|
XR Chest Minimum 4 Views
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.22 |
| Max. Negotiated Rate |
$750.13 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Aetna Managed Medicare |
$228.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.29
|
| Rate for Payer: Health EOS Commercial |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.52
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: NAPHCARE Commercial |
$489.22
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$529.98
|
| Rate for Payer: Quartz Medicare Advantage |
$489.22
|
| Rate for Payer: The Alliance Commercial |
$120.22
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
XR Chest Minimum 4 Views
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
629726
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$721.43 |
| Rate for Payer: Aetna Commercial |
$705.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.38
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.40
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$721.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$697.90
|
| Rate for Payer: HFN Commercial |
$721.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$627.33
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$721.43
|
| Rate for Payer: Quartz Beloit One Network |
$384.24
|
| Rate for Payer: Quartz Commercial |
$509.70
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$431.29
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$580.81
|
|
|
XR Chest Minimum 4 Views
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536930
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$399.53 |
| Max. Negotiated Rate |
$750.13 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| Rate for Payer: Health EOS Commercial |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$489.22
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
XR Chest Minimum 4 Views
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
629726
|
| Min. Negotiated Rate |
$44.69 |
| Max. Negotiated Rate |
$744.95 |
| Rate for Payer: Aetna Commercial |
$744.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.38
|
| Rate for Payer: Aetna Managed Medicare |
$44.69
|
| Rate for Payer: Anthem Medicare Advantage |
$44.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.69
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$744.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$392.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.69
|
| Rate for Payer: Health EOS Commercial |
$713.59
|
| Rate for Payer: HFN Commercial |
$744.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.69
|
| Rate for Payer: Multiplan Commercial |
$627.33
|
| Rate for Payer: NAPHCARE Commercial |
$67.03
|
| Rate for Payer: Preferred Network Access Commercial |
$744.95
|
| Rate for Payer: Quartz Beloit One Network |
$345.03
|
| Rate for Payer: Quartz Commercial |
$446.97
|
| Rate for Payer: Quartz Medicare Advantage |
$44.69
|
| Rate for Payer: The Alliance Commercial |
$169.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.69
|
| Rate for Payer: WEA Trust Commercial |
$431.29
|
| Rate for Payer: WPS Commercial |
$223.44
|
|
|
XR Chest Minimum 4 Views
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 71048
|
| Hospital Charge Code |
629726
|
| Min. Negotiated Rate |
$384.24 |
| Max. Negotiated Rate |
$721.43 |
| Rate for Payer: Aetna Commercial |
$705.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.60
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$721.43
|
| Rate for Payer: Health EOS Commercial |
$697.90
|
| Rate for Payer: HFN Commercial |
$721.43
|
| Rate for Payer: Multiplan Commercial |
$627.33
|
| Rate for Payer: Preferred Network Access Commercial |
$721.43
|
| Rate for Payer: Quartz Beloit One Network |
$384.24
|
| Rate for Payer: Quartz Commercial |
$470.50
|
| Rate for Payer: WEA Trust Commercial |
$431.29
|
| Rate for Payer: WPS Commercial |
$580.81
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Facility
|
OP
|
$1,190.00
|
|
|
Service Code
|
CPT 71034
|
| Hospital Charge Code |
629728
|
| Min. Negotiated Rate |
$346.53 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Aetna Managed Medicare |
$346.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$804.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$618.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$594.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.58
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$928.20
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: NAPHCARE Commercial |
$742.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$804.44
|
| Rate for Payer: Quartz Medicare Advantage |
$742.56
|
| Rate for Payer: The Alliance Commercial |
$618.80
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Facility
|
IP
|
$1,190.00
|
|
|
Service Code
|
CPT 71034
|
| Hospital Charge Code |
629728
|
| Min. Negotiated Rate |
$606.42 |
| Max. Negotiated Rate |
$1,138.59 |
| Rate for Payer: Aetna Commercial |
$1,113.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$655.93
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,138.59
|
| Rate for Payer: Health EOS Commercial |
$1,101.46
|
| Rate for Payer: HFN Commercial |
$1,138.59
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.59
|
| Rate for Payer: Quartz Beloit One Network |
$606.42
|
| Rate for Payer: Quartz Commercial |
$742.56
