|
XR Calcaneous Right
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629620
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$293.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.65
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$293.38
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
XR Calcaneous Right
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 73650 TC,RT
|
| Hospital Charge Code |
2980068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$92.02
|
| 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 |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.91
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$197.18
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Right
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 73650 TC,RT
|
| Hospital Charge Code |
2980068
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Right
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629620
|
| Min. Negotiated Rate |
$221.17 |
| Max. Negotiated Rate |
$415.25 |
| Rate for Payer: Aetna Commercial |
$406.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.22
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$415.25
|
| Rate for Payer: Health EOS Commercial |
$401.71
|
| Rate for Payer: HFN Commercial |
$415.25
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: Preferred Network Access Commercial |
$415.25
|
| Rate for Payer: Quartz Beloit One Network |
$221.17
|
| Rate for Payer: Quartz Commercial |
$270.82
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
XR Calcaneous Right
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 73650 RT,TC
|
| Hospital Charge Code |
1536911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.02 |
| Max. Negotiated Rate |
$350.30 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Aetna Managed Medicare |
$92.02
|
| 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 |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.91
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.48
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: NAPHCARE Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$213.62
|
| Rate for Payer: Quartz Medicare Advantage |
$197.18
|
| Rate for Payer: The Alliance Commercial |
$164.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Calcaneous Right
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 73650
|
| Hospital Charge Code |
629620
|
| Min. Negotiated Rate |
$28.07 |
| Max. Negotiated Rate |
$428.79 |
| Rate for Payer: Aetna Commercial |
$428.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.17
|
| Rate for Payer: Aetna Managed Medicare |
$28.07
|
| Rate for Payer: Anthem Medicare Advantage |
$28.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.07
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$428.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.07
|
| Rate for Payer: Health EOS Commercial |
$410.74
|
| Rate for Payer: HFN Commercial |
$428.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.07
|
| Rate for Payer: Multiplan Commercial |
$361.09
|
| Rate for Payer: NAPHCARE Commercial |
$42.10
|
| Rate for Payer: Preferred Network Access Commercial |
$428.79
|
| Rate for Payer: Quartz Beloit One Network |
$198.60
|
| Rate for Payer: Quartz Commercial |
$257.28
|
| Rate for Payer: Quartz Medicare Advantage |
$28.07
|
| Rate for Payer: The Alliance Commercial |
$106.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.07
|
| Rate for Payer: WEA Trust Commercial |
$248.25
|
| Rate for Payer: WPS Commercial |
$140.35
|
|
|
XR Calcaneous Right
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 73650 RT,TC
|
| Hospital Charge Code |
1536911
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$302.35 |
| Rate for Payer: Aetna Commercial |
$295.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.18
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$302.35
|
| Rate for Payer: Health EOS Commercial |
$292.49
|
| Rate for Payer: HFN Commercial |
$302.35
|
| Rate for Payer: Multiplan Commercial |
$262.91
|
| Rate for Payer: Preferred Network Access Commercial |
$302.35
|
| Rate for Payer: Quartz Beloit One Network |
$161.03
|
| Rate for Payer: Quartz Commercial |
$197.18
|
| Rate for Payer: WEA Trust Commercial |
$180.75
|
| Rate for Payer: WPS Commercial |
$243.41
|
|
|
XR Chest 1 View, Abdomen 1 View
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
6210073
|
|
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 Chest 1 View, Abdomen 1 View
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
6210073
|
|
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 Chest 1 View, Abdomen 1 View
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
6210073
|
|
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 Chest 1 View Frontal
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536915
|
|
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 Chest 1 View Frontal
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536915
|
|
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 Chest 1 View Frontal
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 71010
|
| Hospital Charge Code |
629716
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$371.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Aetna Managed Medicare |
$115.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.83
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$379.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.05
