|
XR Pod Toes Great Right
|
Facility
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T5
|
| Hospital Charge Code |
2587316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$1,628.00 |
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
| Rate for Payer: Aetna Managed Medicare |
$113.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$374.44
|
| Rate for Payer: Health EOS Commercial |
$362.23
|
| Rate for Payer: HFN Commercial |
$374.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$305.25
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: NAPHCARE Commercial |
$244.20
|
| Rate for Payer: Preferred Network Access Commercial |
$374.44
|
| Rate for Payer: Quartz Beloit One Network |
$199.43
|
| Rate for Payer: Quartz Commercial |
$264.55
|
| Rate for Payer: Quartz Medicare Advantage |
$244.20
|
| Rate for Payer: The Alliance Commercial |
$1,628.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
XR Pod Toes Great Right
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448842
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$515.52 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.68
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$515.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Pod Toes Great Right
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448842
|
| Min. Negotiated Rate |
$28.12 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$28.12
|
| Rate for Payer: Anthem Medicare Advantage |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.12
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.12
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.12
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: Quartz Medicare Advantage |
$28.12
|
| Rate for Payer: The Alliance Commercial |
$106.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.12
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$140.60
|
|
|
XR Pod Toes Great Right
|
Facility
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T5
|
| Hospital Charge Code |
2587316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.43 |
| Max. Negotiated Rate |
$374.44 |
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$374.44
|
| Rate for Payer: Health EOS Commercial |
$362.23
|
| Rate for Payer: HFN Commercial |
$374.44
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: NAPHCARE Commercial |
$244.20
|
| Rate for Payer: Preferred Network Access Commercial |
$374.44
|
| Rate for Payer: Quartz Beloit One Network |
$199.43
|
| Rate for Payer: Quartz Commercial |
$244.20
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
XR Pod Toes Great Right
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448842
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Pod Toes Great Right
|
Professional
|
$407.00
|
|
|
Service Code
|
CPT 73660 T5
|
| Hospital Charge Code |
2587316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.08 |
| Max. Negotiated Rate |
$386.65 |
| Rate for Payer: Aetna Commercial |
$386.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$386.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.20
|
| Rate for Payer: Health EOS Commercial |
$370.37
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: Preferred Network Access Commercial |
$386.65
|
| Rate for Payer: Quartz Beloit One Network |
$179.08
|
| Rate for Payer: Quartz Commercial |
$231.99
|
| Rate for Payer: The Alliance Commercial |
$203.50
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
XR Pyelostogram
|
Facility
OP
|
$939.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
3072719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$262.92 |
| Max. Negotiated Rate |
$3,756.00 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$807.54
|
| Rate for Payer: Aetna Managed Medicare |
$262.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$610.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$469.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$450.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.67
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$863.88
|
| Rate for Payer: Health EOS Commercial |
$835.71
|
| Rate for Payer: HFN Commercial |
$863.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$704.25
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: NAPHCARE Commercial |
$563.40
|
| Rate for Payer: Preferred Network Access Commercial |
$863.88
|
| Rate for Payer: Quartz Beloit One Network |
$460.11
|
| Rate for Payer: Quartz Commercial |
$610.35
|
| Rate for Payer: Quartz Medicare Advantage |
$563.40
|
| Rate for Payer: The Alliance Commercial |
$3,756.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$516.45
|
| Rate for Payer: WPS Commercial |
$695.52
|
|
|
XR Pyelostogram
|
Professional
|
$939.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
3072719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$892.05 |
| Rate for Payer: Aetna Commercial |
$892.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$807.54
|
| Rate for Payer: Aetna Managed Medicare |
$109.56
|
| Rate for Payer: Anthem Medicare Advantage |
$109.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$109.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$109.56
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$892.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$469.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.56
|
| Rate for Payer: Health EOS Commercial |
$854.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$389.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$109.56
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: Preferred Network Access Commercial |
$892.05
|
| Rate for Payer: Quartz Beloit One Network |
$413.16
|
| Rate for Payer: Quartz Commercial |
$535.23
|
| Rate for Payer: Quartz Medicare Advantage |
$109.56
|
| Rate for Payer: The Alliance Commercial |
