|
XR Foreign Body Loc Nose/Rectum Child
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 76010 TC
|
| Hospital Charge Code |
1537084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$20.07 |
| Max. Negotiated Rate |
$540.44 |
| Rate for Payer: Aetna Commercial |
$540.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$20.07
|
| Rate for Payer: Anthem Medicare Advantage |
$20.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.07
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$540.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.07
|
| Rate for Payer: Health EOS Commercial |
$517.68
|
| Rate for Payer: HFN Commercial |
$540.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.07
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$30.11
|
| Rate for Payer: Preferred Network Access Commercial |
$540.44
|
| Rate for Payer: Quartz Beloit One Network |
$250.31
|
| Rate for Payer: Quartz Commercial |
$324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$20.07
|
| Rate for Payer: The Alliance Commercial |
$76.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.07
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$100.36
|
|
|
XR Gastrografin Enema
|
Professional
|
Both
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1537086
|
|
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 Gastrografin Enema
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
675797
|
| 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 Gastrografin Enema
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
675797
|
| 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 Gastrografin Enema
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
675797
|
| 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 Gastrografin Enema
|
Facility
|
IP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1537086
|
|
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 Gastrografin Enema
|
Facility
|
OP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1537086
|
|
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 Gastrografin Swallow
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$1,030.48 |
| Rate for Payer: Aetna Commercial |
$1,030.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$93.80
|
| Rate for Payer: Anthem Medicare Advantage |
$93.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.80
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$1,030.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$542.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.80
|
| Rate for Payer: Health EOS Commercial |
$987.10
|
| Rate for Payer: HFN Commercial |
$1,030.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$357.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$357.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$140.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$477.28
|
| Rate for Payer: Quartz Commercial |
$618.29
|
| Rate for Payer: Quartz Medicare Advantage |
$93.80
|
| Rate for Payer: The Alliance Commercial |
$356.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.80
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$468.99
|
|
|
XR Gastrografin Swallow
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
675799
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$990.96 |
| Rate for Payer: Aetna Commercial |
$990.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Aetna Managed Medicare |
$93.80
|
| Rate for Payer: Anthem Medicare Advantage |
$93.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.80
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$990.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$521.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.80
|
| Rate for Payer: Health EOS Commercial |
$949.24
|
| Rate for Payer: HFN Commercial |
$990.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$357.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$357.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$834.50
|
| Rate for Payer: NAPHCARE Commercial |
$140.70
|
| Rate for Payer: Preferred Network Access Commercial |
$990.96
|
| Rate for Payer: Quartz Beloit One Network |
$458.97
|
| Rate for Payer: Quartz Commercial |
$594.58
|
| Rate for Payer: Quartz Medicare Advantage |
$93.80
|
| Rate for Payer: The Alliance Commercial |
$356.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.80
|
| Rate for Payer: WEA Trust Commercial |
$573.72
|
| Rate for Payer: WPS Commercial |
$468.99
|
|
|
XR Gastrografin Swallow
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
675799
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$959.67 |
| Rate for Payer: Aetna Commercial |
$938.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$678.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$521.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$500.70
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.85
|
| 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 |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$959.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$928.38
|
| Rate for Payer: HFN Commercial |
$959.67
|
| 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 |
$834.50
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$959.67
|
| Rate for Payer: Quartz Beloit One Network |
$511.13
|
| Rate for Payer: Quartz Commercial |
$678.03
|
| 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 |
$573.72
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$772.61
|
|
|
XR Gastrografin Swallow
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| 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 |
$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 |
$574.90
|
| 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 |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| 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 |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| 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 |
$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 |
$596.60
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
XR Gastrografin Swallow
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537088
|
|
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 Gastrografin Swallow
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
675799
|
| Min. Negotiated Rate |
$511.13 |
| Max. Negotiated Rate |
$959.67 |
| Rate for Payer: Aetna Commercial |
$938.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.85
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$959.67
|
| Rate for Payer: Health EOS Commercial |
$928.38
|
| Rate for Payer: HFN Commercial |
$959.67
|
| Rate for Payer: Multiplan Commercial |
$834.50
|
| Rate for Payer: Preferred Network Access Commercial |
$959.67
|
| Rate for Payer: Quartz Beloit One Network |
$511.13
|
| Rate for Payer: Quartz Commercial |
$625.87
|
| Rate for Payer: WEA Trust Commercial |
$573.72
|
| Rate for Payer: WPS Commercial |
$772.61
|
|
|
XR Hand 2 Views Bilateral
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$243.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Hand 2 Views Bilateral
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$386.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.98
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.32