|
| Rate for Payer: Health EOS Commercial |
$367.46
|
| Rate for Payer: HFN Commercial |
$379.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.66
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: NAPHCARE Commercial |
$247.73
|
| Rate for Payer: Preferred Network Access Commercial |
$379.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.31
|
| Rate for Payer: Quartz Commercial |
$268.37
|
| Rate for Payer: Quartz Medicare Advantage |
$247.73
|
| Rate for Payer: The Alliance Commercial |
$206.44
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
XR Chest 1 View Frontal
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 71010
|
| Hospital Charge Code |
629716
|
| Min. Negotiated Rate |
$202.31 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$371.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.83
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$379.85
|
| Rate for Payer: Health EOS Commercial |
$367.46
|
| Rate for Payer: HFN Commercial |
$379.85
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: Preferred Network Access Commercial |
$379.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.31
|
| Rate for Payer: Quartz Commercial |
$247.73
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
XR Chest 1 View Frontal
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
CPT 71010
|
| Hospital Charge Code |
629716
|
| Min. Negotiated Rate |
$181.67 |
| Max. Negotiated Rate |
$392.24 |
| Rate for Payer: Aetna Commercial |
$392.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$392.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.73
|
| Rate for Payer: Health EOS Commercial |
$375.72
|
| Rate for Payer: HFN Commercial |
$392.24
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: Preferred Network Access Commercial |
$392.24
|
| Rate for Payer: Quartz Beloit One Network |
$181.67
|
| Rate for Payer: Quartz Commercial |
$235.34
|
| Rate for Payer: The Alliance Commercial |
$206.44
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
XR Chest 1 View Frontal
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536915
|
|
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 Chest 2 Views
|
Professional
|
Both
|
$529.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$22.73 |
| Max. Negotiated Rate |
$522.65 |
| Rate for Payer: Aetna Commercial |
$522.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.14
|
| Rate for Payer: Aetna Managed Medicare |
$22.73
|
| Rate for Payer: Anthem Medicare Advantage |
$22.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.73
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$522.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$275.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.73
|
| Rate for Payer: Health EOS Commercial |
$500.65
|
| Rate for Payer: HFN Commercial |
$522.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.73
|
| Rate for Payer: Multiplan Commercial |
$440.13
|
| Rate for Payer: NAPHCARE Commercial |
$34.10
|
| Rate for Payer: Preferred Network Access Commercial |
$522.65
|
| Rate for Payer: Quartz Beloit One Network |
$242.07
|
| Rate for Payer: Quartz Commercial |
$313.59
|
| Rate for Payer: Quartz Medicare Advantage |
$22.73
|
| Rate for Payer: The Alliance Commercial |
$86.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.73
|
| Rate for Payer: WEA Trust Commercial |
$302.59
|
| Rate for Payer: WPS Commercial |
$113.67
|
|
|
XR Chest 2 Views
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$269.58 |
| Max. Negotiated Rate |
$506.15 |
| Rate for Payer: Aetna Commercial |
$495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.58
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$506.15
|
| Rate for Payer: Health EOS Commercial |
$489.64
|
| Rate for Payer: HFN Commercial |
$506.15
|
| Rate for Payer: Multiplan Commercial |
$440.13
|
| Rate for Payer: Preferred Network Access Commercial |
$506.15
|
| Rate for Payer: Quartz Beloit One Network |
$269.58
|
| Rate for Payer: Quartz Commercial |
$330.10
|
| Rate for Payer: WEA Trust Commercial |
$302.59
|
| Rate for Payer: WPS Commercial |
$407.49
|
|
|
XR Chest 2 Views
|
Facility
|
OP
|
$529.00
|
|
|
Service Code
|
CPT 71046 TC
|
| Hospital Charge Code |
689607
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$90.94 |
| Max. Negotiated Rate |
$506.15 |
| Rate for Payer: Aetna Commercial |
$495.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.14
|
| Rate for Payer: Aetna Managed Medicare |
$154.04
|
| 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 |
$291.58
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cash Price |
$158.70
|
| Rate for Payer: Cigna Commercial |
$506.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.88
|
| Rate for Payer: Health EOS Commercial |
$489.64
|
| Rate for Payer: HFN Commercial |
$506.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$412.62
|
| Rate for Payer: Multiplan Commercial |
$440.13
|
| Rate for Payer: NAPHCARE Commercial |
$330.10
|
| Rate for Payer: Preferred Network Access Commercial |
$506.15
|
| Rate for Payer: Quartz Beloit One Network |
$269.58
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: Quartz Medicare Advantage |
$330.10
|
| Rate for Payer: The Alliance Commercial |
$90.94
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$302.59
|
| Rate for Payer: WPS Commercial |
$407.49
|
|
|
XR Chest 2 Views
|
Facility
|
IP
|
