|
XR Chest Special Views
|
Facility
|
OP
|
$519.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536934
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$66.98 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| 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 |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$66.98
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
XR Chest Special Views
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536934
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.74 |
| Max. Negotiated Rate |
$512.77 |
| Rate for Payer: Aetna Commercial |
$512.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| 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 |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$512.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.74
|
| Rate for Payer: Health EOS Commercial |
$491.18
|
| Rate for Payer: HFN Commercial |
$512.77
|
| 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 |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$25.12
|
| Rate for Payer: Preferred Network Access Commercial |
$512.77
|
| Rate for Payer: Quartz Beloit One Network |
$237.49
|
| Rate for Payer: Quartz Commercial |
$307.66
|
| 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 |
$296.87
|
| Rate for Payer: WPS Commercial |
$83.72
|
|
|
XR Chest Special Views
|
Professional
|
Both
|
$499.00
|
|
|
Service Code
|
CPT 71035
|
| Hospital Charge Code |
629730
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$493.01 |
| Rate for Payer: Aetna Commercial |
$493.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$493.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.38
|
| Rate for Payer: Health EOS Commercial |
$472.25
|
| Rate for Payer: HFN Commercial |
$493.01
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$493.01
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$295.81
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
XR Chest Special Views
|
Facility
|
IP
|
$519.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
1536934
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
XR Cholangiogram Or w/ Existing Catheter
|
Facility
|
IP
|
$1,439.00
|
|
|
Service Code
|
CPT 47505 TC
|
| Hospital Charge Code |
3072711
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$733.31 |
| Max. Negotiated Rate |
$1,376.84 |
| Rate for Payer: Aetna Commercial |
$1,346.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.18
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,376.84
|
| Rate for Payer: Health EOS Commercial |
$1,331.94
|
| Rate for Payer: HFN Commercial |
$1,376.84
|
| Rate for Payer: Multiplan Commercial |
$1,197.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,376.84
|
| Rate for Payer: Quartz Beloit One Network |
$733.31
|
| Rate for Payer: Quartz Commercial |
$897.94
|
| Rate for Payer: WEA Trust Commercial |
$823.11
|
| Rate for Payer: WPS Commercial |
$1,108.46
|
|
|
XR Cholangiogram Or w/ Existing Catheter
|
Professional
|
Both
|
$1,439.00
|
|
|
Service Code
|
CPT 47505 TC
|
| Hospital Charge Code |
3072711
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$658.49 |
| Max. Negotiated Rate |
$1,421.73 |
| Rate for Payer: Aetna Commercial |
$1,421.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.04
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,421.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$748.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$897.94
|
| Rate for Payer: Health EOS Commercial |
$1,361.87
|
| Rate for Payer: HFN Commercial |
$1,421.73
|
| Rate for Payer: Multiplan Commercial |
$1,197.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,421.73
|
| Rate for Payer: Quartz Beloit One Network |
$658.49
|
| Rate for Payer: Quartz Commercial |
$853.04
|
| Rate for Payer: The Alliance Commercial |
$748.28
|
| Rate for Payer: WEA Trust Commercial |
$823.11
|
| Rate for Payer: WPS Commercial |
$1,108.46
|
|
|
XR Cholangiogram Or w/ Existing Catheter
|
Facility
|
OP
|
$1,439.00
|
|
|
Service Code
|
CPT 47505 TC
|
| Hospital Charge Code |
3072711
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$419.04 |
| Max. Negotiated Rate |
$1,376.84 |
| Rate for Payer: Aetna Commercial |
$1,346.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.04
|
| Rate for Payer: Aetna Managed Medicare |
$419.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$972.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$748.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$718.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.18
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cash Price |
$431.70
|
| Rate for Payer: Cigna Commercial |
$1,376.84
|
| Rate for Payer: Health EOS Commercial |
$1,331.94
|
| Rate for Payer: HFN Commercial |
$1,376.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,122.42
|
| Rate for Payer: Multiplan Commercial |
$1,197.25
|
| Rate for Payer: NAPHCARE Commercial |
$897.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,376.84
|
| Rate for Payer: Quartz Beloit One Network |
$733.31
|
| Rate for Payer: Quartz Commercial |
$972.76
|
| Rate for Payer: Quartz Medicare Advantage |
$897.94
|
| Rate for Payer: The Alliance Commercial |
$748.28
|
| Rate for Payer: WEA Trust Commercial |
$823.11
|
| Rate for Payer: WPS Commercial |
$1,108.46
|
|
|
XR Cholangiogram OR w/ Existing Catheter
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1536938
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$531.51 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$650.83
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
XR Cholangiogram OR w/ Existing Catheter
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1536938
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$303.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.03
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.54
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$650.83
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$705.07
|
| Rate for Payer: Quartz Medicare Advantage |
$650.83
|
| Rate for Payer: The Alliance Commercial |
$542.36
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
XR Cholangiogram Perc Transhepatic
|
Facility
|
OP
|
$2,098.00
|
|
|
Service Code
|
CPT 74320 TC
|
| Hospital Charge Code |