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Facility
|
IP
|
$1,238.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536932
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$630.88 |
| Max. Negotiated Rate |
$1,184.52 |
| Rate for Payer: Aetna Commercial |
$1,158.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.39
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,184.52
|
| Rate for Payer: Health EOS Commercial |
$1,145.89
|
| Rate for Payer: HFN Commercial |
$1,184.52
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,184.52
|
| Rate for Payer: Quartz Beloit One Network |
$630.88
|
| Rate for Payer: Quartz Commercial |
$772.51
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$953.63
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Facility
|
OP
|
$1,238.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536932
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.22 |
| Max. Negotiated Rate |
$1,184.52 |
| Rate for Payer: Aetna Commercial |
$1,158.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Aetna Managed Medicare |
$360.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$682.39
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,184.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$720.52
|
| Rate for Payer: Health EOS Commercial |
$1,145.89
|
| Rate for Payer: HFN Commercial |
$1,184.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.64
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: NAPHCARE Commercial |
$772.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,184.52
|
| Rate for Payer: Quartz Beloit One Network |
$630.88
|
| Rate for Payer: Quartz Commercial |
$836.89
|
| Rate for Payer: Quartz Medicare Advantage |
$772.51
|
| Rate for Payer: The Alliance Commercial |
$120.22
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$953.63
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
CPT 71048 TC
|
| Hospital Charge Code |
1536932
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.06 |
| Max. Negotiated Rate |
$1,223.14 |
| Rate for Payer: Aetna Commercial |
$1,223.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Aetna Managed Medicare |
$30.06
|
| Rate for Payer: Anthem Medicare Advantage |
$30.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.06
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,223.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$643.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.06
|
| Rate for Payer: Health EOS Commercial |
$1,171.64
|
| Rate for Payer: HFN Commercial |
$1,223.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.06
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: NAPHCARE Commercial |
$45.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.14
|
| Rate for Payer: Quartz Beloit One Network |
$566.51
|
| Rate for Payer: Quartz Commercial |
$733.89
|
| Rate for Payer: Quartz Medicare Advantage |
$30.06
|
| Rate for Payer: The Alliance Commercial |
$114.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.06
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$150.28
|
|
|
XR Chest Minimum 4 Views w/ Fluoroscopy
|
Professional
|
Both
|
$1,190.00
|
|
|
Service Code
|
CPT 71034
|
| Hospital Charge Code |
629728
|
| Min. Negotiated Rate |
$544.54 |
| Max. Negotiated Rate |
$1,175.72 |
| Rate for Payer: Aetna Commercial |
$1,175.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.34
|
| Rate for Payer: Cash Price |
$357.00
|
| Rate for Payer: Cigna Commercial |
$1,175.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$618.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.56
|
| Rate for Payer: Health EOS Commercial |
$1,126.22
|
| Rate for Payer: HFN Commercial |
$1,175.72
|
| Rate for Payer: Multiplan Commercial |
$990.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,175.72
|
| Rate for Payer: Quartz Beloit One Network |
$544.54
|
| Rate for Payer: Quartz Commercial |
$705.43
|
| Rate for Payer: The Alliance Commercial |
$618.80
|
| Rate for Payer: WEA Trust Commercial |
$680.68
|
| Rate for Payer: WPS Commercial |
$916.66
|
|
|
XR Chest Special Views
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 71035
|
| Hospital Charge Code |
629730
|
| Min. Negotiated Rate |
$254.29 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$311.38
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
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
|
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
|
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 Chest Special Views
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 71035
|
| Hospital Charge Code |
629730
|
| Min. Negotiated Rate |
$145.31 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Aetna Managed Medicare |
$145.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$337.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.42
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.22
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: NAPHCARE Commercial |
$311.38
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$337.32
|
| Rate for Payer: Quartz Medicare Advantage |
$311.38
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
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
|
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 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 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
|
|
