|
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
|
$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
|
$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 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 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
|
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: The Alliance Commercial |
$96.51
|
| 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: 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
|
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
|
$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
|
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 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 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
|
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 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
|
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
|
|
|
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
|
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 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
|
$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
|
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
|
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
|
$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
|
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
|
|
