|
XR Ribs 3 Views Bilateral
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
CPT 71110 TC
|
| Hospital Charge Code |
1537252
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$1,274.52 |
| Rate for Payer: Aetna Commercial |
$1,274.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,153.78
|
| Rate for Payer: Aetna Managed Medicare |
$29.06
|
| Rate for Payer: Anthem Medicare Advantage |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.06
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,274.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$670.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.06
|
| Rate for Payer: Health EOS Commercial |
$1,220.86
|
| Rate for Payer: HFN Commercial |
$1,274.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$104.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.06
|
| Rate for Payer: Multiplan Commercial |
$1,073.28
|
| Rate for Payer: NAPHCARE Commercial |
$43.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.52
|
| Rate for Payer: Quartz Beloit One Network |
$590.30
|
| Rate for Payer: Quartz Commercial |
$764.71
|
| Rate for Payer: Quartz Medicare Advantage |
$29.06
|
| Rate for Payer: The Alliance Commercial |
$110.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.06
|
| Rate for Payer: WEA Trust Commercial |
$737.88
|
| Rate for Payer: WPS Commercial |
$145.29
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
|
IP
|
$1,290.00
|
|
|
Service Code
|
CPT 71110 TC
|
| Hospital Charge Code |
1537252
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$657.38 |
| Max. Negotiated Rate |
$1,234.27 |
| Rate for Payer: Aetna Commercial |
$1,207.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,153.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.05
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,234.27
|
| Rate for Payer: Health EOS Commercial |
$1,194.02
|
| Rate for Payer: HFN Commercial |
$1,234.27
|
| Rate for Payer: Multiplan Commercial |
$1,073.28
|
| Rate for Payer: Preferred Network Access Commercial |
$1,234.27
|
| Rate for Payer: Quartz Beloit One Network |
$657.38
|
| Rate for Payer: Quartz Commercial |
$804.96
|
| Rate for Payer: WEA Trust Commercial |
$737.88
|
| Rate for Payer: WPS Commercial |
$993.69
|
|
|
XR Ribs 3 Views Bilateral
|
Facility
|
OP
|
$1,290.00
|
|
|
Service Code
|
CPT 71110 TC
|
| Hospital Charge Code |
1537252
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.23 |
| Max. Negotiated Rate |
$1,234.27 |
| Rate for Payer: Aetna Commercial |
$1,207.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,153.78
|
| Rate for Payer: Aetna Managed Medicare |
$375.65
|
| 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 |
$711.05
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,234.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$750.78
|
| Rate for Payer: Health EOS Commercial |
$1,194.02
|
| Rate for Payer: HFN Commercial |
$1,234.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,006.20
|
| Rate for Payer: Multiplan Commercial |
$1,073.28
|
| Rate for Payer: NAPHCARE Commercial |
$804.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,234.27
|
| Rate for Payer: Quartz Beloit One Network |
$657.38
|
| Rate for Payer: Quartz Commercial |
$872.04
|
| Rate for Payer: Quartz Medicare Advantage |
$804.96
|
| Rate for Payer: The Alliance Commercial |
$116.23
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$737.88
|
| Rate for Payer: WPS Commercial |
$993.69
|
|
|
XR Ribs 3 Views Bilateral
|
Professional
|
Both
|
$1,193.00
|
|
|
Service Code
|
CPT 71110
|
| Hospital Charge Code |
630231
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$1,178.68 |
| Rate for Payer: Aetna Commercial |
$1,178.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,067.02
|
| Rate for Payer: Aetna Managed Medicare |
$42.56
|
| Rate for Payer: Anthem Medicare Advantage |
$42.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.56
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cash Price |
$357.90
|
| Rate for Payer: Cigna Commercial |
$1,178.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$620.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.56
|
| Rate for Payer: Health EOS Commercial |
$1,129.06
|
| Rate for Payer: HFN Commercial |
$1,178.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$154.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.56
|
| Rate for Payer: Multiplan Commercial |
$992.58
|
| Rate for Payer: NAPHCARE Commercial |
$63.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$545.92
|
| Rate for Payer: Quartz Commercial |
$707.21
|
| Rate for Payer: Quartz Medicare Advantage |
$42.56
|
| Rate for Payer: The Alliance Commercial |
$161.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.56
|
| Rate for Payer: WEA Trust Commercial |
$682.40
|
| Rate for Payer: WPS Commercial |
$212.78
|
|
|
XR Ribs 3 Views Right
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 71100 TC,RT
|
| Hospital Charge Code |
2980134
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$180.54 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$180.54
|
| 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 |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.84
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$386.88
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$419.12
|
| Rate for Payer: Quartz Medicare Advantage |
$386.88
|
| Rate for Payer: The Alliance Commercial |
$322.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
XR Ribs 3 Views Right
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 71100 TC,RT
|
| Hospital Charge Code |
2980134
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.07 |
| Max. Negotiated Rate |
$612.56 |
| Rate for Payer: Aetna Commercial |
$612.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$612.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$322.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.88