$416.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.56
|
| Rate for Payer: WEA Trust Commercial |
$516.45
|
| Rate for Payer: WPS Commercial |
$547.80
|
|
|
XR Pyelostogram
|
Facility
IP
|
$939.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
3072719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$460.11 |
| Max. Negotiated Rate |
$863.88 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.67
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$863.88
|
| Rate for Payer: Health EOS Commercial |
$835.71
|
| Rate for Payer: HFN Commercial |
$863.88
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: NAPHCARE Commercial |
$563.40
|
| Rate for Payer: Preferred Network Access Commercial |
$863.88
|
| Rate for Payer: Quartz Beloit One Network |
$460.11
|
| Rate for Payer: Quartz Commercial |
$563.40
|
| Rate for Payer: WEA Trust Commercial |
$516.45
|
| Rate for Payer: WPS Commercial |
$695.52
|
|
|
XR Ribs 2 Views Left
|
Facility
IP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 2 Views Left
|
Professional
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Aetna Commercial |
$536.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Aetna Managed Medicare |
$25.22
|
| Rate for Payer: Anthem Medicare Advantage |
$25.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.22
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$536.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.22
|
| Rate for Payer: Health EOS Commercial |
$514.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.22
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Preferred Network Access Commercial |
$536.75
|
| Rate for Payer: Quartz Beloit One Network |
$248.60
|
| Rate for Payer: Quartz Commercial |
$322.05
|
| Rate for Payer: Quartz Medicare Advantage |
$25.22
|
| Rate for Payer: The Alliance Commercial |
$95.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.22
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$126.10
|
|
|
XR Ribs 2 Views Left
|
Facility
IP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630229
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Left
|
Facility
OP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630229
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$19.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Left
|
Facility
OP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Aetna Managed Medicare |
$158.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.75
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$367.25
|
| Rate for Payer: Quartz Medicare Advantage |
$339.00
|
| Rate for Payer: The Alliance Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 2 Views Left
|
Professional
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630229
|
| Min. Negotiated Rate |
$35.68 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Aetna Commercial |
$496.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$35.68
|
| Rate for Payer: Anthem Medicare Advantage |
$35.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.68
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$496.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.68
|
| Rate for Payer: Health EOS Commercial |
$475.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.68
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Preferred Network Access Commercial |
$496.85
|
| Rate for Payer: Quartz Beloit One Network |
$230.12
|
| Rate for Payer: Quartz Commercial |
$298.11
|
| Rate for Payer: Quartz Medicare Advantage |
$35.68
|
| Rate for Payer: The Alliance Commercial |
$135.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.68
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$178.40
|
|
|
XR Ribs 2 Views Right
|
Professional
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630227
|
| Min. Negotiated Rate |
$35.68 |
| Max. Negotiated Rate |
$496.85 |
| Rate for Payer: Aetna Commercial |
$496.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$35.68
|
| Rate for Payer: Anthem Medicare Advantage |
$35.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.68
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$496.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$261.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.68
|
| Rate for Payer: Health EOS Commercial |
$475.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.68
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: Preferred Network Access Commercial |
$496.85
|
| Rate for Payer: Quartz Beloit One Network |
$230.12
|
| Rate for Payer: Quartz Commercial |
$298.11
|
| Rate for Payer: Quartz Medicare Advantage |
$35.68
|
| Rate for Payer: The Alliance Commercial |
$135.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.68
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$178.40
|
|
|
XR Ribs 2 Views Right
|
Facility
OP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630227
|
| Min. Negotiated Rate |
$19.64 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.78
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.04
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$339.95
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$19.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Right
|
Facility
IP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 2 Views Right
|
Facility
OP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Aetna Managed Medicare |
$158.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.75
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$367.25
|
| Rate for Payer: Quartz Medicare Advantage |
$339.00
|
| Rate for Payer: The Alliance Commercial |
$2,260.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
XR Ribs 2 Views Right
|
Facility
IP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630227
|
| Min. Negotiated Rate |
