|
XR Pod Toes Great Left
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448837
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$28.36
|
| Rate for Payer: Anthem Medicare Advantage |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.36
|
| 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 |
$28.36
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.36
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$42.54
|
| 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: Quartz Medicare Advantage |
$28.36
|
| Rate for Payer: The Alliance Commercial |
$107.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.36
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$141.80
|
|
|
XR Pod Toes Great Left
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448837
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.19
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| 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 |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Pod Toes Great Right
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
CPT 73660 T5
|
| Hospital Charge Code |
2587316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.88 |
| Max. Negotiated Rate |
$402.12 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$402.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.97
|
| Rate for Payer: Health EOS Commercial |
$385.18
|
| Rate for Payer: HFN Commercial |
$402.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$402.12
|
| Rate for Payer: Quartz Beloit One Network |
$186.24
|
| Rate for Payer: Quartz Commercial |
$241.27
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes Great Right
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T5
|
| Hospital Charge Code |
2587316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$118.52 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Aetna Managed Medicare |
$118.52
|
| 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 |
$224.34
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.87
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.46
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: NAPHCARE Commercial |
$253.97
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$275.13
|
| Rate for Payer: Quartz Medicare Advantage |
$253.97
|
| Rate for Payer: The Alliance Commercial |
$211.64
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pod Toes Great Right
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448842
|
| Min. Negotiated Rate |
$28.36 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$28.36
|
| Rate for Payer: Anthem Medicare Advantage |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.36
|
| 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 |
$28.36
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.36
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$42.54
|
| 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: Quartz Medicare Advantage |
$28.36
|
| Rate for Payer: The Alliance Commercial |
$107.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.36
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$141.80
|
|
|
XR Pod Toes Great Right
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448842
|
| 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 Pod Toes Great Right
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73660
|
| Hospital Charge Code |
2448842
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.19
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| 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 |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
XR Pod Toes Great Right
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
CPT 73660 T5
|
| Hospital Charge Code |
2587316
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$207.41 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$253.97
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
XR Pyelostogram
|
Professional
|
Both
|
$939.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
3072719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.60 |
| Max. Negotiated Rate |
$927.73 |
| Rate for Payer: Aetna Commercial |
$927.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.84
|
| Rate for Payer: Aetna Managed Medicare |
$109.60
|
| Rate for Payer: Anthem Medicare Advantage |
$109.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$109.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$109.60
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$927.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$488.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.60
|
| Rate for Payer: Health EOS Commercial |
$888.67
|
| Rate for Payer: HFN Commercial |
$927.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$404.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$109.60
|
| Rate for Payer: Multiplan Commercial |
$781.25
|
| Rate for Payer: NAPHCARE Commercial |
$164.39
|
| Rate for Payer: Preferred Network Access Commercial |
$927.73
|
| Rate for Payer: Quartz Beloit One Network |
$429.69
|
| Rate for Payer: Quartz Commercial |
$556.64
|
| Rate for Payer: Quartz Medicare Advantage |
$109.60
|
| Rate for Payer: The Alliance Commercial |
$416.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$109.60
|
| Rate for Payer: WEA Trust Commercial |
$537.11
|
| Rate for Payer: WPS Commercial |
$547.98
|
|
|
XR Pyelostogram
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
3072719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$478.51 |
| Max. Negotiated Rate |
$898.44 |
| Rate for Payer: Aetna Commercial |
$878.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.58
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$898.44
|
| Rate for Payer: Health EOS Commercial |
$869.14
|
| Rate for Payer: HFN Commercial |
$898.44
|
| Rate for Payer: Multiplan Commercial |
$781.25
|
| Rate for Payer: Preferred Network Access Commercial |
$898.44
|
| Rate for Payer: Quartz Beloit One Network |
$478.51
