|
XR Biliary Drainage Percutaneous
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
2587211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$3,983.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,876.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.48
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,071.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Health EOS Commercial |
$3,939.14
|
| Rate for Payer: HFN Commercial |
$4,071.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.74
|
| Rate for Payer: Quartz Commercial |
$2,876.90
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
2448800
|
| Min. Negotiated Rate |
$1,191.68 |
| Max. Negotiated Rate |
$17,024.00 |
| Rate for Payer: Aetna Commercial |
$3,830.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,660.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,191.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,766.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,042.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,255.68
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$3,915.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,381.66
|
| Rate for Payer: Health EOS Commercial |
$3,787.84
|
| Rate for Payer: HFN Commercial |
$3,915.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,192.00
|
| Rate for Payer: Multiplan Commercial |
$3,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,553.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,915.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,085.44
|
| Rate for Payer: Quartz Commercial |
$2,766.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,553.60
|
| Rate for Payer: The Alliance Commercial |
$17,024.00
|
| Rate for Payer: WEA Trust Commercial |
$2,340.80
|
| Rate for Payer: WPS Commercial |
$3,152.42
|
|
|
XR Biliary Drainage Percutaneous
|
Professional
|
Both
|
$4,426.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
2587211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.83 |
| Max. Negotiated Rate |
$4,204.70 |
| Rate for Payer: Aetna Commercial |
$4,204.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,204.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$312.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,655.60
|
| Rate for Payer: Health EOS Commercial |
$4,027.66
|
| Rate for Payer: HFN Commercial |
$4,204.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$321.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$321.83
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,204.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,947.44
|
| Rate for Payer: Quartz Commercial |
$2,522.82
|
| Rate for Payer: The Alliance Commercial |
$2,213.00
|
| Rate for Payer: United Healthcare Medicaid |
$312.83
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
IP
|
$4,426.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
2587211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,168.74 |
| Max. Negotiated Rate |
$4,071.92 |
| Rate for Payer: Aetna Commercial |
$3,983.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.78
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,071.92
|
| Rate for Payer: Health EOS Commercial |
$3,939.14
|
| Rate for Payer: HFN Commercial |
$4,071.92
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.74
|
| Rate for Payer: Quartz Commercial |
$2,655.60
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
IP
|
$4,256.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
2448800
|
| Min. Negotiated Rate |
$2,085.44 |
| Max. Negotiated Rate |
$3,915.52 |
| Rate for Payer: Aetna Commercial |
$3,830.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,660.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,255.68
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$3,915.52
|
| Rate for Payer: Health EOS Commercial |
$3,787.84
|
| Rate for Payer: HFN Commercial |
$3,915.52
|
| Rate for Payer: Multiplan Commercial |
$3,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,553.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,915.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,085.44
|
| Rate for Payer: Quartz Commercial |
$2,553.60
|
| Rate for Payer: WEA Trust Commercial |
$2,340.80
|
| Rate for Payer: WPS Commercial |
$3,152.42
|
|
|
XR Biliary Drainage Percutaneous
|
Professional
|
Both
|
$4,256.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
2448800
|
| Min. Negotiated Rate |
$1,872.64 |
| Max. Negotiated Rate |
$4,043.20 |
| Rate for Payer: Aetna Commercial |
$4,043.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,660.16
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,043.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,128.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,553.60
|
| Rate for Payer: Health EOS Commercial |
$3,872.96
|
| Rate for Payer: HFN Commercial |
$4,043.20
|
| Rate for Payer: Multiplan Commercial |
$3,404.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,043.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,872.64
|
| Rate for Payer: Quartz Commercial |
$2,425.92
|
| Rate for Payer: The Alliance Commercial |
$2,128.00
|
| Rate for Payer: WEA Trust Commercial |
$2,340.80
|
| Rate for Payer: WPS Commercial |
$3,152.42
|
|
|
XR Biliary Drain Transhep Perc in + out
|
Professional
|
Both
|
$4,580.00
|
|
|
Service Code
|
CPT 75982
|
| Hospital Charge Code |
2448803
|
| Min. Negotiated Rate |
$2,015.20 |
| Max. Negotiated Rate |
$4,351.00 |
| Rate for Payer: Aetna Commercial |
$4,351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,938.80
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$4,351.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,748.00
|
| Rate for Payer: Health EOS Commercial |
$4,167.80
|
| Rate for Payer: HFN Commercial |
$4,351.00
|
| Rate for Payer: Multiplan Commercial |
$3,664.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,351.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,015.20
|
| Rate for Payer: Quartz Commercial |
$2,610.60
|
| Rate for Payer: The Alliance Commercial |
$2,290.00
|
| Rate for Payer: WEA Trust Commercial |
$2,519.00
|
| Rate for Payer: WPS Commercial |
$3,392.41
|
|
|
XR Biliary Drain Transhep Perc in + out
|
Facility
|
IP
|
$4,580.00
|
|
|
Service Code
|
CPT 75982
|
| Hospital Charge Code |
2448803
|
| Min. Negotiated Rate |
$2,244.20 |
| Max. Negotiated Rate |