|
| Rate for Payer: Health EOS Commercial |
$586.77
|
| Rate for Payer: HFN Commercial |
$612.56
|
| 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: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$612.56
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$367.54
|
| Rate for Payer: The Alliance Commercial |
$322.40
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
XR Ribs 3 Views Right
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 71100 TC,RT
|
| Hospital Charge Code |
2980134
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Professional
|
Both
|
$1,848.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
630225
|
| Min. Negotiated Rate |
$51.02 |
| Max. Negotiated Rate |
$1,825.82 |
| Rate for Payer: Aetna Commercial |
$1,825.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,652.85
|
| Rate for Payer: Aetna Managed Medicare |
$51.02
|
| Rate for Payer: Anthem Medicare Advantage |
$51.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.02
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$1,825.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$960.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.02
|
| Rate for Payer: Health EOS Commercial |
$1,748.95
|
| Rate for Payer: HFN Commercial |
$1,825.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.02
|
| Rate for Payer: Multiplan Commercial |
$1,537.54
|
| Rate for Payer: NAPHCARE Commercial |
$76.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,825.82
|
| Rate for Payer: Quartz Beloit One Network |
$845.64
|
| Rate for Payer: Quartz Commercial |
$1,095.49
|
| Rate for Payer: Quartz Medicare Advantage |
$51.02
|
| Rate for Payer: The Alliance Commercial |
$193.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.02
|
| Rate for Payer: WEA Trust Commercial |
$1,057.06
|
| Rate for Payer: WPS Commercial |
$255.11
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Facility
|
IP
|
$1,848.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
630225
|
| Min. Negotiated Rate |
$941.74 |
| Max. Negotiated Rate |
$1,768.17 |
| Rate for Payer: Aetna Commercial |
$1,729.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,652.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,018.62
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$1,768.17
|
| Rate for Payer: Health EOS Commercial |
$1,710.51
|
| Rate for Payer: HFN Commercial |
$1,768.17
|
| Rate for Payer: Multiplan Commercial |
$1,537.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.17
|
| Rate for Payer: Quartz Beloit One Network |
$941.74
|
| Rate for Payer: Quartz Commercial |
$1,153.15
|
| Rate for Payer: WEA Trust Commercial |
$1,057.06
|
| Rate for Payer: WPS Commercial |
$1,423.51
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Facility
|
OP
|
$1,848.00
|
|
|
Service Code
|
CPT 71111
|
| Hospital Charge Code |
630225
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,768.17 |
| Rate for Payer: Aetna Commercial |
$1,729.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,652.85
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,249.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$960.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$922.52
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,018.62
|
| 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 |
$554.40
|
| Rate for Payer: Cash Price |
$554.40
|
| Rate for Payer: Cigna Commercial |
$1,768.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,075.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,710.51
|
| Rate for Payer: HFN Commercial |
$1,768.17
|
| 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 |
$1,537.54
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.17
|
| Rate for Payer: Quartz Beloit One Network |
$941.74
|
| Rate for Payer: Quartz Commercial |
$1,249.25
|
| 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 |
$1,057.06
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,423.51
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Facility
|
IP
|
$999.00
|
|
|
Service Code
|
CPT 71111 TC
|
| Hospital Charge Code |
1537254
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$509.09 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$623.38
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Professional
|
Both
|
$999.00
|
|
|
Service Code
|
CPT 71111 TC
|
| Hospital Charge Code |
1537254
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$36.05 |
| Max. Negotiated Rate |
$987.01 |
| Rate for Payer: Aetna Commercial |
$987.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Aetna Managed Medicare |
$36.05
|
| Rate for Payer: Anthem Medicare Advantage |
$36.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.05
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$987.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$519.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.05
|
| Rate for Payer: Health EOS Commercial |
$945.45
|
| Rate for Payer: HFN Commercial |
$987.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.05
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: NAPHCARE Commercial |
$54.07
|
| Rate for Payer: Preferred Network Access Commercial |
$987.01
|
| Rate for Payer: Quartz Beloit One Network |
$457.14
|
| Rate for Payer: Quartz Commercial |
$592.21
|
| Rate for Payer: Quartz Medicare Advantage |
$36.05
|
| Rate for Payer: The Alliance Commercial |
$136.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.05
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$180.23
|
|
|
XR Ribs w/ PA Chest Bilateral
|
Facility
|
OP
|
$999.00
|
|
|
Service Code
|
CPT 71111 TC
|
| Hospital Charge Code |
1537254
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$144.19 |
| Max. Negotiated Rate |
$955.84 |
| Rate for Payer: Aetna Commercial |
$935.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$893.51
