|
XR Bone Length Child
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
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 Child
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
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 Studies Scanograms
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
627646
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.24
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| 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 |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| 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 |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$349.70
|
| 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 |
$295.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
XR Bone Length Studies Scanograms
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
627646
|
| Min. Negotiated Rate |
$152.64 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$511.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$322.80
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| Rate for Payer: HFN Commercial |
$511.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$152.64
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: Preferred Network Access Commercial |
$511.10
|
| Rate for Payer: Quartz Beloit One Network |
$236.72
|
| Rate for Payer: Quartz Commercial |
$306.66
|
| Rate for Payer: The Alliance Commercial |
$269.00
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
XR Bone Length Studies Scanograms
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
1536893
|
|
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 Studies Scanograms
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
1536893
|
|
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 Studies Scanograms
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
627646
|
| Min. Negotiated Rate |
$263.62 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$322.80
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$322.80
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
XR Bone Length Studies Scanograms
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
1536893
|
|
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 Survey Complete (Mets)
|
Facility
|
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 77075 TC
|
| Hospital Charge Code |
1536895
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| 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 |
$815.67
|
| 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 |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| 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 |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$1,000.35
|
| 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 |
$846.45
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
XR Bone Survey Complete (Mets)
|
Professional
|
Both
|
$1,539.00
|
|
|
Service Code
|
CPT 77075 TC
|
| Hospital Charge Code |
1536895
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$242.86 |
| Max. Negotiated Rate |
$1,462.05 |
| Rate for Payer: Aetna Commercial |
$1,462.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,462.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$769.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$923.40
|
| Rate for Payer: Health EOS Commercial |
$1,400.49
|
| Rate for Payer: HFN Commercial |
$1,462.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$242.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.86
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,462.05
|
| Rate for Payer: Quartz Beloit One Network |
$677.16
|
| Rate for Payer: Quartz Commercial |
$877.23
|
| Rate for Payer: The Alliance Commercial |
$769.50
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
XR Bone Survey Complete (Mets)
|
Facility
|
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 77075 TC
|
| Hospital Charge Code |
1536895
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$754.11 |
| Max. Negotiated Rate |
$1,415.88 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,415.88
|
| Rate for Payer: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Multiplan Commercial |
$1,231.20
|
| Rate for Payer: NAPHCARE Commercial |
$923.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.88
|
| Rate for Payer: Quartz Beloit One Network |
$754.11
|
| Rate for Payer: Quartz Commercial |
$923.40
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$1,139.94
|
|
|
XR Bone Survey Complete (Mets)
|
Facility
|
OP
|
$1,426.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
627658
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,311.92 |
| Rate for Payer: Aetna Commercial |
$1,283.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,226.36
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$926.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$713.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$684.48
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.78
|
| 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 |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,311.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$797.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,269.14
|
| Rate for Payer: HFN Commercial |
$1,311.92
|
| 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 |
$1,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.92
|
| Rate for Payer: Quartz Beloit One Network |
$698.74
|
| Rate for Payer: Quartz Commercial |
$926.90
|
| 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 |
$784.30
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,056.24
|
|
|
XR Bone Survey Complete (Mets)
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
627658
|
| Min. Negotiated Rate |
$335.28 |
| Max. Negotiated Rate |
$1,354.70 |
| Rate for Payer: Aetna Commercial |
$1,354.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,226.36
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,354.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$713.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$855.60
|
