|
X-RAY Hip 2 Views 7350226
|
Professional
|
$67.00
|
|
|
Service Code
|
CPT 73502 26
|
| Hospital Charge Code |
4605767
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$10.46
|
| Rate for Payer: Anthem Medicare Advantage |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.46
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.46
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.46
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: Quartz Medicare Advantage |
$10.46
|
| Rate for Payer: The Alliance Commercial |
$39.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.46
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$52.30
|
|
|
X-RAY Hips-AP Pelvis & 2V Hips 73521
|
Professional
|
$88.00
|
|
|
Service Code
|
CPT 73521
|
| Hospital Charge Code |
4605769
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$199.30 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$39.86
|
| Rate for Payer: Anthem Medicare Advantage |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.86
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.86
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$139.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.86
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: Quartz Medicare Advantage |
$39.86
|
| Rate for Payer: The Alliance Commercial |
$151.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.86
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$199.30
|
|
|
X-RAY Hips-AP Pelvis & 2V Hips 7352126
|
Professional
|
$88.00
|
|
|
Service Code
|
CPT 73521 26
|
| Hospital Charge Code |
4605770
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$10.46
|
| Rate for Payer: Anthem Medicare Advantage |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.46
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.46
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.46
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: Quartz Medicare Advantage |
$10.46
|
| Rate for Payer: The Alliance Commercial |
$39.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.46
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$52.30
|
|
|
X-RAY Hip Unilateral 1 View 73501
|
Professional
|
$79.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
4605763
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$158.70 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Medicare Advantage |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.74
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.74
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.74
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: Quartz Medicare Advantage |
$31.74
|
| Rate for Payer: The Alliance Commercial |
$120.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.74
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$158.70
|
|
|
X-RAY Hip Unilateral 1 View 7350126
|
Professional
|
$79.00
|
|
|
Service Code
|
CPT 73501 26
|
| Hospital Charge Code |
4605764
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.78
|
| Rate for Payer: Anthem Medicare Advantage |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.78
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.78
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.78
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: Quartz Medicare Advantage |
$8.78
|
| Rate for Payer: The Alliance Commercial |
$33.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.78
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$43.90
|
|
|
X-RAY Humerus Min 2 Views 73060
|
Professional
|
$86.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
3209590
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.07 |
| Max. Negotiated Rate |
$155.35 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$31.07
|
| Rate for Payer: Anthem Medicare Advantage |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.07
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.07
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.07
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: Quartz Medicare Advantage |
$31.07
|
| Rate for Payer: The Alliance Commercial |
$118.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.07
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$155.35
|
|
|
X-RAY Humerus Min 2 Views 7306026
|
Professional
|
$97.00
|
|
|
Service Code
|
CPT 73060 26
|
| Hospital Charge Code |
3209595
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$29.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$38.90
|
|
|
X-RAY Knee, 2 Views 73560
|
Professional
|
$63.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
3236181
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$59.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$33.00
|
| Rate for Payer: Anthem Medicare Advantage |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.00
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$59.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.00
|
| Rate for Payer: Health EOS Commercial |
$57.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$59.85
|
| Rate for Payer: Quartz Beloit One Network |
$27.72
|
| Rate for Payer: Quartz Commercial |
$35.91
|
| Rate for Payer: Quartz Medicare Advantage |
$33.00
|
| Rate for Payer: The Alliance Commercial |
$125.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$165.00
|
|
|
X-RAY Knee, 2 Views 7356026
|
Professional
|
$102.00
|
|
|
Service Code
|
CPT 73560 26
|
| Hospital Charge Code |
3236182
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$29.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$38.90
|
|
|
X-RAY Knee 4 or More 73564
|
Professional
|
$111.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
3236192
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.01 |
| Max. Negotiated Rate |
$225.05 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$45.01
|
| Rate for Payer: Anthem Medicare Advantage |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.01
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$105.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.01
|
| Rate for Payer: Health EOS Commercial |
$101.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.01
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$105.45
|
| Rate for Payer: Quartz Beloit One Network |
$48.84
|
| Rate for Payer: Quartz Commercial |
$63.27
|
