|
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 |
$29.44 |
| Max. Negotiated Rate |
$151.05 |
| Rate for Payer: Aetna Commercial |
$151.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.74
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$151.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.40
|
| Rate for Payer: Health EOS Commercial |
$144.69
|
| Rate for Payer: HFN Commercial |
$151.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.44
|
| Rate for Payer: Multiplan Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$151.05
|
| Rate for Payer: Quartz Beloit One Network |
$69.96
|
| Rate for Payer: Quartz Commercial |
$90.63
|
| Rate for Payer: The Alliance Commercial |
$79.50
|
| Rate for Payer: WEA Trust Commercial |
$87.45
|
| Rate for Payer: WPS Commercial |
$117.77
|
|
|
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 |
$25.80 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.40
|
| Rate for Payer: Health EOS Commercial |
$53.69
|
| Rate for Payer: HFN Commercial |
$56.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.80
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Preferred Network Access Commercial |
$56.05
|
| Rate for Payer: Quartz Beloit One Network |
$25.96
|
| Rate for Payer: Quartz Commercial |
$33.63
|
| Rate for Payer: The Alliance Commercial |
$29.50
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
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 |
$142.97 |
| Max. Negotiated Rate |
$446.50 |
| Rate for Payer: Aetna Commercial |
$446.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.20
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$446.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.00
|
| Rate for Payer: Health EOS Commercial |
$427.70
|
| Rate for Payer: HFN Commercial |
$446.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.97
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: Preferred Network Access Commercial |
$446.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.80
|
| Rate for Payer: Quartz Commercial |
$267.90
|
| Rate for Payer: The Alliance Commercial |
$235.00
|
| Rate for Payer: WEA Trust Commercial |
$258.50
|
| Rate for Payer: WPS Commercial |
$348.13
|
|
|
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 |
$43.98 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Aetna Commercial |
$116.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$116.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.80
|
| Rate for Payer: Health EOS Commercial |
$111.93
|
| Rate for Payer: HFN Commercial |
$116.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$116.85
|
| Rate for Payer: Quartz Beloit One Network |
$54.12
|
| Rate for Payer: Quartz Commercial |
$70.11
|
| Rate for Payer: The Alliance Commercial |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
XRAY Sternoclavicular Joint(s) 71130
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
4616757
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$140.39 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.39
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
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 |
$36.52 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
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 |
$229.70 |
| Max. Negotiated Rate |
$756.20 |
| Rate for Payer: Aetna Commercial |
$756.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$756.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$398.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.60
|
| Rate for Payer: Health EOS Commercial |
$724.36
|
| Rate for Payer: HFN Commercial |
$756.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$229.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$229.70
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$756.20
|
| Rate for Payer: Quartz Beloit One Network |
$350.24
|
| Rate for Payer: Quartz Commercial |
$453.72
|
| Rate for Payer: The Alliance Commercial |
$398.00
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
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 |
$34.28 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.40
|
| Rate for Payer: Health EOS Commercial |
$85.54
|
| Rate for Payer: HFN Commercial |
$89.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.28
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.30
|
| Rate for Payer: Quartz Beloit One Network |
$41.36
|
| Rate for Payer: Quartz Commercial |
$53.58
|
| Rate for Payer: The Alliance Commercial |
$47.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
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 |
$44.00 |
| Max. Negotiated Rate |
$132.34 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.00
|
| Rate for Payer: Health EOS Commercial |
$91.00
|
| Rate for Payer: HFN Commercial |
$95.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.34
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Preferred Network Access Commercial |
$95.00
|
| Rate for Payer: Quartz Beloit One Network |
$44.00
|
| Rate for Payer: Quartz Commercial |
$57.00
|
| Rate for Payer: The Alliance Commercial |
$50.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
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 |
$37.98 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$107.38
|
| Rate for Payer: HFN Commercial |
$112.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.98
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Preferred Network Access Commercial |
$112.10
|
| Rate for Payer: Quartz Beloit One Network |
$51.92
|
| Rate for Payer: Quartz Commercial |
$67.26
|
| Rate for Payer: The Alliance Commercial |
$59.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
X-RAY Thoracolumbar 7208026
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 72080 26
|
| Hospital Charge Code |
3238203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.51 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$82.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.20
|
| Rate for Payer: Health EOS Commercial |
$79.17
|
| Rate for Payer: HFN Commercial |
$82.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.51
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.65
|
| Rate for Payer: Quartz Beloit One Network |
$38.28
|
| Rate for Payer: Quartz Commercial |
$49.59
|
