|
XR Pyelostogram
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
3072719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$460.11 |
| Max. Negotiated Rate |
$863.88 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$807.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.67
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$863.88
|
| Rate for Payer: Health EOS Commercial |
$835.71
|
| Rate for Payer: HFN Commercial |
$863.88
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: NAPHCARE Commercial |
$563.40
|
| Rate for Payer: Preferred Network Access Commercial |
$863.88
|
| Rate for Payer: Quartz Beloit One Network |
$460.11
|
| Rate for Payer: Quartz Commercial |
$563.40
|
| Rate for Payer: WEA Trust Commercial |
$516.45
|
| Rate for Payer: WPS Commercial |
$695.52
|
|
|
XR Ribs 2 Views Left
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630229
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Left
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| 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 |
$299.45
|
| 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 |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| 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 |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$367.25
|
| 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 |
$310.75
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 2 Views Left
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 2 Views Left
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630229
|
| Min. Negotiated Rate |
$124.11 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Aetna Commercial |
$496.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$496.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.80
|
| Rate for Payer: Health EOS Commercial |
$475.93
|
| Rate for Payer: HFN Commercial |
$496.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.11
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Preferred Network Access Commercial |
$496.85
|
| Rate for Payer: Quartz Beloit One Network |
$230.12
|
| Rate for Payer: Quartz Commercial |
$298.11
|
| Rate for Payer: The Alliance Commercial |
$261.50
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Left
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630229
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| 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 |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| 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 |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| 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 |
$287.65
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Left
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Aetna Commercial |
$536.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$536.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.00
|
| Rate for Payer: Health EOS Commercial |
$514.15
|
| Rate for Payer: HFN Commercial |
$536.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Preferred Network Access Commercial |
$536.75
|
| Rate for Payer: Quartz Beloit One Network |
$248.60
|
| Rate for Payer: Quartz Commercial |
$322.05
|
| Rate for Payer: The Alliance Commercial |
$282.50
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 2 Views Right
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$86.20 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Aetna Commercial |
$536.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$536.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.00
|
| Rate for Payer: Health EOS Commercial |
$514.15
|
| Rate for Payer: HFN Commercial |
$536.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.20
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Preferred Network Access Commercial |
$536.75
|
| Rate for Payer: Quartz Beloit One Network |
$248.60
|
| Rate for Payer: Quartz Commercial |
$322.05
|
| Rate for Payer: The Alliance Commercial |
$282.50
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 2 Views Right
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630227
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Right
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| 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 |
$299.45
|
| 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 |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| 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 |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$367.25
|
| 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 |
$310.75
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 2 Views Right
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630227
|
| Min. Negotiated Rate |
$124.11 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Aetna Commercial |
$496.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$496.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.80
|
| Rate for Payer: Health EOS Commercial |
$475.93
|
| Rate for Payer: HFN Commercial |
$496.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.11
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Preferred Network Access Commercial |
$496.85
|
| Rate for Payer: Quartz Beloit One Network |
$230.12
|
| Rate for Payer: Quartz Commercial |
$298.11
|
| Rate for Payer: The Alliance Commercial |
$261.50
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Right
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630227
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| 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 |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| 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 |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| 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 |
$287.65
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Right
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
|
OP
|
$1,290.00
|
|
|
Service Code
|
CPT 71110 TC
|
| Hospital Charge Code |
1537252
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,186.80 |
| Rate for Payer: Aetna Commercial |
$1,161.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.40
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,186.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$721.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,148.10
|
| Rate for Payer: HFN Commercial |
$1,186.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,032.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.80
|
| Rate for Payer: Quartz Beloit One Network |
$632.10
|
| Rate for Payer: Quartz Commercial |
$838.50
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$709.50
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$955.50
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
|
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
630231
|
| Min. Negotiated Rate |
$584.57 |
| Max. Negotiated Rate |
$1,097.56 |
| Rate for Payer: Aetna Commercial |
$1,073.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$632.29
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cigna Commercial |
$1,097.56
|
| Rate for Payer: Health EOS Commercial |
$1,061.77
|
| Rate for Payer: HFN Commercial |
$1,097.56
|
| Rate for Payer: Multiplan Commercial |
$954.40
|
| Rate for Payer: NAPHCARE Commercial |
$715.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,097.56
|
| Rate for Payer: Quartz Beloit One Network |
$584.57
|
| Rate for Payer: Quartz Commercial |
$715.80
|
| Rate for Payer: WEA Trust Commercial |
$656.15
|
| Rate for Payer: WPS Commercial |
$883.66
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
|
IP
|
$1,290.00
|
|
|
Service Code
|
CPT 71110 TC
|
| Hospital Charge Code |
1537252
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$632.10 |
| Max. Negotiated Rate |
