|
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 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
|
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
|
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
|
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 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
|
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 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
|
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
|
|
|
XR Ribs w/ PA Chest Right
|
Facility
|
IP
|
$787.00
|
|
|
Service Code
|
CPT 71101 RT,TC
|
| Hospital Charge Code |
1537258
|
|
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 Right
|
Professional
|
Both
|
$784.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980135
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$358.76 |
| Max. Negotiated Rate |
$1,277.03 |
| Rate for Payer: Aetna Commercial |
$774.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.21
|
| 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 |
$774.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,277.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.22
|
| Rate for Payer: Health EOS Commercial |
$741.98
|
| Rate for Payer: HFN Commercial |
$774.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,191.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,191.08
|
| Rate for Payer: Multiplan Commercial |
$652.29
|
| Rate for Payer: Preferred Network Access Commercial |
$774.59
|
| Rate for Payer: Quartz Beloit One Network |
$358.76
|
| Rate for Payer: Quartz Commercial |
$464.76
|
| Rate for Payer: The Alliance Commercial |
$407.68
|
| Rate for Payer: United Healthcare Medicaid |
$1,277.03
|
| Rate for Payer: WEA Trust Commercial |
$448.45
|
| Rate for Payer: WPS Commercial |
$603.92
|
|
|
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
|
$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
|
OP
|
$729.00
|
|
|
Service Code
|
CPT 71101
|
| Hospital Charge Code |
630217
|
| 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 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
|
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 Sacroiliac Joints 1 or 2 Views
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
CPT 72200 TC
|
| Hospital Charge Code |
1537262
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
XR Sacroiliac Joints 1 or 2 Views
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
CPT 72200 TC
|
| Hospital Charge Code |
1537262
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$25.06 |
| Max. Negotiated Rate |
$441.64 |
| Rate for Payer: Aetna Commercial |
$441.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$25.06
|
| Rate for Payer: Anthem Medicare Advantage |
$25.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.06
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$441.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.06
|
| Rate for Payer: Health EOS Commercial |
$423.04
|
| Rate for Payer: HFN Commercial |
$441.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.06
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$37.60
|
| Rate for Payer: Preferred Network Access Commercial |
$441.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.55
|
| Rate for Payer: Quartz Commercial |
$264.98
|
| Rate for Payer: Quartz Medicare Advantage |
$25.06
|
| Rate for Payer: The Alliance Commercial |
$95.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.06
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$125.32
|
|
|
XR Sacroiliac Joints 1 or 2 Views
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
CPT 72200 TC
|
| Hospital Charge Code |
1537262
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.26 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$130.17
|
| 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 |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.15
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.66
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$278.93
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| Rate for Payer: Quartz Medicare Advantage |
$278.93
|
| Rate for Payer: The Alliance Commercial |
$100.26
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
XR Sacroiliac Joints 1 or 2 Views
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
630215
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$33.40
|
| Rate for Payer: Anthem Medicare Advantage |
$33.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.40
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.40
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.40
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.11
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: Quartz Medicare Advantage |
$33.40
|
| Rate for Payer: The Alliance Commercial |
$126.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$167.02
|
|
|
XR Sacroiliac Joints 1 or 2 Views
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
630215
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
XR Sacroiliac Joints 1 or 2 Views
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 72200
|
| Hospital Charge Code |
630215
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$440.09 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| 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 |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| 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 |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| 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 |
$200.20
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
XR Sacroiliac Joints Minimum 3 Views
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
630196
|
| Min. Negotiated Rate |
$196.71 |
| Max. Negotiated Rate |
$369.32 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| Rate for Payer: Multiplan Commercial |
$321.15
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$240.86
|
| Rate for Payer: WEA Trust Commercial |
$220.79
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
XR Sacroiliac Joints Minimum 3 Views
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 72202
|
| Hospital Charge Code |
630196
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$440.09 |
| Rate for Payer: Aetna Commercial |
$361.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.24
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.69
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.76
|
| 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 |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$369.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$357.28
|
| Rate for Payer: HFN Commercial |
$369.32
|
| 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 |
$321.15
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$369.32
|
| Rate for Payer: Quartz Beloit One Network |
$196.71
|
| Rate for Payer: Quartz Commercial |
$260.94
|
| 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 |
$220.79
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$297.34
|
|
|
XR Sacroiliac Joints Minimum 3 Views
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
CPT 72202 TC
|
| Hospital Charge Code |
1537264
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$423.81 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| 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 |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$112.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