| Rate for Payer: The Alliance Commercial |
$43.50
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
XR Babygram
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
5724181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$135.52 |
| Max. Negotiated Rate |
$1,936.00 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Aetna Managed Medicare |
$135.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.85
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.00
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$314.60
|
| Rate for Payer: Quartz Medicare Advantage |
$290.40
|
| Rate for Payer: The Alliance Commercial |
$1,936.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
XR Babygram
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
5724181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.09 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Aetna Commercial |
$459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$459.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$242.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.40
|
| Rate for Payer: Health EOS Commercial |
$440.44
|
| Rate for Payer: HFN Commercial |
$459.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.09
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Preferred Network Access Commercial |
$459.80
|
| Rate for Payer: Quartz Beloit One Network |
$212.96
|
| Rate for Payer: Quartz Commercial |
$275.88
|
| Rate for Payer: The Alliance Commercial |
$242.00
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
XR Babygram
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
5724181
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$237.16 |
| Max. Negotiated Rate |
$445.28 |
| Rate for Payer: Aetna Commercial |
$435.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.52
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$445.28
|
| Rate for Payer: Health EOS Commercial |
$430.76
|
| Rate for Payer: HFN Commercial |
$445.28
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: NAPHCARE Commercial |
$290.40
|
| Rate for Payer: Preferred Network Access Commercial |
$445.28
|
| Rate for Payer: Quartz Beloit One Network |
$237.16
|
| Rate for Payer: Quartz Commercial |
$290.40
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
XR Barium Enema Complete
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
627608
|
| Min. Negotiated Rate |
$630.14 |
| Max. Negotiated Rate |
$1,183.12 |
| Rate for Payer: Aetna Commercial |
$1,157.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.58
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,183.12
|
| Rate for Payer: Health EOS Commercial |
$1,144.54
|
| Rate for Payer: HFN Commercial |
$1,183.12
|
| Rate for Payer: Multiplan Commercial |
$1,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$771.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,183.12
|
| Rate for Payer: Quartz Beloit One Network |
$630.14
|
| Rate for Payer: Quartz Commercial |
$771.60
|
| Rate for Payer: WEA Trust Commercial |
$707.30
|
| Rate for Payer: WPS Commercial |
$952.54
|
|
|
XR Barium Enema Complete
|
Facility
|
OP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1536879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,276.04 |
| Rate for Payer: Aetna Commercial |
$1,248.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.82
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.56
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$735.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| 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 |
$1,276.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$776.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,234.43
|
| Rate for Payer: HFN Commercial |
$1,276.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$1,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.04
|
| Rate for Payer: Quartz Beloit One Network |
$679.63
|
| Rate for Payer: Quartz Commercial |
$901.55
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$762.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$1,027.35
|
|
|
XR Barium Enema Complete
|
Facility
|
IP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1536879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$679.63 |
| Max. Negotiated Rate |
$1,276.04 |
| Rate for Payer: Aetna Commercial |
$1,248.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$735.11
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,276.04
|
| Rate for Payer: Health EOS Commercial |
$1,234.43
|
| Rate for Payer: HFN Commercial |
$1,276.04
|
| Rate for Payer: Multiplan Commercial |
$1,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$832.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.04
|
| Rate for Payer: Quartz Beloit One Network |
$679.63
|
| Rate for Payer: Quartz Commercial |
$832.20
|
| Rate for Payer: WEA Trust Commercial |
$762.85
|
| Rate for Payer: WPS Commercial |
$1,027.35
|
|
|
XR Barium Enema Complete
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
627608
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,183.12 |
| Rate for Payer: Aetna Commercial |
$1,157.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.96
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$835.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$643.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$617.28
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,183.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$719.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,144.54
|
| Rate for Payer: HFN Commercial |
$1,183.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$1,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,183.12
|
| Rate for Payer: Quartz Beloit One Network |
$630.14
|
| Rate for Payer: Quartz Commercial |
$835.90
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$707.30
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$952.54
|
|
|
XR Barium Enema Complete
|
Professional
|
Both
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1536879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$543.34 |
| Max. Negotiated Rate |
$1,317.65 |
| Rate for Payer: Aetna Commercial |
$1,317.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.82
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,317.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$693.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$832.20