$1,186.80 |
| Rate for Payer: Aetna Commercial |
$1,161.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.70
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,186.80
|
| Rate for Payer: Health EOS Commercial |
$1,148.10
|
| Rate for Payer: HFN Commercial |
$1,186.80
|
| Rate for Payer: Multiplan Commercial |
$1,032.00
|
| Rate for Payer: NAPHCARE Commercial |
$774.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.80
|
| Rate for Payer: Quartz Beloit One Network |
$632.10
|
| Rate for Payer: Quartz Commercial |
$774.00
|
| Rate for Payer: WEA Trust Commercial |
$709.50
|
| Rate for Payer: WPS Commercial |
$955.50
|
|
|
XR Ribs 3 Views Bilateral
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
CPT 71110 TC
|
| Hospital Charge Code |
1537252
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.15 |
| Max. Negotiated Rate |
$1,225.50 |
| Rate for Payer: Aetna Commercial |
$1,225.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.40
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,225.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$645.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$774.00
|
| Rate for Payer: Health EOS Commercial |
$1,173.90
|
| Rate for Payer: HFN Commercial |
$1,225.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.15
|
| Rate for Payer: Multiplan Commercial |
$1,032.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,225.50
|
| Rate for Payer: Quartz Beloit One Network |
$567.60
|
| Rate for Payer: Quartz Commercial |
$735.30
|
| Rate for Payer: The Alliance Commercial |
$645.00
|
| Rate for Payer: WEA Trust Commercial |
$709.50
|
| Rate for Payer: WPS Commercial |
$955.50
|
|
|
XR Ribs 3 Views Bilateral
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
630231
|
| Min. Negotiated Rate |
$149.00 |
| Max. Negotiated Rate |
$1,133.35 |
| Rate for Payer: Aetna Commercial |
$1,133.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.98
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cigna Commercial |
$1,133.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$596.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$715.80
|
| Rate for Payer: Health EOS Commercial |
$1,085.63
|
| Rate for Payer: HFN Commercial |
$1,133.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.00
|
| Rate for Payer: Multiplan Commercial |
$954.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,133.35
|
| Rate for Payer: Quartz Beloit One Network |
$524.92
|
| Rate for Payer: Quartz Commercial |
$680.01
|
| Rate for Payer: The Alliance Commercial |
$596.50
|
| Rate for Payer: WEA Trust Commercial |
$656.15
|
| Rate for Payer: WPS Commercial |
$883.66
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
|
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
630231
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,097.56 |
| Rate for Payer: Aetna Commercial |
$1,073.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.98
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$775.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$596.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$572.64
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$632.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cigna Commercial |
$1,097.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$667.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,061.77
|
| Rate for Payer: HFN Commercial |
$1,097.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$954.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,097.56
|
| Rate for Payer: Quartz Beloit One Network |
$584.57
|
| Rate for Payer: Quartz Commercial |
$775.45
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$656.15
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$883.66
|
|
|
XR Ribs 3 Views Right
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 71100 TC,RT
|
| Hospital Charge Code |
2980134
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
XR Ribs 3 Views Right
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 71100 TC,RT
|
| Hospital Charge Code |
2980134
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| 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 |
$328.60
|
| 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 |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| 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 |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| 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 |
$341.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
XR Ribs 3 Views Right
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 71100 TC,RT
|
| Hospital Charge Code |
2980134
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.11 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna Commercial |
$589.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$589.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.00
|
| Rate for Payer: Health EOS Commercial |
$564.20
|
| Rate for Payer: HFN Commercial |
$589.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.11
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$589.00
|
| Rate for Payer: Quartz Beloit One Network |
$272.80
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$310.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
CPT 71111 TC
|
| Hospital Charge Code |
1537254
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.54 |
| Max. Negotiated Rate |
$949.05 |
| Rate for Payer: Aetna Commercial |
$949.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$949.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$499.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$599.40
|
| Rate for Payer: Health EOS Commercial |
$909.09
|
| Rate for Payer: HFN Commercial |
$949.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.54
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: Preferred Network Access Commercial |
$949.05
|
| Rate for Payer: Quartz Beloit One Network |
$439.56
|
| Rate for Payer: Quartz Commercial |
$569.43
|
| Rate for Payer: The Alliance Commercial |
$499.50
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
CPT 71111 TC
|
| Hospital Charge Code |
1537254
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$489.51 |
| Max. Negotiated Rate |
$919.08 |
| Rate for Payer: Aetna Commercial |
$899.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$859.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$529.47
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$919.08
|
| Rate for Payer: Health EOS Commercial |
$889.11
|
| Rate for Payer: HFN Commercial |
$919.08
|
| Rate for Payer: Multiplan Commercial |
$799.20
|
| Rate for Payer: NAPHCARE Commercial |
$599.40
|
| Rate for Payer: Preferred Network Access Commercial |
$919.08
|
| Rate for Payer: Quartz Beloit One Network |
$489.51
|
| Rate for Payer: Quartz Commercial |
$599.40
|
| Rate for Payer: WEA Trust Commercial |
$549.45
|
| Rate for Payer: WPS Commercial |
$739.96
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Facility
|
IP
|
$1,848.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
630225
|
| Min. Negotiated Rate |
$905.52 |
| Max. Negotiated Rate |
$1,700.16 |
| Rate for Payer: Aetna Commercial |
$1,663.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$979.44
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$1,700.16
|
| Rate for Payer: Health EOS Commercial |
$1,644.72
|
| Rate for Payer: HFN Commercial |
$1,700.16
|
| Rate for Payer: Multiplan Commercial |
$1,478.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,108.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.16
|
| Rate for Payer: Quartz Beloit One Network |
$905.52
|
| Rate for Payer: Quartz Commercial |
$1,108.80
|
| Rate for Payer: WEA Trust Commercial |
$1,016.40
|
| Rate for Payer: WPS Commercial |
$1,368.81
|
|