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$386.31
|
| Rate for Payer: Quartz Beloit One Network |
$178.92
|
| Rate for Payer: Quartz Commercial |
$231.78
|
| Rate for Payer: The Alliance Commercial |
$203.32
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Hand 2 Views Bilateral
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.86 |
| Max. Negotiated Rate |
$423.81 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$113.86
|
| 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 |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.56
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.98
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$243.98
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$264.32
|
| Rate for Payer: Quartz Medicare Advantage |
$243.98
|
| Rate for Payer: The Alliance Commercial |
$203.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Hand 2 Views Bilateral
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630498
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$669.76 |
| Rate for Payer: Aetna Commercial |
$655.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.08
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$473.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$364.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$349.44
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.84
|
| 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 |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$669.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$407.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$647.92
|
| Rate for Payer: HFN Commercial |
$669.76
|
| 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 |
$582.40
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$669.76
|
| Rate for Payer: Quartz Beloit One Network |
$356.72
|
| Rate for Payer: Quartz Commercial |
$473.20
|
| 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 |
$400.40
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$539.21
|
|
|
XR Hand 2 Views Bilateral
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630498
|
| Min. Negotiated Rate |
$31.06 |
| Max. Negotiated Rate |
$691.60 |
| Rate for Payer: Aetna Commercial |
$691.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.08
|
| Rate for Payer: Aetna Managed Medicare |
$31.06
|
| Rate for Payer: Anthem Medicare Advantage |
$31.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.06
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$691.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$364.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.06
|
| Rate for Payer: Health EOS Commercial |
$662.48
|
| Rate for Payer: HFN Commercial |
$691.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.06
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.60
|
| Rate for Payer: Preferred Network Access Commercial |
$691.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.32
|
| Rate for Payer: Quartz Commercial |
$414.96
|
| Rate for Payer: Quartz Medicare Advantage |
$31.06
|
| Rate for Payer: The Alliance Commercial |
$118.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.06
|
| Rate for Payer: WEA Trust Commercial |
$400.40
|
| Rate for Payer: WPS Commercial |
$155.32
|
|
|
XR Hand 2 Views Bilateral
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630498
|
| Min. Negotiated Rate |
$356.72 |
| Max. Negotiated Rate |
$669.76 |
| Rate for Payer: Aetna Commercial |
$655.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.84
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$669.76
|
| Rate for Payer: Health EOS Commercial |
$647.92
|
| Rate for Payer: HFN Commercial |
$669.76
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: Preferred Network Access Commercial |
$669.76
|
| Rate for Payer: Quartz Beloit One Network |
$356.72
|
| Rate for Payer: Quartz Commercial |
$436.80
|
| Rate for Payer: WEA Trust Commercial |
$400.40
|
| Rate for Payer: WPS Commercial |
$539.21
|
|
|
XR Hand 2 Views Left
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630493
|
| Min. Negotiated Rate |
$31.06 |
| Max. Negotiated Rate |
$344.81 |
| Rate for Payer: Aetna Commercial |
$344.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Aetna Managed Medicare |
$31.06
|
| Rate for Payer: Anthem Medicare Advantage |
$31.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.06
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$344.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.06
|
| Rate for Payer: Health EOS Commercial |
$330.29
|
| Rate for Payer: HFN Commercial |
$344.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.06
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: NAPHCARE Commercial |
$46.60
|
| Rate for Payer: Preferred Network Access Commercial |
$344.81
|
| Rate for Payer: Quartz Beloit One Network |
$159.70
|
| Rate for Payer: Quartz Commercial |
$206.89
|
| Rate for Payer: Quartz Medicare Advantage |
$31.06
|
| Rate for Payer: The Alliance Commercial |
$118.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.06
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$155.32
|
|
|
XR Hand 2 Views Left
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.86 |
| Max. Negotiated Rate |
$423.81 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$113.86
|
| 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 |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.56
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.98
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$243.98
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$264.32
|
| Rate for Payer: Quartz Medicare Advantage |
$243.98
|
| Rate for Payer: The Alliance Commercial |
$203.32
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Hand 2 Views Left
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.32 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$386.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.98
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.32
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$386.31
|
| Rate for Payer: Quartz Beloit One Network |
$178.92
|
| Rate for Payer: Quartz Commercial |
$231.78
|
| Rate for Payer: The Alliance Commercial |
$203.32
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Hand 2 Views Left
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$243.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Hand 2 Views Left
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630493
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$440.09 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.22
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| 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 |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| 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 |
$290.37
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$235.92
|
| 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 |
$199.63
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
XR Hand 2 Views Left
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630493
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$333.92 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$217.78
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