3072712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$2,007.37 |
| Rate for Payer: Aetna Commercial |
$1,963.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.45
|
| Rate for Payer: Aetna Managed Medicare |
$610.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,418.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,090.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,047.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.42
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$2,007.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,221.04
|
| Rate for Payer: Health EOS Commercial |
$1,941.91
|
| Rate for Payer: HFN Commercial |
$2,007.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,636.44
|
| Rate for Payer: Multiplan Commercial |
$1,745.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.14
|
| Rate for Payer: Quartz Commercial |
$1,418.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,309.15
|
| Rate for Payer: The Alliance Commercial |
$1,090.96
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,200.06
|
| Rate for Payer: WPS Commercial |
$1,616.09
|
|
|
XR Cholangiogram Perc Transhepatic
|
Professional
|
Both
|
$2,098.00
|
|
|
Service Code
|
CPT 74320 TC
|
| Hospital Charge Code |
3072712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$960.04 |
| Max. Negotiated Rate |
$2,072.82 |
| Rate for Payer: Aetna Commercial |
$2,072.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.45
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$2,072.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,090.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,309.15
|
| Rate for Payer: Health EOS Commercial |
$1,985.55
|
| Rate for Payer: HFN Commercial |
$2,072.82
|
| Rate for Payer: Multiplan Commercial |
$1,745.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,072.82
|
| Rate for Payer: Quartz Beloit One Network |
$960.04
|
| Rate for Payer: Quartz Commercial |
$1,243.69
|
| Rate for Payer: The Alliance Commercial |
$1,090.96
|
| Rate for Payer: WEA Trust Commercial |
$1,200.06
|
| Rate for Payer: WPS Commercial |
$1,616.09
|
|
|
XR Cholangiogram Perc Transhepatic
|
Facility
|
IP
|
$2,098.00
|
|
|
Service Code
|
CPT 74320 TC
|
| Hospital Charge Code |
3072712
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,069.14 |
| Max. Negotiated Rate |
$2,007.37 |
| Rate for Payer: Aetna Commercial |
$1,963.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.42
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$2,007.37
|
| Rate for Payer: Health EOS Commercial |
$1,941.91
|
| Rate for Payer: HFN Commercial |
$2,007.37
|
| Rate for Payer: Multiplan Commercial |
$1,745.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.14
|
| Rate for Payer: Quartz Commercial |
$1,309.15
|
| Rate for Payer: WEA Trust Commercial |
$1,200.06
|
| Rate for Payer: WPS Commercial |
$1,616.09
|
|
|
XR Cisternography
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
1536948
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.62 |
| Max. Negotiated Rate |
$1,333.80 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Aetna Managed Medicare |
$159.62
|
| Rate for Payer: Anthem Medicare Advantage |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.62
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,333.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$702.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.62
|
| Rate for Payer: Health EOS Commercial |
$1,277.64
|
| Rate for Payer: HFN Commercial |
$1,333.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$603.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$603.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.62
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$239.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,333.80
|
| Rate for Payer: Quartz Beloit One Network |
$617.76
|
| Rate for Payer: Quartz Commercial |
$800.28
|
| Rate for Payer: Quartz Medicare Advantage |
$159.62
|
| Rate for Payer: The Alliance Commercial |
$606.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.62
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$798.10
|
|
|
XR Cisternography
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
1536948
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$687.96 |
| Max. Negotiated Rate |
$1,291.68 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$744.12
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$842.40
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
|
XR Cisternography
|
Facility
|
OP
|
$1,298.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
629746
|
| Min. Negotiated Rate |
$647.96 |
| Max. Negotiated Rate |
$3,299.96 |
| Rate for Payer: Aetna Commercial |
$1,214.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.93
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$877.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$674.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$647.96
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,241.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$755.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$1,201.43
|
| Rate for Payer: HFN Commercial |
$1,241.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$1,079.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,241.93
|
| Rate for Payer: Quartz Beloit One Network |
$661.46
|
| Rate for Payer: Quartz Commercial |
$877.45
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$742.46
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$999.85
|
|
|
XR Cisternography
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
1536948
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$3,299.96 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,086.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,469.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,345.71
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$744.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$785.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$912.60
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
|
XR Cisternography
|
Professional
|
Both
|
$1,298.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
629746
|
| Min. Negotiated Rate |
$159.62 |
| Max. Negotiated Rate |
$1,282.42 |
| Rate for Payer: Aetna Commercial |
$1,282.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.93
