|
X-RAY Thoracic Spine 3 View 7207226
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 72072 26
|
| Hospital Charge Code |
3238192
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.41 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$10.41
|
| Rate for Payer: Anthem Medicare Advantage |
$10.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.41
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.41
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.41
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$15.62
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10.41
|
| Rate for Payer: The Alliance Commercial |
$39.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.41
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$52.05
|
|
|
X-RAY Thoracolumbar 7208026
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 72080 26
|
| Hospital Charge Code |
3238203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$10.05
|
| Rate for Payer: Anthem Medicare Advantage |
$10.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.05
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.05
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$15.07
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: Quartz Medicare Advantage |
$10.05
|
| Rate for Payer: The Alliance Commercial |
$38.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.05
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$50.23
|
|
|
XR Babygram
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
5724181
|
|
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 Babygram
|
Facility
|
OP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
5724181
|
|
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 Babygram
|
Facility
|
IP
|
$484.00
|
|
|
Service Code
|
CPT 71045 TC
|
| Hospital Charge Code |
5724181
|
|
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 Barium Enema Complete
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
627608
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$1,270.57 |
| Rate for Payer: Aetna Commercial |
$1,270.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,150.20
|
| Rate for Payer: Aetna Managed Medicare |
$147.98
|
| Rate for Payer: Anthem Medicare Advantage |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.98
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,270.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$668.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.98
|
| Rate for Payer: Health EOS Commercial |
$1,217.07
|
| Rate for Payer: HFN Commercial |
$1,270.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$565.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$565.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.98
|
| Rate for Payer: Multiplan Commercial |
$1,069.95
|
| Rate for Payer: NAPHCARE Commercial |
$221.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,270.57
|
| Rate for Payer: Quartz Beloit One Network |
$588.47
|
| Rate for Payer: Quartz Commercial |
$762.34
|
| Rate for Payer: Quartz Medicare Advantage |
$147.98
|
| Rate for Payer: The Alliance Commercial |
$562.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.98
|
| Rate for Payer: WEA Trust Commercial |
$735.59
|
| Rate for Payer: WPS Commercial |
$739.91
|
|
|
XR Barium Enema Complete
|
Professional
|
Both
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1536879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$1,370.36 |
| Rate for Payer: Aetna Commercial |
$1,370.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,240.53
|
| Rate for Payer: Aetna Managed Medicare |
$147.98
|
| Rate for Payer: Anthem Medicare Advantage |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.98
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,370.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$721.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.98
|
| Rate for Payer: Health EOS Commercial |
$1,312.66
|
| Rate for Payer: HFN Commercial |
$1,370.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$565.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$565.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.98
|
| Rate for Payer: Multiplan Commercial |
$1,153.98
|
| Rate for Payer: NAPHCARE Commercial |
$221.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,370.36
|
| Rate for Payer: Quartz Beloit One Network |
$634.69
|
| Rate for Payer: Quartz Commercial |
$822.21
|
| Rate for Payer: Quartz Medicare Advantage |
$147.98
|
| Rate for Payer: The Alliance Commercial |
$562.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.98
|
| Rate for Payer: WEA Trust Commercial |
$793.36
|
| Rate for Payer: WPS Commercial |
$739.91
|
|
|
XR Barium Enema Complete
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
627608
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,230.44 |
| Rate for Payer: Aetna Commercial |
$1,203.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,150.20
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.97
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,230.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,190.32
|
| Rate for Payer: HFN Commercial |
$1,230.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,069.95
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.44
|
| Rate for Payer: Quartz Beloit One Network |
$655.35
|
| Rate for Payer: Quartz Commercial |
$869.34
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$735.59
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$990.61
|
|
|
XR Barium Enema Complete
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
627608
|
| Min. Negotiated Rate |
$655.35 |
| Max. Negotiated Rate |
$1,230.44 |
| Rate for Payer: Aetna Commercial |
$1,203.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,150.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.84
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,230.44
|
| Rate for Payer: Health EOS Commercial |
$1,190.32
|
| Rate for Payer: HFN Commercial |
$1,230.44
|
| Rate for Payer: Multiplan Commercial |
$1,069.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.44
|
| Rate for Payer: Quartz Beloit One Network |
$655.35
|
| Rate for Payer: Quartz Commercial |
$802.46
|
| Rate for Payer: WEA Trust Commercial |
$735.59
|
| Rate for Payer: WPS Commercial |
$990.61
|
|
|
XR Barium Enema Complete
|
Facility
|
IP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1536879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$706.82 |
| Max. Negotiated Rate |
$1,327.08 |
| Rate for Payer: Aetna Commercial |
$1,298.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,240.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$764.51
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,327.08
|
| Rate for Payer: Health EOS Commercial |
$1,283.81
|
| Rate for Payer: HFN Commercial |
$1,327.08
|
| Rate for Payer: Multiplan Commercial |
$1,153.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,327.08
|
| Rate for Payer: Quartz Beloit One Network |
$706.82
|
| Rate for Payer: Quartz Commercial |
$865.49
|
| Rate for Payer: WEA Trust Commercial |
$793.36
|
| Rate for Payer: WPS Commercial |
$1,068.41
|
|
|
XR Barium Enema Complete
|
Facility
|
