|
XR Skull < 4 Views
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
5510675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.91 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$531.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Aetna Managed Medicare |
$165.40
|
| 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 |
$313.08
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$543.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.58
|
| Rate for Payer: Health EOS Commercial |
$525.74
|
| Rate for Payer: HFN Commercial |
$543.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.04
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: NAPHCARE Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$543.46
|
| Rate for Payer: Quartz Beloit One Network |
$289.45
|
| Rate for Payer: Quartz Commercial |
$383.97
|
| Rate for Payer: Quartz Medicare Advantage |
$354.43
|
| Rate for Payer: The Alliance Commercial |
$106.91
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
XR Skull < 4 Views
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
1537313
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$106.91 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$531.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Aetna Managed Medicare |
$165.40
|
| 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 |
$313.08
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$543.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.58
|
| Rate for Payer: Health EOS Commercial |
$525.74
|
| Rate for Payer: HFN Commercial |
$543.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.04
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: NAPHCARE Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$543.46
|
| Rate for Payer: Quartz Beloit One Network |
$289.45
|
| Rate for Payer: Quartz Commercial |
$383.97
|
| Rate for Payer: Quartz Medicare Advantage |
$354.43
|
| Rate for Payer: The Alliance Commercial |
$106.91
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
XR Skull < 4 Views
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 70250 TC
|
| Hospital Charge Code |
5510675
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$289.45 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$531.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.08
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$543.46
|
| Rate for Payer: Health EOS Commercial |
$525.74
|
| Rate for Payer: HFN Commercial |
$543.46
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: Preferred Network Access Commercial |
$543.46
|
| Rate for Payer: Quartz Beloit One Network |
$289.45
|
| Rate for Payer: Quartz Commercial |
$354.43
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
XR Skull Complete
|
Facility
|
OP
|
$687.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
630092
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$657.32 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.95
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| 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 |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| 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 |
$571.58
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$464.41
|
| 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 |
$392.96
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
XR Skull Complete
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
630092
|
| Min. Negotiated Rate |
$43.53 |
| Max. Negotiated Rate |
$678.76 |
| Rate for Payer: Aetna Commercial |
$678.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Aetna Managed Medicare |
$43.53
|
| Rate for Payer: Anthem Medicare Advantage |
$43.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.53
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$678.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$357.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.53
|
| Rate for Payer: Health EOS Commercial |
$650.18
|
| Rate for Payer: HFN Commercial |
$678.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$158.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$158.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.53
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: NAPHCARE Commercial |
$65.30
|
| Rate for Payer: Preferred Network Access Commercial |
$678.76
|
| Rate for Payer: Quartz Beloit One Network |
$314.37
|
| Rate for Payer: Quartz Commercial |
$407.25
|
| Rate for Payer: Quartz Medicare Advantage |
$43.53
|
| Rate for Payer: The Alliance Commercial |
$165.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.53
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$217.67
|
|
|
XR Skull Complete
|
Professional
|
Both
|
$743.00
|
|
|
Service Code
|
CPT 70260 TC
|
| Hospital Charge Code |
1537315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$734.08 |
| Rate for Payer: Aetna Commercial |
$734.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.54
|
| Rate for Payer: Aetna Managed Medicare |
$30.39
|
| Rate for Payer: Anthem Medicare Advantage |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.39
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$734.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$386.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.39
|
| Rate for Payer: Health EOS Commercial |
$703.18
|
| Rate for Payer: HFN Commercial |
$734.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.39
|
| Rate for Payer: Multiplan Commercial |
$618.18
|