|
| Rate for Payer: Health EOS Commercial |
$1,262.17
|
| Rate for Payer: HFN Commercial |
$1,317.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.34
|
| Rate for Payer: Multiplan Commercial |
$1,109.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,317.65
|
| Rate for Payer: Quartz Beloit One Network |
$610.28
|
| Rate for Payer: Quartz Commercial |
$790.59
|
| Rate for Payer: The Alliance Commercial |
$693.50
|
| Rate for Payer: WEA Trust Commercial |
$762.85
|
| Rate for Payer: WPS Commercial |
$1,027.35
|
|
|
XR Barium Enema Complete
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
627608
|
| Min. Negotiated Rate |
$543.34 |
| Max. Negotiated Rate |
$1,221.70 |
| Rate for Payer: Aetna Commercial |
$1,221.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.96
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,221.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$643.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.60
|
| Rate for Payer: Health EOS Commercial |
$1,170.26
|
| Rate for Payer: HFN Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.34
|
| Rate for Payer: Multiplan Commercial |
$1,028.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,221.70
|
| Rate for Payer: Quartz Beloit One Network |
$565.84
|
| Rate for Payer: Quartz Commercial |
$733.02
|
| Rate for Payer: The Alliance Commercial |
$643.00
|
| Rate for Payer: WEA Trust Commercial |
$707.30
|
| Rate for Payer: WPS Commercial |
$952.54
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
1536881
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,404.84 |
| Rate for Payer: Aetna Commercial |
$1,374.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,313.22
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.56
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$809.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| 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 |
$1,404.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$854.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,359.03
|
| Rate for Payer: HFN Commercial |
$1,404.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$1,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,404.84
|
| Rate for Payer: Quartz Beloit One Network |
$748.23
|
| Rate for Payer: Quartz Commercial |
$992.55
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$839.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$1,131.05
|
|
|
XR Barium Enema Therapeutic
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
1536881
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$671.88 |
| Max. Negotiated Rate |
$1,450.65 |
| Rate for Payer: Aetna Commercial |
$1,450.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,313.22
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cigna Commercial |
$1,450.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$763.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$916.20
|
| Rate for Payer: Health EOS Commercial |
$1,389.57
|
| Rate for Payer: HFN Commercial |
$1,450.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$903.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.36
|
| Rate for Payer: Multiplan Commercial |
$1,221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.65
|
| Rate for Payer: Quartz Beloit One Network |
$671.88
|
| Rate for Payer: Quartz Commercial |
$870.39
|
| Rate for Payer: The Alliance Commercial |
$763.50
|
| Rate for Payer: WEA Trust Commercial |
$839.85
|
| Rate for Payer: WPS Commercial |
$1,131.05
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
627610
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,350.56 |
| Rate for Payer: Aetna Commercial |
$1,321.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.48
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$954.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$734.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$704.64
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$778.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,350.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$821.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,306.52
|
| Rate for Payer: HFN Commercial |
$1,350.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$1,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,350.56
|
| Rate for Payer: Quartz Beloit One Network |
$719.32
|
| Rate for Payer: Quartz Commercial |
$954.20
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$807.40
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$1,087.35
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
1536881
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$748.23 |
| Max. Negotiated Rate |
$1,404.84 |
| Rate for Payer: Aetna Commercial |
$1,374.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,313.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$809.31
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cigna Commercial |
$1,404.84
|
| Rate for Payer: Health EOS Commercial |
$1,359.03
|
| Rate for Payer: HFN Commercial |
$1,404.84
|
| Rate for Payer: Multiplan Commercial |
$1,221.60
|
| Rate for Payer: NAPHCARE Commercial |
$916.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,404.84
|
| Rate for Payer: Quartz Beloit One Network |
$748.23
|
| Rate for Payer: Quartz Commercial |
$916.20
|
| Rate for Payer: WEA Trust Commercial |
$839.85
|
| Rate for Payer: WPS Commercial |
$1,131.05
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
627610
|
| Min. Negotiated Rate |
$719.32 |
| Max. Negotiated Rate |
$1,350.56 |
| Rate for Payer: Aetna Commercial |
$1,321.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,262.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$778.04
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,350.56
|
| Rate for Payer: Health EOS Commercial |
$1,306.52
|
| Rate for Payer: HFN Commercial |
$1,350.56
|
| Rate for Payer: Multiplan Commercial |
$1,174.40
|
| Rate for Payer: NAPHCARE Commercial |
$880.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,350.56
|
| Rate for Payer: Quartz Beloit One Network |
$719.32
|
| Rate for Payer: Quartz Commercial |
$880.80
|
| Rate for Payer: WEA Trust Commercial |
$807.40
|
| Rate for Payer: WPS Commercial |
$1,087.35
|
|