|
| Rate for Payer: Aetna Managed Medicare |
$290.91
|
| 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 |
$550.65
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cash Price |
$299.70
|
| Rate for Payer: Cigna Commercial |
$955.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$581.42
|
| Rate for Payer: Health EOS Commercial |
$924.67
|
| Rate for Payer: HFN Commercial |
$955.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$779.22
|
| Rate for Payer: Multiplan Commercial |
$831.17
|
| Rate for Payer: NAPHCARE Commercial |
$623.38
|
| Rate for Payer: Preferred Network Access Commercial |
$955.84
|
| Rate for Payer: Quartz Beloit One Network |
$509.09
|
| Rate for Payer: Quartz Commercial |
$675.32
|
| Rate for Payer: Quartz Medicare Advantage |
$623.38
|
| Rate for Payer: The Alliance Commercial |
$144.19
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$571.43
|
| Rate for Payer: WPS Commercial |
$769.53
|
|
|
XR Ribs w/ PA Chest Left
|
Facility
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
630222
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$697.51 |
| Rate for Payer: Aetna Commercial |
$682.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$363.92
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.82
|
| 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 |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$697.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$674.76
|
| Rate for Payer: HFN Commercial |
$697.51
|
| 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 |
$606.53
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$697.51
|
| Rate for Payer: Quartz Beloit One Network |
$371.50
|
| Rate for Payer: Quartz Commercial |
$492.80
|
| 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 |
$416.99
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$561.55
|
|
|
XR Ribs w/ PA Chest Left
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 71101 TC,LT
|
| Hospital Charge Code |
1537256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$401.06 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$736.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.79
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$753.00
|
| Rate for Payer: Health EOS Commercial |
$728.45
|
| Rate for Payer: HFN Commercial |
$753.00
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: Preferred Network Access Commercial |
$753.00
|
| Rate for Payer: Quartz Beloit One Network |
$401.06
|
| Rate for Payer: Quartz Commercial |
$491.09
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
XR Ribs w/ PA Chest Left
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
630222
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$720.25 |
| Rate for Payer: Aetna Commercial |
$720.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Aetna Managed Medicare |
$41.30
|
| Rate for Payer: Anthem Medicare Advantage |
$41.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.30
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$720.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.30
|
| Rate for Payer: Health EOS Commercial |
$689.93
|
| Rate for Payer: HFN Commercial |
$720.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: NAPHCARE Commercial |
$61.95
|
| Rate for Payer: Preferred Network Access Commercial |
$720.25
|
| Rate for Payer: Quartz Beloit One Network |
$333.59
|
| Rate for Payer: Quartz Commercial |
$432.15
|
| Rate for Payer: Quartz Medicare Advantage |
$41.30
|
| Rate for Payer: The Alliance Commercial |
$156.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.30
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: WPS Commercial |
$206.49
|
|
|
XR Ribs w/ PA Chest Left
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 71101 TC,LT
|
| Hospital Charge Code |
1537256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.17 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$736.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Aetna Managed Medicare |
$229.17
|
| 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 |
$433.79
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$753.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.03
|
| Rate for Payer: Health EOS Commercial |
$728.45
|
| Rate for Payer: HFN Commercial |
$753.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.86
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: NAPHCARE Commercial |
$491.09
|
| Rate for Payer: Preferred Network Access Commercial |
$753.00
|
| Rate for Payer: Quartz Beloit One Network |
$401.06
|
| Rate for Payer: Quartz Commercial |
$532.01
|
| Rate for Payer: Quartz Medicare Advantage |
$491.09
|
| Rate for Payer: The Alliance Commercial |
$409.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
XR Ribs w/ PA Chest Left
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
CPT 71101 TC,LT
|
| Hospital Charge Code |
1537256
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$777.56 |
| Rate for Payer: Aetna Commercial |
$777.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$777.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$409.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$491.09
|
| Rate for Payer: Health EOS Commercial |
$744.82
|
| Rate for Payer: HFN Commercial |
$777.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.76
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: Preferred Network Access Commercial |
$777.56
|
| Rate for Payer: Quartz Beloit One Network |
$360.13
|
| Rate for Payer: Quartz Commercial |
$466.53
|
| Rate for Payer: The Alliance Commercial |
$409.24
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
XR Ribs w/ PA Chest Left
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
630222
|
| Min. Negotiated Rate |
$371.50 |
| Max. Negotiated Rate |
$697.51 |
| Rate for Payer: Aetna Commercial |
$682.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.82
