|
XR Orbits Complete Left
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 70200 LT,TC
|
| Hospital Charge Code |
1537216
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$340.92 |
| Max. Negotiated Rate |
$640.10 |
| Rate for Payer: Aetna Commercial |
$626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.75
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$640.10
|
| Rate for Payer: Health EOS Commercial |
$619.23
|
| Rate for Payer: HFN Commercial |
$640.10
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: Preferred Network Access Commercial |
$640.10
|
| Rate for Payer: Quartz Beloit One Network |
$340.92
|
| Rate for Payer: Quartz Commercial |
$417.46
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Orbits Complete Left
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 70200 LT,TC
|
| Hospital Charge Code |
1537216
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.81 |
| Max. Negotiated Rate |
$640.10 |
| Rate for Payer: Aetna Commercial |
$626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Aetna Managed Medicare |
$194.81
|
| 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 |
$368.75
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$640.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.36
|
| Rate for Payer: Health EOS Commercial |
$619.23
|
| Rate for Payer: HFN Commercial |
$640.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.82
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: NAPHCARE Commercial |
$417.46
|
| Rate for Payer: Preferred Network Access Commercial |
$640.10
|
| Rate for Payer: Quartz Beloit One Network |
$340.92
|
| Rate for Payer: Quartz Commercial |
$452.24
|
| Rate for Payer: Quartz Medicare Advantage |
$417.46
|
| Rate for Payer: The Alliance Commercial |
$347.88
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Orbits Complete Right
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 70200 TC,RT
|
| Hospital Charge Code |
2979985
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.81 |
| Max. Negotiated Rate |
$640.10 |
| Rate for Payer: Aetna Commercial |
$626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Aetna Managed Medicare |
$194.81
|
| 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 |
$368.75
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$640.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.36
|
| Rate for Payer: Health EOS Commercial |
$619.23
|
| Rate for Payer: HFN Commercial |
$640.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.82
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: NAPHCARE Commercial |
$417.46
|
| Rate for Payer: Preferred Network Access Commercial |
$640.10
|
| Rate for Payer: Quartz Beloit One Network |
$340.92
|
| Rate for Payer: Quartz Commercial |
$452.24
|
| Rate for Payer: Quartz Medicare Advantage |
$417.46
|
| Rate for Payer: The Alliance Commercial |
$347.88
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Orbits Complete Right
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 70200 TC,RT
|
| Hospital Charge Code |
1537218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$340.92 |
| Max. Negotiated Rate |
$640.10 |
| Rate for Payer: Aetna Commercial |
$626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.75
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$640.10
|
| Rate for Payer: Health EOS Commercial |
$619.23
|
| Rate for Payer: HFN Commercial |
$640.10
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: Preferred Network Access Commercial |
$640.10
|
| Rate for Payer: Quartz Beloit One Network |
$340.92
|
| Rate for Payer: Quartz Commercial |
$417.46
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Orbits Complete Right
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
630297
|
| Min. Negotiated Rate |
$315.44 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$386.26
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
XR Orbits Complete Right
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
630297
|
| Min. Negotiated Rate |
$46.53 |
| Max. Negotiated Rate |
$611.57 |
| Rate for Payer: Aetna Commercial |
$611.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$46.53
|
| Rate for Payer: Anthem Medicare Advantage |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.53
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$611.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.53
|
| Rate for Payer: Health EOS Commercial |
$585.82
|
| Rate for Payer: HFN Commercial |
$611.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$170.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.53
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$69.79
|
| Rate for Payer: Preferred Network Access Commercial |
$611.57
|
| Rate for Payer: Quartz Beloit One Network |
$283.25
|
| Rate for Payer: Quartz Commercial |
$366.94
|
| Rate for Payer: Quartz Medicare Advantage |
$46.53
|
| Rate for Payer: The Alliance Commercial |
$176.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.53
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$232.65
|
|
|
XR Orbits Complete Right
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 70200 TC,RT
|
| Hospital Charge Code |
2979985
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$340.92 |
| Max. Negotiated Rate |
$640.10 |
| Rate for Payer: Aetna Commercial |
$626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.75
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$640.10
|
| Rate for Payer: Health EOS Commercial |
$619.23
|