$478.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$243.59 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$298.27
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
XR Chest 2 Views
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.80 |
| Max. Negotiated Rate |
$472.26 |
| Rate for Payer: Aetna Commercial |
$472.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Aetna Managed Medicare |
$32.80
|
| Rate for Payer: Anthem Medicare Advantage |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.80
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$472.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$248.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.80
|
| Rate for Payer: Health EOS Commercial |
$452.38
|
| Rate for Payer: HFN Commercial |
$472.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.80
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$472.26
|
| Rate for Payer: Quartz Beloit One Network |
$218.73
|
| Rate for Payer: Quartz Commercial |
$283.36
|
| Rate for Payer: Quartz Medicare Advantage |
$32.80
|
| Rate for Payer: The Alliance Commercial |
$124.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.80
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: WPS Commercial |
$164.01
|
|
|
XR Chest 2 Views
|
Facility
|
OP
|
$478.00
|
|
|
Service Code
|
CPT 71046
|
| Hospital Charge Code |
629718
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$457.35 |
| Rate for Payer: Aetna Commercial |
$447.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.52
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| 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: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$457.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$442.44
|
| Rate for Payer: HFN Commercial |
$457.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$397.70
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$457.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.59
|
| Rate for Payer: Quartz Commercial |
$323.13
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$273.42
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$368.20
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Facility
|
OP
|
$701.00
|
|
|
Service Code
|
CPT 71047 TC
|
| Hospital Charge Code |
1536917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.24 |
| Max. Negotiated Rate |
$670.72 |
| Rate for Payer: Aetna Commercial |
$656.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.97
|
| Rate for Payer: Aetna Managed Medicare |
$204.13
|
| 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 |
$386.39
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$670.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$407.98
|
| Rate for Payer: Health EOS Commercial |
$648.85
|
| Rate for Payer: HFN Commercial |
$670.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.78
|
| Rate for Payer: Multiplan Commercial |
$583.23
|
| Rate for Payer: NAPHCARE Commercial |
$437.42
|
| Rate for Payer: Preferred Network Access Commercial |
$670.72
|
| Rate for Payer: Quartz Beloit One Network |
$357.23
|
| Rate for Payer: Quartz Commercial |
$473.88
|
| Rate for Payer: Quartz Medicare Advantage |
$437.42
|
| Rate for Payer: The Alliance Commercial |
$112.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$400.97
|
| Rate for Payer: WPS Commercial |
$539.98
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
CPT 71047 TC
|
| Hospital Charge Code |
1536917
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$692.59 |
| Rate for Payer: Aetna Commercial |
$692.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.97
|
| Rate for Payer: Aetna Managed Medicare |
$28.06
|
| Rate for Payer: Anthem Medicare Advantage |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.06
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$692.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$364.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.06
|
| Rate for Payer: Health EOS Commercial |
$663.43
|
| Rate for Payer: HFN Commercial |
$692.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.06
|
| Rate for Payer: Multiplan Commercial |
$583.23
|
| Rate for Payer: NAPHCARE Commercial |
$42.09
|
| Rate for Payer: Preferred Network Access Commercial |
$692.59
|
| Rate for Payer: Quartz Beloit One Network |
$320.78
|
| Rate for Payer: Quartz Commercial |
$415.55
|
| Rate for Payer: Quartz Medicare Advantage |
$28.06
|
| Rate for Payer: The Alliance Commercial |
$106.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.06
|
| Rate for Payer: WEA Trust Commercial |
$400.97
|
| Rate for Payer: WPS Commercial |
$140.30
|
|
|
XR Chest 2 Views w/ Apical Lordotic
|
Facility
|
IP
|
$674.00
|
|
|
Service Code
|
CPT 71021
|
| Hospital Charge Code |
629720
|
| Min. Negotiated Rate |
$343.47 |
| Max. Negotiated Rate |
$644.88 |
| Rate for Payer: Aetna Commercial |
$630.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.51
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$644.88
|
| Rate for Payer: Health EOS Commercial |
$623.85
|
| Rate for Payer: HFN Commercial |
$644.88
|
| Rate for Payer: Multiplan Commercial |
$560.77
|
| Rate for Payer: Preferred Network Access Commercial |
$644.88
|
| Rate for Payer: Quartz Beloit One Network |
$343.47
|
| Rate for Payer: Quartz Commercial |
$420.58
|
| Rate for Payer: WEA Trust Commercial |
$385.53
|
| Rate for Payer: WPS Commercial |
$519.18
|
|