|
| Rate for Payer: Quartz Commercial |
$585.94
|
| Rate for Payer: WEA Trust Commercial |
$537.11
|
| Rate for Payer: WPS Commercial |
$723.31
|
|
|
XR Pyelostogram
|
Facility
|
OP
|
$939.00
|
|
|
Service Code
|
CPT 74425 TC
|
| Hospital Charge Code |
3072719
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$273.44 |
| Max. Negotiated Rate |
$1,482.47 |
| Rate for Payer: Aetna Commercial |
$878.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.84
|
| Rate for Payer: Aetna Managed Medicare |
$273.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.58
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$898.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$546.50
|
| Rate for Payer: Health EOS Commercial |
$869.14
|
| Rate for Payer: HFN Commercial |
$898.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$732.42
|
| Rate for Payer: Multiplan Commercial |
$781.25
|
| Rate for Payer: NAPHCARE Commercial |
$585.94
|
| Rate for Payer: Preferred Network Access Commercial |
$898.44
|
| Rate for Payer: Quartz Beloit One Network |
$478.51
|
| Rate for Payer: Quartz Commercial |
$634.76
|
| Rate for Payer: Quartz Medicare Advantage |
$585.94
|
| Rate for Payer: The Alliance Commercial |
$438.38
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$537.11
|
| Rate for Payer: WPS Commercial |
$723.31
|
|
|
XR Ribs 2 Views Left
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Aetna Managed Medicare |
$164.53
|
| 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 |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.83
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.70
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: NAPHCARE Commercial |
$352.56
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$381.94
|
| Rate for Payer: Quartz Medicare Advantage |
$352.56
|
| Rate for Payer: The Alliance Commercial |
$101.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
XR Ribs 2 Views Left
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630229
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$326.35
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Ribs 2 Views Left
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630229
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$516.72 |
| Rate for Payer: Aetna Commercial |
$516.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Aetna Managed Medicare |
$35.80
|
| Rate for Payer: Anthem Medicare Advantage |
$35.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.80
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$516.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.80
|
| Rate for Payer: Health EOS Commercial |
$494.97
|
| Rate for Payer: HFN Commercial |
$516.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.80
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: NAPHCARE Commercial |
$53.70
|
| Rate for Payer: Preferred Network Access Commercial |
$516.72
|
| Rate for Payer: Quartz Beloit One Network |
$239.32
|
| Rate for Payer: Quartz Commercial |
$310.03
|
| Rate for Payer: Quartz Medicare Advantage |
$35.80
|
| Rate for Payer: The Alliance Commercial |
$136.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.80
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$178.98
|
|
|
XR Ribs 2 Views Left
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$558.22 |
| Rate for Payer: Aetna Commercial |
$558.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Aetna Managed Medicare |
$25.40
|
| Rate for Payer: Anthem Medicare Advantage |
$25.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.40
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$558.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$293.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.40
|
| Rate for Payer: Health EOS Commercial |
$534.72
|
| Rate for Payer: HFN Commercial |
$558.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.40
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: NAPHCARE Commercial |
$38.10
|
| Rate for Payer: Preferred Network Access Commercial |
$558.22
|
| Rate for Payer: Quartz Beloit One Network |
$258.54
|
| Rate for Payer: Quartz Commercial |
$334.93
|
| Rate for Payer: Quartz Medicare Advantage |
$25.40
|
| Rate for Payer: The Alliance Commercial |
$96.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.40
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$126.98
|
|
|
XR Ribs 2 Views Left
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630229
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$353.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$261.08
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$353.55
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Ribs 2 Views Left
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537248
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.92 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$352.56
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
XR Ribs 2 Views Right
|
Professional
|
Both
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.40 |
| Max. Negotiated Rate |
$558.22 |
| Rate for Payer: Aetna Commercial |
$558.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Aetna Managed Medicare |
$25.40
|
| Rate for Payer: Anthem Medicare Advantage |
$25.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.40
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$558.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$293.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.40
|
| Rate for Payer: Health EOS Commercial |
$534.72
|
| Rate for Payer: HFN Commercial |
$558.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.40
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: NAPHCARE Commercial |
$38.10
|
| Rate for Payer: Preferred Network Access Commercial |
$558.22
|
| Rate for Payer: Quartz Beloit One Network |
$258.54
|
| Rate for Payer: Quartz Commercial |
$334.93
|
| Rate for Payer: Quartz Medicare Advantage |
$25.40
|