| Rate for Payer: HFN Commercial |
$640.10
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: Preferred Network Access Commercial |
$640.10
|
| Rate for Payer: Quartz Beloit One Network |
$340.92
|
| Rate for Payer: Quartz Commercial |
$417.46
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Orbits Complete Right
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 70200 TC,RT
|
| Hospital Charge Code |
1537218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.81 |
| Max. Negotiated Rate |
$640.10 |
| Rate for Payer: Aetna Commercial |
$626.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Aetna Managed Medicare |
$194.81
|
| 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 |
$368.75
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$640.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.36
|
| Rate for Payer: Health EOS Commercial |
$619.23
|
| Rate for Payer: HFN Commercial |
$640.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.82
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: NAPHCARE Commercial |
$417.46
|
| Rate for Payer: Preferred Network Access Commercial |
$640.10
|
| Rate for Payer: Quartz Beloit One Network |
$340.92
|
| Rate for Payer: Quartz Commercial |
$452.24
|
| Rate for Payer: Quartz Medicare Advantage |
$417.46
|
| Rate for Payer: The Alliance Commercial |
$347.88
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Orbits Complete Right
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
CPT 70200 TC,RT
|
| Hospital Charge Code |
1537218
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$660.97 |
| Rate for Payer: Aetna Commercial |
$660.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$660.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$347.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$417.46
|
| Rate for Payer: Health EOS Commercial |
$633.14
|
| Rate for Payer: HFN Commercial |
$660.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$170.56
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: Preferred Network Access Commercial |
$660.97
|
| Rate for Payer: Quartz Beloit One Network |
$306.13
|
| Rate for Payer: Quartz Commercial |
$396.58
|
| Rate for Payer: The Alliance Commercial |
$347.88
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Orbits Complete Right
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
CPT 70200 TC,RT
|
| Hospital Charge Code |
2979985
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$170.56 |
| Max. Negotiated Rate |
$660.97 |
| Rate for Payer: Aetna Commercial |
$660.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.35
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$660.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$347.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$417.46
|
| Rate for Payer: Health EOS Commercial |
$633.14
|
| Rate for Payer: HFN Commercial |
$660.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$170.56
|
| Rate for Payer: Multiplan Commercial |
$556.61
|
| Rate for Payer: Preferred Network Access Commercial |
$660.97
|
| Rate for Payer: Quartz Beloit One Network |
$306.13
|
| Rate for Payer: Quartz Commercial |
$396.58
|
| Rate for Payer: The Alliance Commercial |
$347.88
|
| Rate for Payer: WEA Trust Commercial |
$382.67
|
| Rate for Payer: WPS Commercial |
$515.33
|
|
|
XR Orbits Complete Right
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 70200
|
| Hospital Charge Code |
630297
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$418.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.00
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| 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 |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| 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 |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$418.44
|
| 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 |
$354.07
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
XR OR Cholangiogram
|
Facility
|
OP
|
$973.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
629736
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$930.97 |
| Rate for Payer: Aetna Commercial |
$910.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.25
|
| Rate for Payer: Aetna Managed Medicare |
$283.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$657.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$505.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$485.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.32
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: Cigna Commercial |
$930.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$566.29
|
| Rate for Payer: Health EOS Commercial |
$900.61
|
| Rate for Payer: HFN Commercial |
$930.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$758.94
|
| Rate for Payer: Multiplan Commercial |
$809.54
|
| Rate for Payer: NAPHCARE Commercial |
$607.15
|
| Rate for Payer: Preferred Network Access Commercial |
$930.97
|
| Rate for Payer: Quartz Beloit One Network |
$495.84
|
| Rate for Payer: Quartz Commercial |
$657.75
|
| Rate for Payer: Quartz Medicare Advantage |
$607.15
|
| Rate for Payer: The Alliance Commercial |
$505.96
|
| Rate for Payer: WEA Trust Commercial |
$556.56
|
| Rate for Payer: WPS Commercial |
$749.50
|
|
|
XR OR Cholangiogram
|
Professional
|
Both
|
$973.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
629736
|
| Min. Negotiated Rate |
$225.96 |
| Max. Negotiated Rate |
$961.32 |
| Rate for Payer: Aetna Commercial |