| Rate for Payer: Health EOS Commercial |
$1,297.66
|
| Rate for Payer: HFN Commercial |
$1,354.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$335.28
|
| Rate for Payer: Multiplan Commercial |
$1,140.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.70
|
| Rate for Payer: Quartz Beloit One Network |
$627.44
|
| Rate for Payer: Quartz Commercial |
$812.82
|
| Rate for Payer: The Alliance Commercial |
$713.00
|
| Rate for Payer: WEA Trust Commercial |
$784.30
|
| Rate for Payer: WPS Commercial |
$1,056.24
|
|
|
XR Bone Survey Complete (Mets)
|
Facility
|
IP
|
$1,426.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
627658
|
| Min. Negotiated Rate |
$698.74 |
| Max. Negotiated Rate |
$1,311.92 |
| Rate for Payer: Aetna Commercial |
$1,283.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,226.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.78
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,311.92
|
| Rate for Payer: Health EOS Commercial |
$1,269.14
|
| Rate for Payer: HFN Commercial |
$1,311.92
|
| Rate for Payer: Multiplan Commercial |
$1,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$855.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.92
|
| Rate for Payer: Quartz Beloit One Network |
$698.74
|
| Rate for Payer: Quartz Commercial |
$855.60
|
| Rate for Payer: WEA Trust Commercial |
$784.30
|
| Rate for Payer: WPS Commercial |
$1,056.24
|
|
|
XR Bone Survey Infant
|
Facility
|
IP
|
$669.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
627660
|
| Min. Negotiated Rate |
$327.81 |
| Max. Negotiated Rate |
$615.48 |
| Rate for Payer: Aetna Commercial |
$602.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.57
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$615.48
|
| Rate for Payer: Health EOS Commercial |
$595.41
|
| Rate for Payer: HFN Commercial |
$615.48
|
| Rate for Payer: Multiplan Commercial |
$535.20
|
| Rate for Payer: NAPHCARE Commercial |
$401.40
|
| Rate for Payer: Preferred Network Access Commercial |
$615.48
|
| Rate for Payer: Quartz Beloit One Network |
$327.81
|
| Rate for Payer: Quartz Commercial |
$401.40
|
| Rate for Payer: WEA Trust Commercial |
$367.95
|
| Rate for Payer: WPS Commercial |
$495.53
|
|
|
XR Bone Survey Infant
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 77076 TC
|
| Hospital Charge Code |
1536897
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$341.04 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$626.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.88
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$640.32
|
| Rate for Payer: Health EOS Commercial |
$619.44
|
| Rate for Payer: HFN Commercial |
$640.32
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: NAPHCARE Commercial |
$417.60
|
| Rate for Payer: Preferred Network Access Commercial |
$640.32
|
| Rate for Payer: Quartz Beloit One Network |
$341.04
|
| Rate for Payer: Quartz Commercial |
$417.60
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
XR Bone Survey Infant
|
Facility
|
OP
|
$669.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
627660
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$615.48 |
| Rate for Payer: Aetna Commercial |
$602.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.34
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$434.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$334.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$321.12
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.57
|
| 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 |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$615.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$374.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$595.41
|
| Rate for Payer: HFN Commercial |
$615.48
|
| 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 |
$535.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$615.48
|
| Rate for Payer: Quartz Beloit One Network |
$327.81
|
| Rate for Payer: Quartz Commercial |
$434.85
|
| 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 |
$367.95
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$495.53
|
|
|
XR Bone Survey Infant
|
Professional
|
Both
|
$669.00
|
|
|
Service Code
|
CPT 77076
|
| Hospital Charge Code |
627660
|
| Min. Negotiated Rate |
$294.36 |
| Max. Negotiated Rate |
$635.55 |
| Rate for Payer: Aetna Commercial |
$635.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.34
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cash Price |
$200.70
|
| Rate for Payer: Cigna Commercial |
$635.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$334.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$401.40
|
| Rate for Payer: Health EOS Commercial |
$608.79
|
| Rate for Payer: HFN Commercial |
$635.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$361.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$361.86
|
| Rate for Payer: Multiplan Commercial |
$535.20
|
| Rate for Payer: Preferred Network Access Commercial |
$635.55
|
| Rate for Payer: Quartz Beloit One Network |
$294.36
|
| Rate for Payer: Quartz Commercial |
$381.33
|
| Rate for Payer: The Alliance Commercial |
$334.50
|
| Rate for Payer: WEA Trust Commercial |
$367.95
|
| Rate for Payer: WPS Commercial |
$495.53
|
|
|
XR Bone Survey Infant
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 77076 TC
|
| Hospital Charge Code |
1536897
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$245.16 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna Commercial |
$661.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$661.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$348.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$417.60
|
| Rate for Payer: Health EOS Commercial |
$633.36
|
| Rate for Payer: HFN Commercial |
$661.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$245.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$245.16
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: Preferred Network Access Commercial |
$661.20
|
| Rate for Payer: Quartz Beloit One Network |
$306.24
|
| Rate for Payer: Quartz Commercial |
$396.72