$4,213.60 |
| Rate for Payer: Aetna Commercial |
$4,122.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,938.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,427.40
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$4,213.60
|
| Rate for Payer: Health EOS Commercial |
$4,076.20
|
| Rate for Payer: HFN Commercial |
$4,213.60
|
| Rate for Payer: Multiplan Commercial |
$3,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,213.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,244.20
|
| Rate for Payer: Quartz Commercial |
$2,748.00
|
| Rate for Payer: WEA Trust Commercial |
$2,519.00
|
| Rate for Payer: WPS Commercial |
$3,392.41
|
|
|
XR Biliary Drain Transhep Perc in + out
|
Facility
|
OP
|
$4,580.00
|
|
|
Service Code
|
CPT 75982
|
| Hospital Charge Code |
2448803
|
| Min. Negotiated Rate |
$1,282.40 |
| Max. Negotiated Rate |
$18,320.00 |
| Rate for Payer: Aetna Commercial |
$4,122.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,938.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,282.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,977.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,290.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,198.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,427.40
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$4,213.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,562.97
|
| Rate for Payer: Health EOS Commercial |
$4,076.20
|
| Rate for Payer: HFN Commercial |
$4,213.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,435.00
|
| Rate for Payer: Multiplan Commercial |
$3,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,748.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,213.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,244.20
|
| Rate for Payer: Quartz Commercial |
$2,977.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,748.00
|
| Rate for Payer: The Alliance Commercial |
$18,320.00
|
| Rate for Payer: WEA Trust Commercial |
$2,519.00
|
| Rate for Payer: WPS Commercial |
$3,392.41
|
|
|
XR Biliary Drain Transhep Perc w/ Cont
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
3072724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$17,704.00 |
| Rate for Payer: Aetna Commercial |
$3,983.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,876.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.78
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,071.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.79
|
| Rate for Payer: Health EOS Commercial |
$3,939.14
|
| Rate for Payer: HFN Commercial |
$4,071.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,319.50
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.74
|
| Rate for Payer: Quartz Commercial |
$2,876.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.60
|
| Rate for Payer: The Alliance Commercial |
$17,704.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
XR Biliary Drain Transhep Perc w/ Cont
|
Professional
|
Both
|
$4,426.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
3072724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,947.44 |
| Max. Negotiated Rate |
$4,204.70 |
| Rate for Payer: Aetna Commercial |
$4,204.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,204.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,213.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,655.60
|
| Rate for Payer: Health EOS Commercial |
$4,027.66
|
| Rate for Payer: HFN Commercial |
$4,204.70
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,204.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,947.44
|
| Rate for Payer: Quartz Commercial |
$2,522.82
|
| Rate for Payer: The Alliance Commercial |
$2,213.00
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
XR Biliary Drain Transhep Perc w/ Cont
|
Facility
|
IP
|
$4,426.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
3072724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,168.74 |
| Max. Negotiated Rate |
$4,071.92 |
| Rate for Payer: Aetna Commercial |
$3,983.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.78
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,071.92
|
| Rate for Payer: Health EOS Commercial |
$3,939.14
|
| Rate for Payer: HFN Commercial |
$4,071.92
|
| Rate for Payer: Multiplan Commercial |
$3,540.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,071.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.74
|
| Rate for Payer: Quartz Commercial |
$2,655.60
|
| Rate for Payer: WEA Trust Commercial |
$2,434.30
|
| Rate for Payer: WPS Commercial |
$3,278.34
|
|
|
XR Biliary Duct Calculus Removal
|
Professional
|
Both
|
$2,578.00
|
|
|
Service Code
|
CPT 74327
|
| Hospital Charge Code |
627616
|
| Min. Negotiated Rate |
$1,134.32 |
| Max. Negotiated Rate |
$2,449.10 |
| Rate for Payer: Aetna Commercial |
$2,449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,449.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,289.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,546.80
|
| Rate for Payer: Health EOS Commercial |
$2,345.98
|
| Rate for Payer: HFN Commercial |
$2,449.10
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,449.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,134.32
|
| Rate for Payer: Quartz Commercial |
$1,469.46
|
| Rate for Payer: The Alliance Commercial |
$1,289.00
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
XR Biliary Duct Calculus Removal
|
Facility
|
IP
|
$2,578.00
|
|
|
Service Code
|
CPT 74327
|
| Hospital Charge Code |
627616
|
| Min. Negotiated Rate |
$1,263.22 |
| Max. Negotiated Rate |
$2,371.76 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,546.80
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
XR Biliary Duct Calculus Removal
|
Facility
|
OP
|
$2,578.00
|
|
|
Service Code
|
CPT 74327
|
| Hospital Charge Code |
627616
|
| Min. Negotiated Rate |
$721.84 |
| Max. Negotiated Rate |
$10,312.00 |
| Rate for Payer: Aetna Commercial |
$2,320.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,217.08
|
| Rate for Payer: Aetna Managed Medicare |
$721.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,675.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,289.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,237.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,366.34
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,371.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,442.65
