|
XR OR Venous Access
|
Facility
|
OP
|
$1,231.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
6179872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna Commercial |
$1,152.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.01
|
| Rate for Payer: Aetna Managed Medicare |
$358.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.53
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,177.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.44
|
| Rate for Payer: Health EOS Commercial |
$1,139.41
|
| Rate for Payer: HFN Commercial |
$1,177.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.18
|
| Rate for Payer: Multiplan Commercial |
$1,024.19
|
| Rate for Payer: NAPHCARE Commercial |
$768.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.82
|
| Rate for Payer: Quartz Beloit One Network |
$627.32
|
| Rate for Payer: Quartz Commercial |
$832.16
|
| Rate for Payer: Quartz Medicare Advantage |
$768.14
|
| Rate for Payer: The Alliance Commercial |
$390.33
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$704.13
|
| Rate for Payer: WPS Commercial |
$948.24
|
|
|
XR OR Venous Access
|
Facility
|
IP
|
$1,231.00
|
|
|
Service Code
|
CPT 77001
|
| Hospital Charge Code |
6179872
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$627.32 |
| Max. Negotiated Rate |
$1,177.82 |
| Rate for Payer: Aetna Commercial |
$1,152.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,101.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.53
|
| Rate for Payer: Cash Price |
$369.30
|
| Rate for Payer: Cigna Commercial |
$1,177.82
|
| Rate for Payer: Health EOS Commercial |
$1,139.41
|
| Rate for Payer: HFN Commercial |
$1,177.82
|
| Rate for Payer: Multiplan Commercial |
$1,024.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.82
|
| Rate for Payer: Quartz Beloit One Network |
$627.32
|
| Rate for Payer: Quartz Commercial |
$768.14
|
| Rate for Payer: WEA Trust Commercial |
$704.13
|
| Rate for Payer: WPS Commercial |
$948.24
|
|
|
XR OR Wrist
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$43.46 |
| Max. Negotiated Rate |
$1,047.28 |
| Rate for Payer: Aetna Commercial |
$1,047.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.46
|
| Rate for Payer: Anthem Medicare Advantage |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.46
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,047.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$551.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.46
|
| Rate for Payer: Health EOS Commercial |
$1,003.18
|
| Rate for Payer: HFN Commercial |
$1,047.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.46
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$65.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,047.28
|
| Rate for Payer: Quartz Beloit One Network |
$485.06
|
| Rate for Payer: Quartz Commercial |
$628.37
|
| Rate for Payer: Quartz Medicare Advantage |
$43.46
|
| Rate for Payer: The Alliance Commercial |
$165.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.46
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$217.31
|
|
|
XR OR Wrist
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$716.56
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR OR Wrist
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000
|
| Hospital Charge Code |
5724226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,014.21 |
| Rate for Payer: Aetna Commercial |
$992.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$948.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,014.21
|
| Rate for Payer: Health EOS Commercial |
$981.14
|
| Rate for Payer: HFN Commercial |
$1,014.21
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,014.21
|
| Rate for Payer: Quartz Beloit One Network |
$540.18
|
| Rate for Payer: Quartz Commercial |
$661.44
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR Pacemaker Insertion
|
Professional
|
Both
|
$981.00
|
|
| Hospital Charge Code |
630295
|
| Min. Negotiated Rate |
$448.91 |
| Max. Negotiated Rate |
$969.23 |
| Rate for Payer: Aetna Commercial |
$969.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.41
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna Commercial |
$969.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$510.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$612.14
|
| Rate for Payer: Health EOS Commercial |
$928.42
|
| Rate for Payer: HFN Commercial |
$969.23
|
| Rate for Payer: Multiplan Commercial |
$816.19
|
| Rate for Payer: Preferred Network Access Commercial |
$969.23
|
| Rate for Payer: Quartz Beloit One Network |
$448.91
|
| Rate for Payer: Quartz Commercial |
$581.54
|
| Rate for Payer: The Alliance Commercial |
$510.12
|
| Rate for Payer: WEA Trust Commercial |
$561.13
|
| Rate for Payer: WPS Commercial |
$755.66
|
|
|
XR Pacemaker Insertion
|
Professional
|
Both
|
$1,020.00
|
|
| Hospital Charge Code |
1537220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$466.75 |
| Max. Negotiated Rate |
$1,007.76 |
| Rate for Payer: Aetna Commercial |
$1,007.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$1,007.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$530.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.48
|
| Rate for Payer: Health EOS Commercial |
$965.33
|
| Rate for Payer: HFN Commercial |
$1,007.76
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,007.76
|
| Rate for Payer: Quartz Beloit One Network |
$466.75
|
| Rate for Payer: Quartz Commercial |
$604.66
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
XR Pacemaker Insertion
|
Facility
|
OP
|
$981.00
|
|
| Hospital Charge Code |
630295
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$938.62 |
| Rate for Payer: Aetna Commercial |
$918.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.41
|
| Rate for Payer: Aetna Managed Medicare |
$285.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.73
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna Commercial |
$938.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.94
|
| Rate for Payer: Health EOS Commercial |
$908.01
|
| Rate for Payer: HFN Commercial |
$938.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.18
|