| Rate for Payer: NAPHCARE Commercial |
$45.58
|
| Rate for Payer: Preferred Network Access Commercial |
$734.08
|
| Rate for Payer: Quartz Beloit One Network |
$340.00
|
| Rate for Payer: Quartz Commercial |
$440.45
|
| Rate for Payer: Quartz Medicare Advantage |
$30.39
|
| Rate for Payer: The Alliance Commercial |
$115.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.39
|
| Rate for Payer: WEA Trust Commercial |
$425.00
|
| Rate for Payer: WPS Commercial |
$151.94
|
|
|
XR Skull Complete
|
Facility
|
IP
|
$687.00
|
|
|
Service Code
|
CPT 70260
|
| Hospital Charge Code |
630092
|
| Min. Negotiated Rate |
$350.10 |
| Max. Negotiated Rate |
$657.32 |
| Rate for Payer: Aetna Commercial |
$643.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.67
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$657.32
|
| Rate for Payer: Health EOS Commercial |
$635.89
|
| Rate for Payer: HFN Commercial |
$657.32
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: Preferred Network Access Commercial |
$657.32
|
| Rate for Payer: Quartz Beloit One Network |
$350.10
|
| Rate for Payer: Quartz Commercial |
$428.69
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$529.20
|
|
|
XR Skull Complete
|
Facility
|
OP
|
$743.00
|
|
|
Service Code
|
CPT 70260 TC
|
| Hospital Charge Code |
1537315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.56 |
| Max. Negotiated Rate |
$710.90 |
| Rate for Payer: Aetna Commercial |
$695.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.54
|
| Rate for Payer: Aetna Managed Medicare |
$216.36
|
| 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 |
$409.54
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$710.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$432.43
|
| Rate for Payer: Health EOS Commercial |
$687.72
|
| Rate for Payer: HFN Commercial |
$710.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.54
|
| Rate for Payer: Multiplan Commercial |
$618.18
|
| Rate for Payer: NAPHCARE Commercial |
$463.63
|
| Rate for Payer: Preferred Network Access Commercial |
$710.90
|
| Rate for Payer: Quartz Beloit One Network |
$378.63
|
| Rate for Payer: Quartz Commercial |
$502.27
|
| Rate for Payer: Quartz Medicare Advantage |
$463.63
|
| Rate for Payer: The Alliance Commercial |
$121.56
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$425.00
|
| Rate for Payer: WPS Commercial |
$572.33
|
|
|
XR Skull Complete
|
Facility
|
IP
|
$743.00
|
|
|
Service Code
|
CPT 70260 TC
|
| Hospital Charge Code |
1537315
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$378.63 |
| Max. Negotiated Rate |
$710.90 |
| Rate for Payer: Aetna Commercial |
$695.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$664.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$409.54
|
| Rate for Payer: Cash Price |
$222.90
|
| Rate for Payer: Cigna Commercial |
$710.90
|
| Rate for Payer: Health EOS Commercial |
$687.72
|
| Rate for Payer: HFN Commercial |
$710.90
|
| Rate for Payer: Multiplan Commercial |
$618.18
|
| Rate for Payer: Preferred Network Access Commercial |
$710.90
|
| Rate for Payer: Quartz Beloit One Network |
$378.63
|
| Rate for Payer: Quartz Commercial |
$463.63
|
| Rate for Payer: WEA Trust Commercial |
$425.00
|
| Rate for Payer: WPS Commercial |
$572.33
|
|
|
XR Small Bowel
|
Facility
|
OP
|
$912.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
5609775
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$265.57 |
| Max. Negotiated Rate |
$872.60 |
| Rate for Payer: Aetna Commercial |
$853.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.69
|
| Rate for Payer: Aetna Managed Medicare |
$265.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$616.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$474.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$455.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.69
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$872.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$530.78
|
| Rate for Payer: Health EOS Commercial |
$844.15
|
| Rate for Payer: HFN Commercial |
$872.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$711.36
|
| Rate for Payer: Multiplan Commercial |
$758.78
|
| Rate for Payer: NAPHCARE Commercial |
$569.09
|
| Rate for Payer: Preferred Network Access Commercial |
$872.60
|
| Rate for Payer: Quartz Beloit One Network |
$464.76
|
| Rate for Payer: Quartz Commercial |
$616.51
|
| Rate for Payer: Quartz Medicare Advantage |
$569.09
|
| Rate for Payer: The Alliance Commercial |
$316.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$521.66
|
| Rate for Payer: WPS Commercial |
$702.51
|
|
|
XR Small Bowel
|
Facility
|
IP
|
$912.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
5609775
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$464.76 |
| Max. Negotiated Rate |
$872.60 |
| Rate for Payer: Aetna Commercial |
$853.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.69
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$872.60
|
| Rate for Payer: Health EOS Commercial |
$844.15
|
| Rate for Payer: HFN Commercial |
$872.60
|
| Rate for Payer: Multiplan Commercial |
$758.78
|
| Rate for Payer: Preferred Network Access Commercial |
$872.60
|
| Rate for Payer: Quartz Beloit One Network |
$464.76
|
| Rate for Payer: Quartz Commercial |
$569.09
|
| Rate for Payer: WEA Trust Commercial |
$521.66
|
| Rate for Payer: WPS Commercial |
$702.51
|
|
|
XR Small Bowel
|
Professional
|
Both
|
$912.00
|
|
|
Service Code
|
CPT 74248
|
| Hospital Charge Code |
5609775