OP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1536879
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,327.08 |
| Rate for Payer: Aetna Commercial |
$1,298.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,240.53
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$764.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,327.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$807.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,283.81
|
| Rate for Payer: HFN Commercial |
$1,327.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,153.98
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,327.08
|
| Rate for Payer: Quartz Beloit One Network |
$706.82
|
| Rate for Payer: Quartz Commercial |
$937.61
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$793.36
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,068.41
|
|
|
XR Barium Enema Therapeutic
|
Professional
|
Both
|
$1,468.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
627610
|
| Min. Negotiated Rate |
$279.14 |
| Max. Negotiated Rate |
$1,450.38 |
| Rate for Payer: Aetna Commercial |
$1,450.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Aetna Managed Medicare |
$279.14
|
| Rate for Payer: Anthem Medicare Advantage |
$279.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$279.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$279.14
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,450.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$763.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.14
|
| Rate for Payer: Health EOS Commercial |
$1,389.32
|
| Rate for Payer: HFN Commercial |
$1,450.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$939.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$939.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$279.14
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: NAPHCARE Commercial |
$418.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.38
|
| Rate for Payer: Quartz Beloit One Network |
$671.76
|
| Rate for Payer: Quartz Commercial |
$870.23
|
| Rate for Payer: Quartz Medicare Advantage |
$279.14
|
| Rate for Payer: The Alliance Commercial |
$1,060.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.14
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: WPS Commercial |
$1,395.68
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
1536881
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$778.16 |
| Max. Negotiated Rate |
$1,461.03 |
| Rate for Payer: Aetna Commercial |
$1,429.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,365.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$841.68
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cigna Commercial |
$1,461.03
|
| Rate for Payer: Health EOS Commercial |
$1,413.39
|
| Rate for Payer: HFN Commercial |
$1,461.03
|
| Rate for Payer: Multiplan Commercial |
$1,270.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,461.03
|
| Rate for Payer: Quartz Beloit One Network |
$778.16
|
| Rate for Payer: Quartz Commercial |
$952.85
|
| Rate for Payer: WEA Trust Commercial |
$873.44
|
| Rate for Payer: WPS Commercial |
$1,176.25
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
IP
|
$1,468.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
627610
|
| Min. Negotiated Rate |
$748.09 |
| Max. Negotiated Rate |
$1,404.58 |
| Rate for Payer: Aetna Commercial |
$1,374.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$809.16
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,404.58
|
| Rate for Payer: Health EOS Commercial |
$1,358.78
|
| Rate for Payer: HFN Commercial |
$1,404.58
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,404.58
|
| Rate for Payer: Quartz Beloit One Network |
$748.09
|
| Rate for Payer: Quartz Commercial |
$916.03
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: WPS Commercial |
$1,130.80
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
OP
|
$1,527.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
1536881
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,461.03 |
| Rate for Payer: Aetna Commercial |
$1,429.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,365.75
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$841.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cigna Commercial |
$1,461.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$888.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,413.39
|
| Rate for Payer: HFN Commercial |
$1,461.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,270.46
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,461.03
|
| Rate for Payer: Quartz Beloit One Network |
$778.16
|
| Rate for Payer: Quartz Commercial |
$1,032.25
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$873.44
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,176.25
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
627610
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,404.58 |
| Rate for Payer: Aetna Commercial |
$1,374.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$992.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$763.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.83
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$809.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,404.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$854.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,358.78
|
| Rate for Payer: HFN Commercial |
$1,404.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,404.58
|
| Rate for Payer: Quartz Beloit One Network |
$748.09
|
| Rate for Payer: Quartz Commercial |
$992.37
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,130.80
|
|
|
XR Barium Enema Therapeutic
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
1536881
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$279.14 |
| Max. Negotiated Rate |
$1,508.68 |
| Rate for Payer: Aetna Commercial |
$1,508.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,365.75
|
| Rate for Payer: Aetna Managed Medicare |
$279.14
|
| Rate for Payer: Anthem Medicare Advantage |
$279.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$279.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$279.14
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cigna Commercial |
$1,508.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$794.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.14
|
| Rate for Payer: Health EOS Commercial |
$1,445.15
|
| Rate for Payer: HFN Commercial |
$1,508.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$939.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$939.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$279.14
|
| Rate for Payer: Multiplan Commercial |
$1,270.46
|
| Rate for Payer: NAPHCARE Commercial |
$418.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,508.68
|
| Rate for Payer: Quartz Beloit One Network |
$698.76
|
| Rate for Payer: Quartz Commercial |
$905.21
|
| Rate for Payer: Quartz Medicare Advantage |
$279.14
|
| Rate for Payer: The Alliance Commercial |
$1,060.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.14
|
| Rate for Payer: WEA Trust Commercial |
$873.44
|
| Rate for Payer: WPS Commercial |
$1,395.68
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
627612