| Rate for Payer: The Alliance Commercial |
$96.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.40
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$126.98
|
|
|
XR Ribs 2 Views Right
|
Facility
|
IP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$287.92 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$352.56
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
XR Ribs 2 Views Right
|
Facility
|
OP
|
$565.00
|
|
|
Service Code
|
CPT 71100 TC
|
| Hospital Charge Code |
1537250
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$101.59 |
| Max. Negotiated Rate |
$540.59 |
| Rate for Payer: Aetna Commercial |
$528.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.34
|
| Rate for Payer: Aetna Managed Medicare |
$164.53
|
| 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 |
$311.43
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$540.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.83
|
| Rate for Payer: Health EOS Commercial |
$522.96
|
| Rate for Payer: HFN Commercial |
$540.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.70
|
| Rate for Payer: Multiplan Commercial |
$470.08
|
| Rate for Payer: NAPHCARE Commercial |
$352.56
|
| Rate for Payer: Preferred Network Access Commercial |
$540.59
|
| Rate for Payer: Quartz Beloit One Network |
$287.92
|
| Rate for Payer: Quartz Commercial |
$381.94
|
| Rate for Payer: Quartz Medicare Advantage |
$352.56
|
| Rate for Payer: The Alliance Commercial |
$101.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$323.18
|
| Rate for Payer: WPS Commercial |
$435.22
|
|
|
XR Ribs 2 Views Right
|
Facility
|
OP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630227
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$353.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$261.08
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$353.55
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Ribs 2 Views Right
|
Facility
|
IP
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630227
|
| Min. Negotiated Rate |
$266.52 |
| Max. Negotiated Rate |
$500.41 |
| Rate for Payer: Aetna Commercial |
$489.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.28
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$500.41
|
| Rate for Payer: Health EOS Commercial |
$484.09
|
| Rate for Payer: HFN Commercial |
$500.41
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: Preferred Network Access Commercial |
$500.41
|
| Rate for Payer: Quartz Beloit One Network |
$266.52
|
| Rate for Payer: Quartz Commercial |
$326.35
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$402.87
|
|
|
XR Ribs 2 Views Right
|
Professional
|
Both
|
$523.00
|
|
|
Service Code
|
CPT 71100
|
| Hospital Charge Code |
630227
|
| Min. Negotiated Rate |
$35.80 |
| Max. Negotiated Rate |
$516.72 |
| Rate for Payer: Aetna Commercial |
$516.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$467.77
|
| Rate for Payer: Aetna Managed Medicare |
$35.80
|
| Rate for Payer: Anthem Medicare Advantage |
$35.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.80
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cash Price |
$156.90
|
| Rate for Payer: Cigna Commercial |
$516.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.80
|
| Rate for Payer: Health EOS Commercial |
$494.97
|
| Rate for Payer: HFN Commercial |
$516.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.80
|
| Rate for Payer: Multiplan Commercial |
$435.14
|
| Rate for Payer: NAPHCARE Commercial |
$53.70
|
| Rate for Payer: Preferred Network Access Commercial |
$516.72
|
| Rate for Payer: Quartz Beloit One Network |
$239.32
|
| Rate for Payer: Quartz Commercial |
$310.03
|
| Rate for Payer: Quartz Medicare Advantage |
$35.80
|
| Rate for Payer: The Alliance Commercial |
$136.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.80
|
| Rate for Payer: WEA Trust Commercial |
$299.16
|
| Rate for Payer: WPS Commercial |
$178.98
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
|
OP
|
$1,193.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
630231
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,141.46 |
| Rate for Payer: Aetna Commercial |
$1,116.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,067.02
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$806.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$620.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$595.55
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.58
|
| 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 |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cigna Commercial |
$1,141.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$694.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,104.24
|
| Rate for Payer: HFN Commercial |
$1,141.46
|
| 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 |
$992.58
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,141.46
|
| Rate for Payer: Quartz Beloit One Network |
$607.95
|
| Rate for Payer: Quartz Commercial |
$806.47
|
| 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 |
$682.40
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$918.97
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
|
IP
|
$1,193.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
630231
|
| Min. Negotiated Rate |
$607.95 |
| Max. Negotiated Rate |
$1,141.46 |
| Rate for Payer: Aetna Commercial |
$1,116.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,067.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.58
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cigna Commercial |
$1,141.46
|
| Rate for Payer: Health EOS Commercial |
$1,104.24
|
| Rate for Payer: HFN Commercial |
$1,141.46
|
| Rate for Payer: Multiplan Commercial |
$992.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,141.46
|
| Rate for Payer: Quartz Beloit One Network |
$607.95
|
| Rate for Payer: Quartz Commercial |
$744.43
|
| Rate for Payer: WEA Trust Commercial |
$682.40
|
| Rate for Payer: WPS Commercial |
$918.97
|
|