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$79.06 |
| Max. Negotiated Rate |
$901.06 |
| Rate for Payer: Aetna Commercial |
$901.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.69
|
| Rate for Payer: Aetna Managed Medicare |
$79.06
|
| Rate for Payer: Anthem Medicare Advantage |
$79.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.06
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$901.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$474.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.06
|
| Rate for Payer: Health EOS Commercial |
$863.12
|
| Rate for Payer: HFN Commercial |
$901.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.06
|
| Rate for Payer: Multiplan Commercial |
$758.78
|
| Rate for Payer: NAPHCARE Commercial |
$118.59
|
| Rate for Payer: Preferred Network Access Commercial |
$901.06
|
| Rate for Payer: Quartz Beloit One Network |
$417.33
|
| Rate for Payer: Quartz Commercial |
$540.63
|
| Rate for Payer: Quartz Medicare Advantage |
$79.06
|
| Rate for Payer: The Alliance Commercial |
$300.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.06
|
| Rate for Payer: WEA Trust Commercial |
$521.66
|
| Rate for Payer: WPS Commercial |
$395.30
|
|
|
XR Small Bowel w/ Serial Films
|
Facility
|
OP
|
$985.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
1537319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$942.45 |
| Rate for Payer: Aetna Commercial |
$921.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.98
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$942.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$911.72
|
| Rate for Payer: HFN Commercial |
$942.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$819.52
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$942.45
|
| Rate for Payer: Quartz Beloit One Network |
$501.96
|
| Rate for Payer: Quartz Commercial |
$665.86
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$563.42
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$758.75
|
|
|
XR Small Bowel w/ Serial Films
|
Professional
|
Both
|
$985.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
1537319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$973.18 |
| Rate for Payer: Aetna Commercial |
$973.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.98
|
| Rate for Payer: Aetna Managed Medicare |
$117.60
|
| Rate for Payer: Anthem Medicare Advantage |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$117.60
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$973.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$512.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.60
|
| Rate for Payer: Health EOS Commercial |
$932.20
|
| Rate for Payer: HFN Commercial |
$973.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$445.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$445.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$819.52
|
| Rate for Payer: NAPHCARE Commercial |
$176.40
|
| Rate for Payer: Preferred Network Access Commercial |
$973.18
|
| Rate for Payer: Quartz Beloit One Network |
$450.74
|
| Rate for Payer: Quartz Commercial |
$583.91
|
| Rate for Payer: Quartz Medicare Advantage |
$117.60
|
| Rate for Payer: The Alliance Commercial |
$446.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$563.42
|
| Rate for Payer: WPS Commercial |
$588.02
|
|
|
XR Small Bowel w/ Serial Films
|
Facility
|
IP
|
$985.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
1537319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$501.96 |
| Max. Negotiated Rate |
$942.45 |
| Rate for Payer: Aetna Commercial |
$921.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$542.93
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$942.45
|
| Rate for Payer: Health EOS Commercial |
$911.72
|
| Rate for Payer: HFN Commercial |
$942.45
|
| Rate for Payer: Multiplan Commercial |
$819.52
|
| Rate for Payer: Preferred Network Access Commercial |
$942.45
|
| Rate for Payer: Quartz Beloit One Network |
$501.96
|
| Rate for Payer: Quartz Commercial |
$614.64
|
| Rate for Payer: WEA Trust Commercial |
$563.42
|
| Rate for Payer: WPS Commercial |
$758.75
|
|
|
XR Small Bowel w/ Serial Films
|
Facility
|
IP
|
$912.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
630084
|
| Min. Negotiated Rate |
$464.76 |
| Max. Negotiated Rate |
$872.60 |
| Rate for Payer: Aetna Commercial |
$853.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.69
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$872.60
|
| Rate for Payer: Health EOS Commercial |
$844.15
|
| Rate for Payer: HFN Commercial |
$872.60
|
| Rate for Payer: Multiplan Commercial |
$758.78
|
| Rate for Payer: Preferred Network Access Commercial |
$872.60
|
| Rate for Payer: Quartz Beloit One Network |
$464.76
|
| Rate for Payer: Quartz Commercial |
$569.09
|
| Rate for Payer: WEA Trust Commercial |
$521.66
|
| Rate for Payer: WPS Commercial |
$702.51
|
|
|
XR Small Bowel w/ Serial Films
|
Professional
|
Both
|
$912.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
630084
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$901.06 |
| Rate for Payer: Aetna Commercial |
$901.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.69
|
| Rate for Payer: Aetna Managed Medicare |
$117.60
|
| Rate for Payer: Anthem Medicare Advantage |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$117.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$901.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$474.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.60
|