| Rate for Payer: Multiplan Commercial |
$816.19
|
| Rate for Payer: NAPHCARE Commercial |
$612.14
|
| Rate for Payer: Preferred Network Access Commercial |
$938.62
|
| Rate for Payer: Quartz Beloit One Network |
$499.92
|
| Rate for Payer: Quartz Commercial |
$663.16
|
| Rate for Payer: Quartz Medicare Advantage |
$612.14
|
| Rate for Payer: The Alliance Commercial |
$510.12
|
| Rate for Payer: WEA Trust Commercial |
$561.13
|
| Rate for Payer: WPS Commercial |
$755.66
|
|
|
XR Pacemaker Insertion
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
1537220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
XR Pacemaker Insertion
|
Facility
|
IP
|
$981.00
|
|
| Hospital Charge Code |
630295
|
| Min. Negotiated Rate |
$499.92 |
| Max. Negotiated Rate |
$938.62 |
| Rate for Payer: Aetna Commercial |
$918.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.73
|
| Rate for Payer: Cash Price |
$294.30
|
| Rate for Payer: Cigna Commercial |
$938.62
|
| Rate for Payer: Health EOS Commercial |
$908.01
|
| Rate for Payer: HFN Commercial |
$938.62
|
| Rate for Payer: Multiplan Commercial |
$816.19
|
| Rate for Payer: Preferred Network Access Commercial |
$938.62
|
| Rate for Payer: Quartz Beloit One Network |
$499.92
|
| Rate for Payer: Quartz Commercial |
$612.14
|
| Rate for Payer: WEA Trust Commercial |
$561.13
|
| Rate for Payer: WPS Commercial |
$755.66
|
|
|
XR Pacemaker Insertion
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
1537220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
XR PAIN Fluoro Guided Joint
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
5963664
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$329.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$659.41
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.74
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$706.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$765.91
|
| Rate for Payer: Quartz Medicare Advantage |
$706.99
|
| Rate for Payer: The Alliance Commercial |
$482.68
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR PAIN Fluoro Guided Joint
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
5963664
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$577.38 |
| Max. Negotiated Rate |
$1,084.05 |
| Rate for Payer: Aetna Commercial |
$1,060.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.51
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,084.05
|
| Rate for Payer: Health EOS Commercial |
$1,048.70
|
| Rate for Payer: HFN Commercial |
$1,084.05
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,084.05
|
| Rate for Payer: Quartz Beloit One Network |
$577.38
|
| Rate for Payer: Quartz Commercial |
$706.99
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$872.75
|
|
|
XR PAIN Fluoro Guided Joint
|
Professional
|
Both
|
$1,133.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
5963664
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$1,119.40 |
| Rate for Payer: Aetna Commercial |
$1,119.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.36
|
| Rate for Payer: Aetna Managed Medicare |
$120.67
|
| Rate for Payer: Anthem Medicare Advantage |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.67
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,119.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$589.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.67
|
| Rate for Payer: Health EOS Commercial |
$1,072.27
|
| Rate for Payer: HFN Commercial |
$1,119.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.67
|
| Rate for Payer: Multiplan Commercial |
$942.66
|
| Rate for Payer: NAPHCARE Commercial |
$181.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,119.40
|
| Rate for Payer: Quartz Beloit One Network |
$518.46
|
| Rate for Payer: Quartz Commercial |
$671.64
|
| Rate for Payer: Quartz Medicare Advantage |
$120.67
|
| Rate for Payer: The Alliance Commercial |
$458.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.67
|
| Rate for Payer: WEA Trust Commercial |
$648.08
|
| Rate for Payer: WPS Commercial |
$603.36
|
|
|
XR Panorex/Orthopantogram
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
630293
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$473.25 |
| Rate for Payer: Aetna Commercial |
$473.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$19.15
|
| Rate for Payer: Anthem Medicare Advantage |
$19.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.15
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$473.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.15
|
| Rate for Payer: Health EOS Commercial |
$453.33
|
| Rate for Payer: HFN Commercial |
$473.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.15
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$28.72
|
| Rate for Payer: Preferred Network Access Commercial |
$473.25
|
| Rate for Payer: Quartz Beloit One Network |
$219.19
|
| Rate for Payer: Quartz Commercial |
$283.95
|
| Rate for Payer: Quartz Medicare Advantage |
$19.15
|
| Rate for Payer: The Alliance Commercial |
$72.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.15
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$95.73
|
|
|
XR Panorex/Orthopantogram
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
630293
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$298.90
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Panorex/Orthopantogram
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
630293
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$239.12
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| 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 |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| 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 |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$323.80
|
| 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 |
$273.99
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Panorex/Orthopantogram
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
1537222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| 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: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| 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 |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| 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 |