|
| Rate for Payer: Health EOS Commercial |
$2,294.42
|
| Rate for Payer: HFN Commercial |
$2,371.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,933.50
|
| Rate for Payer: Multiplan Commercial |
$2,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,546.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,371.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,263.22
|
| Rate for Payer: Quartz Commercial |
$1,675.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,546.80
|
| Rate for Payer: The Alliance Commercial |
$10,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,417.90
|
| Rate for Payer: WPS Commercial |
$1,909.52
|
|
|
XR Bone Age Studies
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$417.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$308.16
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$590.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$359.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$571.38
|
| Rate for Payer: HFN Commercial |
$590.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$590.64
|
| Rate for Payer: Quartz Beloit One Network |
$314.58
|
| Rate for Payer: Quartz Commercial |
$417.30
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$475.53
|
|
|
XR Bone Age Studies
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$314.58 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.26
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$590.64
|
| Rate for Payer: Health EOS Commercial |
$571.38
|
| Rate for Payer: HFN Commercial |
$590.64
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: NAPHCARE Commercial |
$385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$590.64
|
| Rate for Payer: Quartz Beloit One Network |
$314.58
|
| Rate for Payer: Quartz Commercial |
$385.20
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: WPS Commercial |
$475.53
|
|
|
XR Bone Age Studies
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$87.93 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Aetna Commercial |
$609.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$609.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$385.20
|
| Rate for Payer: Health EOS Commercial |
$584.22
|
| Rate for Payer: HFN Commercial |
$609.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.93
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: Preferred Network Access Commercial |
$609.90
|
| Rate for Payer: Quartz Beloit One Network |
$282.48
|
| Rate for Payer: Quartz Commercial |
$365.94
|
| Rate for Payer: The Alliance Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: WPS Commercial |
$475.53
|
|
|
XR Bone Age Studies
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$638.48 |
| Rate for Payer: Aetna Commercial |
$624.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.84
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$638.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$617.66
|
| Rate for Payer: HFN Commercial |
$638.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$638.48
|
| Rate for Payer: Quartz Beloit One Network |
$340.06
|
| Rate for Payer: Quartz Commercial |
$451.10
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$381.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$514.05
|
|
|
XR Bone Age Studies
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Aetna Commercial |
$659.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.84
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$659.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$347.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.40
|
| Rate for Payer: Health EOS Commercial |
$631.54
|
| Rate for Payer: HFN Commercial |
$659.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.06
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: Preferred Network Access Commercial |
$659.30
|
| Rate for Payer: Quartz Beloit One Network |
$305.36
|
| Rate for Payer: Quartz Commercial |
$395.58
|
| Rate for Payer: The Alliance Commercial |
$347.00
|
| Rate for Payer: WEA Trust Commercial |
$381.70
|
| Rate for Payer: WPS Commercial |
$514.05
|
|
|
XR Bone Age Studies
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$340.06 |
| Max. Negotiated Rate |
$638.48 |
| Rate for Payer: Aetna Commercial |
$624.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.82
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$638.48
|
| Rate for Payer: Health EOS Commercial |
$617.66
|
| Rate for Payer: HFN Commercial |
$638.48
|
| Rate for Payer: Multiplan Commercial |
$555.20
|
| Rate for Payer: NAPHCARE Commercial |
$416.40
|
| Rate for Payer: Preferred Network Access Commercial |
$638.48
|
| Rate for Payer: Quartz Beloit One Network |
$340.06
|
| Rate for Payer: Quartz Commercial |
$416.40
|
| Rate for Payer: WEA Trust Commercial |
$381.70
|
| Rate for Payer: WPS Commercial |
$514.05
|
|
|
XR Bone Length Adult
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$503.24 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$355.55
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
XR Bone Length Adult
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$268.03 |
| Max. Negotiated Rate |
$503.24 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$328.20
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$328.20
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
XR Bone Length Adult
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.14 |
| Max. Negotiated Rate |
$519.65 |
| Rate for Payer: Aetna Commercial |
$519.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$519.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.20
|
| Rate for Payer: Health EOS Commercial |
$497.77
|
| Rate for Payer: HFN Commercial |
$519.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$107.14
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$519.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.68
|
| Rate for Payer: Quartz Commercial |
$311.79
|
| Rate for Payer: The Alliance Commercial |
$273.50
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
XR Bone Length Child
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$268.03 |
| Max. Negotiated Rate |
$503.24 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$328.20
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$328.20
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
