercial |
$464.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.62
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$65.43
|
| Rate for Payer: Preferred Network Access Commercial |
$464.36
|
| Rate for Payer: Quartz Beloit One Network |
$215.07
|
| Rate for Payer: Quartz Commercial |
$278.62
|
| Rate for Payer: Quartz Medicare Advantage |
$43.62
|
| Rate for Payer: The Alliance Commercial |
$165.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.62
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$218.09
|
|
|
X-Ray Spine Scoliosis Study Standing 7208126
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 72081 26
|
| Hospital Charge Code |
5294617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$121.52 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$12.56
|
| Rate for Payer: Anthem Medicare Advantage |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.56
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.56
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$18.84
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: Quartz Medicare Advantage |
$12.56
|
| Rate for Payer: The Alliance Commercial |
$47.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.56
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$62.82
|
|
|
XRAY Sternoclavicular Joint(s) 71130
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
4616757
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$205.61 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$41.12
|
| Rate for Payer: Anthem Medicare Advantage |
$41.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.12
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.12
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$146.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.12
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$61.68
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$41.12
|
| Rate for Payer: The Alliance Commercial |
$156.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.12
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$205.61
|
|
|
XRAY sternoclavicular Joint(s) 7113026
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 71130 26
|
| Hospital Charge Code |
4616758
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$10.40
|
| Rate for Payer: Anthem Medicare Advantage |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.40
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.40
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10.40
|
| Rate for Payer: The Alliance Commercial |
$39.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.40
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$52.00
|
|
|
X-RAYS, TRANSCATH THERAPY 7589426
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
CPT 75894 26
|
| Hospital Charge Code |
3015295
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.48 |
| Max. Negotiated Rate |
$786.45 |
| Rate for Payer: Aetna Commercial |
$786.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.94
|
| Rate for Payer: Aetna Managed Medicare |
$119.48
|
| Rate for Payer: Anthem Medicare Advantage |
$119.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.48
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$786.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$413.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.48
|
| Rate for Payer: Health EOS Commercial |
$753.33
|
| Rate for Payer: HFN Commercial |
$786.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$238.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$238.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.48
|
| Rate for Payer: Multiplan Commercial |
$662.27
|
| Rate for Payer: NAPHCARE Commercial |
$179.21
|
| Rate for Payer: Preferred Network Access Commercial |
$786.45
|
| Rate for Payer: Quartz Beloit One Network |
$364.25
|
| Rate for Payer: Quartz Commercial |
$471.87
|
| Rate for Payer: Quartz Medicare Advantage |
$119.48
|
| Rate for Payer: The Alliance Commercial |
$454.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.48
|
| Rate for Payer: WEA Trust Commercial |
$455.31
|
| Rate for Payer: WPS Commercial |
$597.38
|
|
|
X-RAY Thoracic Spine 2 View 7207026
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
CPT 72070 26
|
| Hospital Charge Code |
3238180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$92.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$92.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$88.96
|
| Rate for Payer: HFN Commercial |
$92.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$14.57
|
| Rate for Payer: Preferred Network Access Commercial |
$92.87
|
| Rate for Payer: Quartz Beloit One Network |
$43.01
|
| Rate for Payer: Quartz Commercial |
$55.72
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$36.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$48.57
|
|
|
X-RAY Thoracic Spine 3 View 72072
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
3238191
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$192.35 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$38.47
|
| Rate for Payer: Anthem Medicare Advantage |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.47
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.47
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.47
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$57.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$38.47
|
| Rate for Payer: The Alliance Commercial |
$146.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.47
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$192.35
|
|
|
X-RAY Thoracic Spine 3 View 7207226
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 72072 26
|
| Hospital Charge Code |
3238192
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$10.41
|
| Rate for Payer: Anthem Medicare Advantage |
$10.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.41
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.41
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$15.62
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10.41
|
| Rate for Payer: The Alliance Commercial |
$39.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.41
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$52.05
|
|
|
X-RAY Thoracolumbar 7208026
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 72080 26
|
| Hospital Charge Code |
3238203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$10.05
|
| Rate for Payer: Anthem Medicare Advantage |
$10.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.05
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.05
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$15.07
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: Quartz Medicare Advantage |
$10.05
|
| Rate for Payer: The Alliance Commercial |
$38.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.05
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$50.23
|
|
|
XR Babygram
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
5724181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$246.65 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$302.02
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
XR Babygram
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
5724181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$478.19 |
| Rate for Payer: Aetna Commercial |
$478.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$16.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.74
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$478.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.74
|
| Rate for Payer: Health EOS Commercial |
$458.06
|
| Rate for Payer: HFN Commercial |
$478.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.74
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$25.12
|
| Rate for Payer: Preferred Network Access Commercial |
$478.19
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$286.92
|
| Rate for Payer: Quartz Medicare Advantage |
$16.74
|
| Rate for Payer: The Alliance Commercial |
$63.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.74
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$83.72
|
|
|
XR Babygram
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
5724181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.98 |
| Max. Negotiated Rate |
$463.09 |
| Rate for Payer: Aetna Commercial |
$453.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.89
|
| Rate for Payer: Aetna Managed Medicare |
$140.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.78