$430.14
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$349.49
|
| 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: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
XR Panorex/Orthopantogram
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
1537222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.46 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$322.61
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
XR Panorex/Orthopantogram
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
CPT 70355
|
| Hospital Charge Code |
1537222
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.15 |
| Max. Negotiated Rate |
$510.80 |
| Rate for Payer: Aetna Commercial |
$510.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Aetna Managed Medicare |
$19.15
|
| Rate for Payer: Anthem Medicare Advantage |
$19.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.15
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$510.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.15
|
| Rate for Payer: Health EOS Commercial |
$489.29
|
| Rate for Payer: HFN Commercial |
$510.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.15
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: NAPHCARE Commercial |
$28.72
|
| Rate for Payer: Preferred Network Access Commercial |
$510.80
|
| Rate for Payer: Quartz Beloit One Network |
$236.58
|
| Rate for Payer: Quartz Commercial |
$306.48
|
| Rate for Payer: Quartz Medicare Advantage |
$19.15
|
| Rate for Payer: The Alliance Commercial |
$72.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.15
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$95.73
|
|
|
XR Pelvimetry
|
Facility
|
IP
|
$754.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
630291
|
| Min. Negotiated Rate |
$384.24 |
| Max. Negotiated Rate |
$721.43 |
| Rate for Payer: Aetna Commercial |
$705.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.60
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$721.43
|
| Rate for Payer: Health EOS Commercial |
$697.90
|
| Rate for Payer: HFN Commercial |
$721.43
|
| Rate for Payer: Multiplan Commercial |
$627.33
|
| Rate for Payer: Preferred Network Access Commercial |
$721.43
|
| Rate for Payer: Quartz Beloit One Network |
$384.24
|
| Rate for Payer: Quartz Commercial |
$470.50
|
| Rate for Payer: WEA Trust Commercial |
$431.29
|
| Rate for Payer: WPS Commercial |
$580.81
|
|
|
XR Pelvimetry
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
1537224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| 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: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| 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 |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| 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 |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$390.05
|
| 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: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Pelvimetry
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
1537224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna Commercial |
$570.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.75
|
| Rate for Payer: Anthem Medicare Advantage |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.75
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$570.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$546.07
|
| Rate for Payer: HFN Commercial |
$570.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$41.62
|
| Rate for Payer: Preferred Network Access Commercial |
$570.08
|
| Rate for Payer: Quartz Beloit One Network |
$264.04
|
| Rate for Payer: Quartz Commercial |
$342.05
|
| Rate for Payer: Quartz Medicare Advantage |
$27.75
|
| Rate for Payer: The Alliance Commercial |
$105.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.75
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$138.74
|
|
|
XR Pelvimetry
|
Professional
|
Both
|
$754.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
630291
|
| Min. Negotiated Rate |
$141.23 |
| Max. Negotiated Rate |
$744.95 |
| Rate for Payer: Aetna Commercial |
$744.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.38
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$744.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$392.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$470.50
|
| Rate for Payer: Health EOS Commercial |
$713.59
|
| Rate for Payer: HFN Commercial |
$744.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.23
|
| Rate for Payer: Multiplan Commercial |
$627.33
|
| Rate for Payer: Preferred Network Access Commercial |
$744.95
|
| Rate for Payer: Quartz Beloit One Network |
$345.03
|
| Rate for Payer: Quartz Commercial |
$446.97
|
| Rate for Payer: The Alliance Commercial |
$392.08
|
| Rate for Payer: WEA Trust Commercial |
$431.29
|
| Rate for Payer: WPS Commercial |
$580.81
|
|
|
XR Pelvimetry
|
Facility
|
OP
|
$754.00
|
|
|
Service Code
|
CPT 74710
|
| Hospital Charge Code |
630291
|
| Min. Negotiated Rate |
$219.56 |
| Max. Negotiated Rate |
$721.43 |
| Rate for Payer: Aetna Commercial |
$705.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$674.38
|
| Rate for Payer: Aetna Managed Medicare |
$219.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.60
|
| Rate for Payer: Cash Price |
$226.20
|
| Rate for Payer: Cigna Commercial |
$721.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.83
|
| Rate for Payer: Health EOS Commercial |
$697.90
|
| Rate for Payer: HFN Commercial |
$721.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.12
|
| Rate for Payer: Multiplan Commercial |
$627.33
|
| Rate for Payer: NAPHCARE Commercial |
$470.50
|
| Rate for Payer: Preferred Network Access Commercial |
$721.43
|
| Rate for Payer: Quartz Beloit One Network |
$384.24
|
| Rate for Payer: Quartz Commercial |
$509.70
|
| Rate for Payer: Quartz Medicare Advantage |
$470.50
|
| Rate for Payer: The Alliance Commercial |
$392.08
|
| Rate for Payer: WEA Trust Commercial |
$431.29
|
| Rate for Payer: WPS Commercial |
$580.81
|
|