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
XR Bone Survey Infant
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 77076 TC
|
| Hospital Charge Code |
1536897
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$626.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| 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 |
$368.88
|
| 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 |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$640.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$619.44
|
| Rate for Payer: HFN Commercial |
$640.32
|
| 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 |
$556.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$640.32
|
| Rate for Payer: Quartz Beloit One Network |
$341.04
|
| Rate for Payer: Quartz Commercial |
$452.40
|
| 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 |
$382.80
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
XR Bone Survey Limited (Mets)
|
Facility
|
OP
|
$1,070.00
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
627662
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$984.40 |
| Rate for Payer: Aetna Commercial |
$963.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.20
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$695.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$535.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$513.60
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$567.10
|
| 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 |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$984.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$598.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$952.30
|
| Rate for Payer: HFN Commercial |
$984.40
|
| 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 |
$856.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$984.40
|
| Rate for Payer: Quartz Beloit One Network |
$524.30
|
| Rate for Payer: Quartz Commercial |
$695.50
|
| 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 |
$588.50
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
|
XR Bone Survey Limited (Mets)
|
Facility
|
OP
|
$1,155.00
|
|
|
Service Code
|
CPT 77074 TC
|
| Hospital Charge Code |
1536899
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,062.60 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$993.30
|
| 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 |
$612.15
|
| 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 |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$1,062.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$646.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,027.95
|
| Rate for Payer: HFN Commercial |
$1,062.60
|
| 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 |
$924.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,062.60
|
| Rate for Payer: Quartz Beloit One Network |
$565.95
|
| Rate for Payer: Quartz Commercial |
$750.75
|
| 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 |
$635.25
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$855.51
|
|
|
XR Bone Survey Limited (Mets)
|
Facility
|
IP
|
$1,155.00
|
|
|
Service Code
|
CPT 77074 TC
|
| Hospital Charge Code |
1536899
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$565.95 |
| Max. Negotiated Rate |
$1,062.60 |
| Rate for Payer: Aetna Commercial |
$1,039.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$993.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$612.15
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$1,062.60
|
| Rate for Payer: Health EOS Commercial |
$1,027.95
|
| Rate for Payer: HFN Commercial |
$1,062.60
|
| Rate for Payer: Multiplan Commercial |
$924.00
|
| Rate for Payer: NAPHCARE Commercial |
$693.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,062.60
|
| Rate for Payer: Quartz Beloit One Network |
$565.95
|
| Rate for Payer: Quartz Commercial |
$693.00
|
| Rate for Payer: WEA Trust Commercial |
$635.25
|
| Rate for Payer: WPS Commercial |
$855.51
|
|
|
XR Bone Survey Limited (Mets)
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
CPT 77074
|
| Hospital Charge Code |
627662
|
| Min. Negotiated Rate |
$221.23 |
| Max. Negotiated Rate |
$1,016.50 |
| Rate for Payer: Aetna Commercial |
$1,016.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.20
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,016.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$535.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.00
|
| Rate for Payer: Health EOS Commercial |
$973.70
|
| Rate for Payer: HFN Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$221.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$221.23
|
| Rate for Payer: Multiplan Commercial |
$856.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.50
|
| Rate for Payer: Quartz Beloit One Network |
$470.80
|
| Rate for Payer: Quartz Commercial |
$609.90
|
| Rate for Payer: The Alliance Commercial |
$535.00
|
| Rate for Payer: WEA Trust Commercial |
$588.50
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
|
XR Bone Survey Limited (Mets)
|
Professional
|
Both
|
$1,155.00
|
|
|
Service Code
|
CPT 77074 TC
|
| Hospital Charge Code |
1536899
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.73 |
| Max. Negotiated Rate |
$1,097.25 |
| Rate for Payer: Aetna Commercial |
$1,097.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$993.30
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cash Price |
$346.50
|
| Rate for Payer: Cigna Commercial |
$1,097.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$577.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$693.00
|
| Rate for Payer: Health EOS Commercial |
$1,051.05
|
| Rate for Payer: HFN Commercial |
$1,097.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.73
|
| Rate for Payer: Multiplan Commercial |
$924.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,097.25
|
| Rate for Payer: Quartz Beloit One Network |
$508.20
|
| Rate for Payer: Quartz Commercial |
$658.35
|
| Rate for Payer: The Alliance Commercial |
$577.50
|
| Rate for Payer: WEA Trust Commercial |
$635.25
|
| Rate for Payer: WPS Commercial |
$855.51
|
|