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$463.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$281.69
|
| Rate for Payer: Health EOS Commercial |
$447.99
|
| Rate for Payer: HFN Commercial |
$463.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$377.52
|
| Rate for Payer: Multiplan Commercial |
$402.69
|
| Rate for Payer: NAPHCARE Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$463.09
|
| Rate for Payer: Quartz Beloit One Network |
$246.65
|
| Rate for Payer: Quartz Commercial |
$327.18
|
| Rate for Payer: Quartz Medicare Advantage |
$302.02
|
| Rate for Payer: The Alliance Commercial |
$66.98
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$276.85
|
| Rate for Payer: WPS Commercial |
$372.83
|
|
|
XR Barium Enema Complete
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
627608
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,230.44 |
| Rate for Payer: Aetna Commercial |
$1,203.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,150.20
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.97
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,230.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,190.32
|
| Rate for Payer: HFN Commercial |
$1,230.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,069.95
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.44
|
| Rate for Payer: Quartz Beloit One Network |
$655.35
|
| Rate for Payer: Quartz Commercial |
$869.34
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$735.59
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$990.61
|
|
|
XR Barium Enema Complete
|
Facility
|
IP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1536879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$706.82 |
| Max. Negotiated Rate |
$1,327.08 |
| Rate for Payer: Aetna Commercial |
$1,298.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,240.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$764.51
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,327.08
|
| Rate for Payer: Health EOS Commercial |
$1,283.81
|
| Rate for Payer: HFN Commercial |
$1,327.08
|
| Rate for Payer: Multiplan Commercial |
$1,153.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,327.08
|
| Rate for Payer: Quartz Beloit One Network |
$706.82
|
| Rate for Payer: Quartz Commercial |
$865.49
|
| Rate for Payer: WEA Trust Commercial |
$793.36
|
| Rate for Payer: WPS Commercial |
$1,068.41
|
|
|
XR Barium Enema Complete
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
627608
|
| Min. Negotiated Rate |
$655.35 |
| Max. Negotiated Rate |
$1,230.44 |
| Rate for Payer: Aetna Commercial |
$1,203.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,150.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.84
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,230.44
|
| Rate for Payer: Health EOS Commercial |
$1,190.32
|
| Rate for Payer: HFN Commercial |
$1,230.44
|
| Rate for Payer: Multiplan Commercial |
$1,069.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.44
|
| Rate for Payer: Quartz Beloit One Network |
$655.35
|
| Rate for Payer: Quartz Commercial |
$802.46
|
| Rate for Payer: WEA Trust Commercial |
$735.59
|
| Rate for Payer: WPS Commercial |
$990.61
|
|
|
XR Barium Enema Complete
|
Professional
|
Both
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1536879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$1,370.36 |
| Rate for Payer: Aetna Commercial |
$1,370.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,240.53
|
| Rate for Payer: Aetna Managed Medicare |
$147.98
|
| Rate for Payer: Anthem Medicare Advantage |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.98
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,370.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$721.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.98
|
| Rate for Payer: Health EOS Commercial |
$1,312.66
|
| Rate for Payer: HFN Commercial |
$1,370.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$565.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$565.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.98
|
| Rate for Payer: Multiplan Commercial |
$1,153.98
|
| Rate for Payer: NAPHCARE Commercial |
$221.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,370.36
|
| Rate for Payer: Quartz Beloit One Network |
$634.69
|
| Rate for Payer: Quartz Commercial |
$822.21
|
| Rate for Payer: Quartz Medicare Advantage |
$147.98
|
| Rate for Payer: The Alliance Commercial |
$562.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.98
|
| Rate for Payer: WEA Trust Commercial |
$793.36
|
| Rate for Payer: WPS Commercial |
$739.91
|
|
|
XR Barium Enema Complete
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
627608
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$1,270.57 |
| Rate for Payer: Aetna Commercial |
$1,270.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,150.20
|
| Rate for Payer: Aetna Managed Medicare |
$147.98
|
| Rate for Payer: Anthem Medicare Advantage |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.98
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,270.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$668.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.98
|
| Rate for Payer: Health EOS Commercial |
$1,217.07
|
| Rate for Payer: HFN Commercial |
$1,270.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$565.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$565.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.98
|
| Rate for Payer: Multiplan Commercial |
$1,069.95
|
| Rate for Payer: NAPHCARE Commercial |
$221.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,270.57
|
| Rate for Payer: Quartz Beloit One Network |
$588.47
|
| Rate for Payer: Quartz Commercial |
$762.34
|
| Rate for Payer: Quartz Medicare Advantage |
$147.98
|
| Rate for Payer: The Alliance Commercial |
$562.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.98
|
| Rate for Payer: WEA Trust Commercial |
$735.59
|
| Rate for Payer: WPS Commercial |
$739.91
|
|
|
XR Barium Enema Complete
|
Facility
|
OP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1536879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,327.08 |
| Rate for Payer: Aetna Commercial |
$1,298.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,240.53
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$764.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,327.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$807.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,283.81
|
| Rate for Payer: HFN Commercial |
$1,327.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,153.98
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,327.08
|
| Rate for Payer: Quartz Beloit One Network |
$706.82
|
| Rate for Payer: Quartz Commercial |
$937.61
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$793.36
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,068.41
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
627610
|
| Min. Negotiated Rate |
$748.09 |
| Max. Negotiated Rate |
$1,404.58 |
| Rate for Payer: Aetna Commercial |
$1,374.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$809.16
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,404.58
|
| Rate for Payer: Health EOS Commercial |
$1,358.78
|
| Rate for Payer: HFN Commercial |
$1,404.58
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,404.58
|
| Rate for Payer: Quartz Beloit One Network |
$748.09
|
| Rate for Payer: Quartz Commercial |
$916.03
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: WPS Commercial |
$1,130.80
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
1536881
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,461.03 |
| Rate for Payer: Aetna Commercial |
$1,429.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,365.75
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$841.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cigna Commercial |
$1,461.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$888.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,413.39
|
| Rate for Payer: HFN Commercial |
$1,461.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,270.46
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,461.03
|
| Rate for Payer: Quartz Beloit One Network |
$778.16
|
| Rate for Payer: Quartz Commercial |
$1,032.25
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$873.44
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,176.25
|
|