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,610.29 |
| Rate for Payer: Aetna Commercial |
$1,575.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.28
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,137.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.15
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna Commercial |
$1,610.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,557.78
|
| Rate for Payer: HFN Commercial |
$1,610.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,400.26
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.29
|
| Rate for Payer: Quartz Beloit One Network |
$857.66
|
| Rate for Payer: Quartz Commercial |
$1,137.71
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$962.68
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,296.41
|
|
|
XR Barium Enema w/ Air Complete
|
Professional
|
Both
|
$1,683.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
627612
|
| Min. Negotiated Rate |
$210.41 |
| Max. Negotiated Rate |
$1,662.80 |
| Rate for Payer: Aetna Commercial |
$1,662.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.28
|
| Rate for Payer: Aetna Managed Medicare |
$210.41
|
| Rate for Payer: Anthem Medicare Advantage |
$210.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.41
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna Commercial |
$1,662.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$875.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.41
|
| Rate for Payer: Health EOS Commercial |
$1,592.79
|
| Rate for Payer: HFN Commercial |
$1,662.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$816.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$816.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.41
|
| Rate for Payer: Multiplan Commercial |
$1,400.26
|
| Rate for Payer: NAPHCARE Commercial |
$315.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.80
|
| Rate for Payer: Quartz Beloit One Network |
$770.14
|
| Rate for Payer: Quartz Commercial |
$997.68
|
| Rate for Payer: Quartz Medicare Advantage |
$210.41
|
| Rate for Payer: The Alliance Commercial |
$799.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.41
|
| Rate for Payer: WEA Trust Commercial |
$962.68
|
| Rate for Payer: WPS Commercial |
$1,052.06
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
627612
|
| Min. Negotiated Rate |
$857.66 |
| Max. Negotiated Rate |
$1,610.29 |
| Rate for Payer: Aetna Commercial |
$1,575.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.67
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna Commercial |
$1,610.29
|
| Rate for Payer: Health EOS Commercial |
$1,557.78
|
| Rate for Payer: HFN Commercial |
$1,610.29
|
| Rate for Payer: Multiplan Commercial |
$1,400.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.29
|
| Rate for Payer: Quartz Beloit One Network |
$857.66
|
| Rate for Payer: Quartz Commercial |
$1,050.19
|
| Rate for Payer: WEA Trust Commercial |
$962.68
|
| Rate for Payer: WPS Commercial |
$1,296.41
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
IP
|
$1,818.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1536883
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$926.45 |
| Max. Negotiated Rate |
$1,739.46 |
| Rate for Payer: Aetna Commercial |
$1,701.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.08
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$1,739.46
|
| Rate for Payer: Health EOS Commercial |
$1,682.74
|
| Rate for Payer: HFN Commercial |
$1,739.46
|
| Rate for Payer: Multiplan Commercial |
$1,512.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,739.46
|
| Rate for Payer: Quartz Beloit One Network |
$926.45
|
| Rate for Payer: Quartz Commercial |
$1,134.43
|
| Rate for Payer: WEA Trust Commercial |
$1,039.90
|
| Rate for Payer: WPS Commercial |
$1,400.41
|
|
|
XR Barium Enema w/ Air Complete
|
Professional
|
Both
|
$1,818.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1536883
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.41 |
| Max. Negotiated Rate |
$1,796.18 |
| Rate for Payer: Aetna Commercial |
$1,796.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.02
|
| Rate for Payer: Aetna Managed Medicare |
$210.41
|
| Rate for Payer: Anthem Medicare Advantage |
$210.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.41
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$1,796.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$945.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.41
|
| Rate for Payer: Health EOS Commercial |
$1,720.56
|
| Rate for Payer: HFN Commercial |
$1,796.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$816.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$816.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.41
|
| Rate for Payer: Multiplan Commercial |
$1,512.58
|
| Rate for Payer: NAPHCARE Commercial |
$315.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.18
|
| Rate for Payer: Quartz Beloit One Network |
$831.92
|
| Rate for Payer: Quartz Commercial |
$1,077.71
|
| Rate for Payer: Quartz Medicare Advantage |
$210.41
|
| Rate for Payer: The Alliance Commercial |
$799.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.41
|
| Rate for Payer: WEA Trust Commercial |
$1,039.90
|
| Rate for Payer: WPS Commercial |
$1,052.06
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
OP
|
$1,818.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1536883
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,739.46 |
| Rate for Payer: Aetna Commercial |
$1,701.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.02
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$1,739.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,058.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,682.74
|
| Rate for Payer: HFN Commercial |
$1,739.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,512.58
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,739.46
|
| Rate for Payer: Quartz Beloit One Network |
$926.45
|
| Rate for Payer: Quartz Commercial |
$1,228.97
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,039.90
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,400.41
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
IP
|
$4,426.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
2587211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,255.49 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,761.82
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
2587211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,209.46
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$954.50
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$954.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$954.50
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,550.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$954.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$954.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$954.50
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,991.98
|
| Rate for Payer: Quartz Medicare Advantage |
$954.50
|
| Rate for Payer: The Alliance Commercial |
$3,818.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$954.50
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