|
| Rate for Payer: Aetna Managed Medicare |
$159.62
|
| Rate for Payer: Anthem Medicare Advantage |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.62
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,282.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$674.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.62
|
| Rate for Payer: Health EOS Commercial |
$1,228.43
|
| Rate for Payer: HFN Commercial |
$1,282.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$603.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$603.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.62
|
| Rate for Payer: Multiplan Commercial |
$1,079.94
|
| Rate for Payer: NAPHCARE Commercial |
$239.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,282.42
|
| Rate for Payer: Quartz Beloit One Network |
$593.96
|
| Rate for Payer: Quartz Commercial |
$769.45
|
| Rate for Payer: Quartz Medicare Advantage |
$159.62
|
| Rate for Payer: The Alliance Commercial |
$606.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.62
|
| Rate for Payer: WEA Trust Commercial |
$742.46
|
| Rate for Payer: WPS Commercial |
$798.10
|
|
|
XR Cisternography
|
Facility
|
IP
|
$1,298.00
|
|
|
Service Code
|
CPT 70015
|
| Hospital Charge Code |
629746
|
| Min. Negotiated Rate |
$661.46 |
| Max. Negotiated Rate |
$1,241.93 |
| Rate for Payer: Aetna Commercial |
$1,214.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.46
|
| Rate for Payer: Cash Price |
$389.40
|
| Rate for Payer: Cigna Commercial |
$1,241.93
|
| Rate for Payer: Health EOS Commercial |
$1,201.43
|
| Rate for Payer: HFN Commercial |
$1,241.93
|
| Rate for Payer: Multiplan Commercial |
$1,079.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,241.93
|
| Rate for Payer: Quartz Beloit One Network |
$661.46
|
| Rate for Payer: Quartz Commercial |
$809.95
|
| Rate for Payer: WEA Trust Commercial |
$742.46
|
| Rate for Payer: WPS Commercial |
$999.85
|
|
|
XR Clavicle Bilateral
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536950
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$553.28 |
| Rate for Payer: Aetna Commercial |
$553.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$553.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.44
|
| Rate for Payer: Health EOS Commercial |
$529.98
|
| Rate for Payer: HFN Commercial |
$553.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Preferred Network Access Commercial |
$553.28
|
| Rate for Payer: Quartz Beloit One Network |
$256.26
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: The Alliance Commercial |
$291.20
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Bilateral
|
Facility
|
OP
|
$1,100.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629750
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$743.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$572.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$549.12
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| 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 |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| 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 |
$915.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$743.60
|
| 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 |
$629.20
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
|
XR Clavicle Bilateral
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536950
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$163.07
|
| 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 |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.92
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.80
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$349.44
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$378.56
|
| Rate for Payer: Quartz Medicare Advantage |
$349.44
|
| Rate for Payer: The Alliance Commercial |
$291.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Bilateral
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536950
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.38 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$349.44
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Bilateral
|
Facility
|
IP
|
$1,100.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629750
|
| Min. Negotiated Rate |
$560.56 |
| Max. Negotiated Rate |
$1,052.48 |
| Rate for Payer: Aetna Commercial |
$1,029.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.32
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,052.48
|
| Rate for Payer: Health EOS Commercial |
$1,018.16
|
| Rate for Payer: HFN Commercial |
$1,052.48
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.48
|
| Rate for Payer: Quartz Beloit One Network |
$560.56
|
| Rate for Payer: Quartz Commercial |
$686.40
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.33
|
|
|
XR Clavicle Bilateral
|
Professional
|
Both
|
$1,100.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629750
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna Commercial |
$1,086.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Aetna Managed Medicare |
$33.06
|
| Rate for Payer: Anthem Medicare Advantage |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.06
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cash Price |
$330.00
|
| Rate for Payer: Cigna Commercial |
$1,086.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$572.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.06
|
| Rate for Payer: Health EOS Commercial |
$1,041.04
|
| Rate for Payer: HFN Commercial |
$1,086.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.06
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: NAPHCARE Commercial |
$49.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.80
|
| Rate for Payer: Quartz Beloit One Network |
$503.36
|
| Rate for Payer: Quartz Commercial |
$652.08
|
| Rate for Payer: Quartz Medicare Advantage |
$33.06
|
| Rate for Payer: The Alliance Commercial |
$125.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.06
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$165.31
|
|
|
XR Clavicle Left
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536952
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.38 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$349.44
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