$256.27 |
| Max. Negotiated Rate |
$481.16 |
| Rate for Payer: Aetna Commercial |
$470.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.19
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$481.16
|
| Rate for Payer: Health EOS Commercial |
$465.47
|
| Rate for Payer: HFN Commercial |
$481.16
|
| Rate for Payer: Multiplan Commercial |
$418.40
|
| Rate for Payer: NAPHCARE Commercial |
$313.80
|
| Rate for Payer: Preferred Network Access Commercial |
$481.16
|
| Rate for Payer: Quartz Beloit One Network |
$256.27
|
| Rate for Payer: Quartz Commercial |
$313.80
|
| Rate for Payer: WEA Trust Commercial |
$287.65
|
| Rate for Payer: WPS Commercial |
$387.39
|
|
|
XR Ribs 2 Views Right
|
Professional
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.22 |
| Max. Negotiated Rate |
$536.75 |
| Rate for Payer: Aetna Commercial |
$536.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Aetna Managed Medicare |
$25.22
|
| Rate for Payer: Anthem Medicare Advantage |
$25.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.22
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$536.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.22
|
| Rate for Payer: Health EOS Commercial |
$514.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.22
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: Preferred Network Access Commercial |
$536.75
|
| Rate for Payer: Quartz Beloit One Network |
$248.60
|
| Rate for Payer: Quartz Commercial |
$322.05
|
| Rate for Payer: Quartz Medicare Advantage |
$25.22
|
| Rate for Payer: The Alliance Commercial |
$95.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.22
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$126.10
|
|
|
XR Ribs 3 Views Bilateral
|
Professional
|
$1,193.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
630231
|
| Min. Negotiated Rate |
$42.55 |
| Max. Negotiated Rate |
$1,133.35 |
| Rate for Payer: Aetna Commercial |
$1,133.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,025.98
|
| Rate for Payer: Aetna Managed Medicare |
$42.55
|
| Rate for Payer: Anthem Medicare Advantage |
$42.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.55
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cigna Commercial |
$1,133.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$596.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.55
|
| Rate for Payer: Health EOS Commercial |
$1,085.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.55
|
| Rate for Payer: Multiplan Commercial |
$954.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,133.35
|
| Rate for Payer: Quartz Beloit One Network |
$524.92
|
| Rate for Payer: Quartz Commercial |
$680.01
|
| Rate for Payer: Quartz Medicare Advantage |
$42.55
|
| Rate for Payer: The Alliance Commercial |
$161.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.55
|
| Rate for Payer: WEA Trust Commercial |
$656.15
|
| Rate for Payer: WPS Commercial |
$212.75
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
OP
|
$1,290.00
|
|
|
Service Code
|
CPT 71110 TC
|
| Hospital Charge Code |
1537252
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$5,160.00 |
| Rate for Payer: Aetna Commercial |
$1,161.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,109.40
|
| Rate for Payer: Aetna Managed Medicare |
$361.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$838.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$619.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.70
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,186.80
|
| Rate for Payer: Health EOS Commercial |
$1,148.10
|
| Rate for Payer: HFN Commercial |
$1,186.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$967.50
|
| Rate for Payer: Multiplan Commercial |
$1,032.00
|
| Rate for Payer: NAPHCARE Commercial |
$774.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.80
|
| Rate for Payer: Quartz Beloit One Network |
$632.10
|
| Rate for Payer: Quartz Commercial |
$838.50
|
| Rate for Payer: Quartz Medicare Advantage |
$774.00
|
| Rate for Payer: The Alliance Commercial |
$5,160.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$709.50
|
| Rate for Payer: WPS Commercial |
$955.50
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
630231
|
| Min. Negotiated Rate |
$584.57 |
| Max. Negotiated Rate |
$1,097.56 |
| Rate for Payer: Aetna Commercial |
$1,073.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$632.29
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cigna Commercial |
$1,097.56
|
| Rate for Payer: Health EOS Commercial |
$1,061.77
|
| Rate for Payer: HFN Commercial |
$1,097.56
|
| Rate for Payer: Multiplan Commercial |
$954.40
|
| Rate for Payer: NAPHCARE Commercial |
$715.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,097.56
|
| Rate for Payer: Quartz Beloit One Network |
$584.57
|
| Rate for Payer: Quartz Commercial |
$715.80
|
| Rate for Payer: WEA Trust Commercial |
$656.15
|
| Rate for Payer: WPS Commercial |
$883.66
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
IP
|
$1,290.00
|
|
|
Service Code
|
CPT 71110 TC
|
| Hospital Charge Code |
1537252
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$632.10 |
| Max. Negotiated Rate |
$1,186.80 |
| Rate for Payer: Aetna Commercial |
$1,161.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.70
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,186.80
|
| Rate for Payer: Health EOS Commercial |
$1,148.10
|
| Rate for Payer: HFN Commercial |
$1,186.80
|
| Rate for Payer: Multiplan Commercial |
$1,032.00
|
| Rate for Payer: NAPHCARE Commercial |
$774.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,186.80
|
| Rate for Payer: Quartz Beloit One Network |
$632.10
|
| Rate for Payer: Quartz Commercial |
$774.00
|
| Rate for Payer: WEA Trust Commercial |
$709.50
|
| Rate for Payer: WPS Commercial |
$955.50
|
|