| Rate for Payer: Health EOS Commercial |
$863.12
|
| Rate for Payer: HFN Commercial |
$901.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$445.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$445.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$117.60
|
| Rate for Payer: Multiplan Commercial |
$758.78
|
| Rate for Payer: NAPHCARE Commercial |
$176.40
|
| Rate for Payer: Preferred Network Access Commercial |
$901.06
|
| Rate for Payer: Quartz Beloit One Network |
$417.33
|
| Rate for Payer: Quartz Commercial |
$540.63
|
| Rate for Payer: Quartz Medicare Advantage |
$117.60
|
| Rate for Payer: The Alliance Commercial |
$446.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$521.66
|
| Rate for Payer: WPS Commercial |
$588.02
|
|
|
XR Small Bowel w/ Serial Films
|
Facility
|
OP
|
$912.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
630084
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$872.60 |
| Rate for Payer: Aetna Commercial |
$853.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.69
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$616.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$474.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$455.27
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$502.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$872.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$530.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$844.15
|
| Rate for Payer: HFN Commercial |
$872.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$758.78
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$872.60
|
| Rate for Payer: Quartz Beloit One Network |
$464.76
|
| Rate for Payer: Quartz Commercial |
$616.51
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$521.66
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$702.51
|
|
|
XR Sniff Test
|
Facility
|
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000 TC
|
| Hospital Charge Code |
5084629
|
|
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 Sniff Test
|
Professional
|
Both
|
$1,060.00
|
|
|
Service Code
|
CPT 76000 TC
|
| Hospital Charge Code |
5084629
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.39 |
| 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 |
$28.39
|
| Rate for Payer: Anthem Medicare Advantage |
$28.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.39
|
| 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 |
$28.39
|
| 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 |
$95.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.39
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$42.59
|
| 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 |
$28.39
|
| Rate for Payer: The Alliance Commercial |
$107.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.39
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$141.96
|
|
|
XR Sniff Test
|
Facility
|
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000 TC
|
| Hospital Charge Code |
5084629
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$113.57 |
| 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 |
$308.67
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$584.27
|
| 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: Dean Health DHI/DHP/ASO |
$616.92
|
| 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 |
$826.80
|
| Rate for Payer: Multiplan Commercial |
$881.92
|
| Rate for Payer: NAPHCARE Commercial |
$661.44
|
| 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 |
$661.44
|
| Rate for Payer: The Alliance Commercial |
$113.57
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$606.32
|
| Rate for Payer: WPS Commercial |
$816.52
|
|
|
XR Spine 1 View Cervical
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629692
|
| Min. Negotiated Rate |
$219.13 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$268.32
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
XR Spine 1 View Cervical
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$163.07
|
| 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 |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.92
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.80
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$349.44
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$378.56
|
| Rate for Payer: Quartz Medicare Advantage |
$349.44
|
| Rate for Payer: The Alliance Commercial |
$62.98
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Spine 1 View Cervical
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$553.28 |
| Rate for Payer: Aetna Commercial |
$553.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$15.75
|
| Rate for Payer: Anthem Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.75
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$553.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.75
|
| Rate for Payer: Health EOS Commercial |
$529.98
|
| Rate for Payer: HFN Commercial |
$553.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$23.62
|
| Rate for Payer: Preferred Network Access Commercial |
$553.28
|
| Rate for Payer: Quartz Beloit One Network |
$256.26
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: Quartz Medicare Advantage |
$15.75
|
| Rate for Payer: The Alliance Commercial |
$59.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$78.73
|
|
|
XR Spine 1 View Cervical
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.38 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$349.44
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