$961.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.25
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: Cigna Commercial |
$961.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$505.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.15
|
| Rate for Payer: Health EOS Commercial |
$920.85
|
| Rate for Payer: HFN Commercial |
$961.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$225.96
|
| Rate for Payer: Multiplan Commercial |
$809.54
|
| Rate for Payer: Preferred Network Access Commercial |
$961.32
|
| Rate for Payer: Quartz Beloit One Network |
$445.24
|
| Rate for Payer: Quartz Commercial |
$576.79
|
| Rate for Payer: The Alliance Commercial |
$505.96
|
| Rate for Payer: WEA Trust Commercial |
$556.56
|
| Rate for Payer: WPS Commercial |
$749.50
|
|
|
XR OR Cholangiogram
|
Facility
|
IP
|
$1,266.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1536942
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$645.15 |
| Max. Negotiated Rate |
$1,211.31 |
| Rate for Payer: Aetna Commercial |
$1,184.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,132.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.82
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,211.31
|
| Rate for Payer: Health EOS Commercial |
$1,171.81
|
| Rate for Payer: HFN Commercial |
$1,211.31
|
| Rate for Payer: Multiplan Commercial |
$1,053.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,211.31
|
| Rate for Payer: Quartz Beloit One Network |
$645.15
|
| Rate for Payer: Quartz Commercial |
$789.98
|
| Rate for Payer: WEA Trust Commercial |
$724.15
|
| Rate for Payer: WPS Commercial |
$975.20
|
|
|
XR OR Cholangiogram
|
Facility
|
IP
|
$973.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
629736
|
| Min. Negotiated Rate |
$495.84 |
| Max. Negotiated Rate |
$930.97 |
| Rate for Payer: Aetna Commercial |
$910.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.32
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: Cigna Commercial |
$930.97
|
| Rate for Payer: Health EOS Commercial |
$900.61
|
| Rate for Payer: HFN Commercial |
$930.97
|
| Rate for Payer: Multiplan Commercial |
$809.54
|
| Rate for Payer: Preferred Network Access Commercial |
$930.97
|
| Rate for Payer: Quartz Beloit One Network |
$495.84
|
| Rate for Payer: Quartz Commercial |
$607.15
|
| Rate for Payer: WEA Trust Commercial |
$556.56
|
| Rate for Payer: WPS Commercial |
$749.50
|
|
|
XR OR Cholangiogram
|
Facility
|
OP
|
$1,266.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1536942
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,211.31 |
| Rate for Payer: Aetna Commercial |
$1,184.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,132.31
|
| Rate for Payer: Aetna Managed Medicare |
$368.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$855.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$658.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.82
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,211.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.81
|
| Rate for Payer: Health EOS Commercial |
$1,171.81
|
| Rate for Payer: HFN Commercial |
$1,211.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$987.48
|
| Rate for Payer: Multiplan Commercial |
$1,053.31
|
| Rate for Payer: NAPHCARE Commercial |
$789.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,211.31
|
| Rate for Payer: Quartz Beloit One Network |
$645.15
|
| Rate for Payer: Quartz Commercial |
$855.82
|
| Rate for Payer: Quartz Medicare Advantage |
$789.98
|
| Rate for Payer: The Alliance Commercial |
$658.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$724.15
|
| Rate for Payer: WPS Commercial |
$975.20
|
|
|
XR OR Cholangiogram
|
Professional
|
Both
|
$1,266.00
|
|
|
Service Code
|
CPT 74300
|
| Hospital Charge Code |
1536942
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$225.96 |
| Max. Negotiated Rate |
$1,250.81 |
| Rate for Payer: Aetna Commercial |
$1,250.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,132.31
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,250.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$658.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$789.98
|
| Rate for Payer: Health EOS Commercial |
$1,198.14
|
| Rate for Payer: HFN Commercial |
$1,250.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$225.96
|
| Rate for Payer: Multiplan Commercial |
$1,053.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,250.81
|
| Rate for Payer: Quartz Beloit One Network |
$579.32
|
| Rate for Payer: Quartz Commercial |
$750.48
|
| Rate for Payer: The Alliance Commercial |
$658.32
|
| Rate for Payer: WEA Trust Commercial |
$724.15
|
| Rate for Payer: WPS Commercial |
$975.20
|
|
|
XR OR Clavicle
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Clavicle
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Clavicle
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724187
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Cystography
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
6179845
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Cystography
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
6179845
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Cystography
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
6179845
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Elbow
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Elbow
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724190
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