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$697.51
|
| Rate for Payer: Health EOS Commercial |
$674.76
|
| Rate for Payer: HFN Commercial |
$697.51
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: Preferred Network Access Commercial |
$697.51
|
| Rate for Payer: Quartz Beloit One Network |
$371.50
|
| Rate for Payer: Quartz Commercial |
$454.90
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: WPS Commercial |
$561.55
|
|
|
XR Ribs w/ PA Chest Right
|
Facility
|
OP
|
$787.00
|
|
|
Service Code
|
CPT 71101 RT,TC
|
| Hospital Charge Code |
1537258
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$229.17 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$736.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Aetna Managed Medicare |
$229.17
|
| 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 |
$433.79
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$753.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.03
|
| Rate for Payer: Health EOS Commercial |
$728.45
|
| Rate for Payer: HFN Commercial |
$753.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.86
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: NAPHCARE Commercial |
$491.09
|
| Rate for Payer: Preferred Network Access Commercial |
$753.00
|
| Rate for Payer: Quartz Beloit One Network |
$401.06
|
| Rate for Payer: Quartz Commercial |
$532.01
|
| Rate for Payer: Quartz Medicare Advantage |
$491.09
|
| Rate for Payer: The Alliance Commercial |
$409.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
XR Ribs w/ PA Chest Right
|
Professional
|
Both
|
$729.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
630217
|
| Min. Negotiated Rate |
$41.30 |
| Max. Negotiated Rate |
$720.25 |
| Rate for Payer: Aetna Commercial |
$720.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Aetna Managed Medicare |
$41.30
|
| Rate for Payer: Anthem Medicare Advantage |
$41.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.30
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$720.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.30
|
| Rate for Payer: Health EOS Commercial |
$689.93
|
| Rate for Payer: HFN Commercial |
$720.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.30
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: NAPHCARE Commercial |
$61.95
|
| Rate for Payer: Preferred Network Access Commercial |
$720.25
|
| Rate for Payer: Quartz Beloit One Network |
$333.59
|
| Rate for Payer: Quartz Commercial |
$432.15
|
| Rate for Payer: Quartz Medicare Advantage |
$41.30
|
| Rate for Payer: The Alliance Commercial |
$156.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.30
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: WPS Commercial |
$206.49
|
|
|
XR Ribs w/ PA Chest Right
|
Professional
|
Both
|
$787.00
|
|
|
Service Code
|
CPT 71101 RT,TC
|
| Hospital Charge Code |
1537258
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.76 |
| Max. Negotiated Rate |
$777.56 |
| Rate for Payer: Aetna Commercial |
$777.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$777.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$409.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$491.09
|
| Rate for Payer: Health EOS Commercial |
$744.82
|
| Rate for Payer: HFN Commercial |
$777.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.76
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: Preferred Network Access Commercial |
$777.56
|
| Rate for Payer: Quartz Beloit One Network |
$360.13
|
| Rate for Payer: Quartz Commercial |
$466.53
|
| Rate for Payer: The Alliance Commercial |
$409.24
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
XR Ribs w/ PA Chest Right
|
Facility
|
IP
|
$729.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
630217
|
| Min. Negotiated Rate |
$371.50 |
| Max. Negotiated Rate |
$697.51 |
| Rate for Payer: Aetna Commercial |
$682.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.82
|
| Rate for Payer: Cash Price |
$218.70
|
| Rate for Payer: Cigna Commercial |
$697.51
|
| Rate for Payer: Health EOS Commercial |
$674.76
|
| Rate for Payer: HFN Commercial |
$697.51
|
| Rate for Payer: Multiplan Commercial |
$606.53
|
| Rate for Payer: Preferred Network Access Commercial |
$697.51
|
| Rate for Payer: Quartz Beloit One Network |
$371.50
|
| Rate for Payer: Quartz Commercial |
$454.90
|
| Rate for Payer: WEA Trust Commercial |
$416.99
|
| Rate for Payer: WPS Commercial |
$561.55
|
|
|
XR Ribs w/ PA Chest Right
|
Facility
|
IP
|
$784.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$399.53 |
| Max. Negotiated Rate |
$750.13 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| Rate for Payer: Health EOS Commercial |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$489.22
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
XR Ribs w/ PA Chest Right
|
Facility
|
OP
|
$784.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$228.30 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$733.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| Rate for Payer: Aetna Managed Medicare |
$228.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$391.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.14
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cash Price |
$235.20
|
| Rate for Payer: Cigna Commercial |
$750.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$725.67
|
| Rate for Payer: HFN Commercial |
$750.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.52
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: NAPHCARE Commercial |
$489.22
|
| Rate for Payer: Preferred Network Access Commercial |
$750.13
|
| Rate for Payer: Quartz Beloit One Network |
$399.53
|
| Rate for Payer: Quartz Commercial |
$529.98
|
| Rate for Payer: Quartz Medicare Advantage |
$489.22
|
| Rate for Payer: The Alliance Commercial |
$407.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