| Rate for Payer: Quartz Medicare Advantage |
$45.01
|
| Rate for Payer: The Alliance Commercial |
$171.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.01
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$225.05
|
|
|
X-RAY Knee 4 or More 7356426
|
Professional
|
$148.00
|
|
|
Service Code
|
CPT 73564 26
|
| Hospital Charge Code |
3236193
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna Commercial |
$140.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$10.78
|
| Rate for Payer: Anthem Medicare Advantage |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.78
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$140.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.78
|
| Rate for Payer: Health EOS Commercial |
$134.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.78
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$140.60
|
| Rate for Payer: Quartz Beloit One Network |
$65.12
|
| Rate for Payer: Quartz Commercial |
$84.36
|
| Rate for Payer: Quartz Medicare Advantage |
$10.78
|
| Rate for Payer: The Alliance Commercial |
$40.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.78
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$53.90
|
|
|
X-RAY Knees Standing 73565
|
Professional
|
$35.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
3209604
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$192.35 |
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Aetna Managed Medicare |
$38.47
|
| Rate for Payer: Anthem Medicare Advantage |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.47
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.47
|
| Rate for Payer: Health EOS Commercial |
$31.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.47
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Preferred Network Access Commercial |
$33.25
|
| Rate for Payer: Quartz Beloit One Network |
$15.40
|
| Rate for Payer: Quartz Commercial |
$19.95
|
| Rate for Payer: Quartz Medicare Advantage |
$38.47
|
| Rate for Payer: The Alliance Commercial |
$146.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.47
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$192.35
|
|
|
X-RAY Knees Standing 7356526
|
Professional
|
$61.00
|
|
|
Service Code
|
CPT 73565 26
|
| Hospital Charge Code |
3209609
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna Commercial |
$57.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$8.10
|
| Rate for Payer: Anthem Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.10
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$57.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.10
|
| Rate for Payer: Health EOS Commercial |
$55.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.95
|
| Rate for Payer: Quartz Beloit One Network |
$26.84
|
| Rate for Payer: Quartz Commercial |
$34.77
|
| Rate for Payer: Quartz Medicare Advantage |
$8.10
|
| Rate for Payer: The Alliance Commercial |
$30.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.10
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$40.50
|
|
|
X-RAY Lumbar 2-3 Views 7210026
|
Professional
|
$118.00
|
|
|
Service Code
|
CPT 72100 26
|
| Hospital Charge Code |
3236237
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.46 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$10.46
|
| Rate for Payer: Anthem Medicare Advantage |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.46
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.46
|
| Rate for Payer: Health EOS Commercial |
$107.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.46
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Preferred Network Access Commercial |
$112.10
|
| Rate for Payer: Quartz Beloit One Network |
$51.92
|
| Rate for Payer: Quartz Commercial |
$67.26
|
| Rate for Payer: Quartz Medicare Advantage |
$10.46
|
| Rate for Payer: The Alliance Commercial |
$39.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.46
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$52.30
|
|
|
X-RAY Lumbar 4 Views 72110
|
Professional
|
$108.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
3236247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.52 |
| Max. Negotiated Rate |
$247.95 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.88
|
| Rate for Payer: Aetna Managed Medicare |
$49.59
|
| Rate for Payer: Anthem Medicare Advantage |
$49.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.59
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$102.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.59
|
| Rate for Payer: Health EOS Commercial |
$98.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.59
|
| Rate for Payer: Multiplan Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$102.60
|
| Rate for Payer: Quartz Beloit One Network |
$47.52
|
| Rate for Payer: Quartz Commercial |
$61.56
|
| Rate for Payer: Quartz Medicare Advantage |
$49.59
|
| Rate for Payer: The Alliance Commercial |
$188.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.59
|
| Rate for Payer: WEA Trust Commercial |
$59.40
|
| Rate for Payer: WPS Commercial |
$247.95
|
|
|
X-RAY Lumbar 4 Views 7211026
|
Professional
|
$112.00
|
|
|
Service Code
|
CPT 72110 26
|
| Hospital Charge Code |
3236248
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.14 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Quartz Beloit One Network |
$49.28
|
| Rate for Payer: Aetna Commercial |
$106.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Aetna Managed Medicare |
$12.14
|
| Rate for Payer: Anthem Medicare Advantage |
$12.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.14
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$106.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.14
|
| Rate for Payer: Health EOS Commercial |
$101.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.14
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.40
|
| Rate for Payer: Quartz Commercial |
$63.84
|
| Rate for Payer: Quartz Medicare Advantage |
$12.14
|
| Rate for Payer: The Alliance Commercial |
$46.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.14
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$60.70
|
|
|
X-Ray of Scapula 7301026
|
Professional
|
$110.00
|
|
|
Service Code
|
CPT 73010 26
|
| Hospital Charge Code |
3453522
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.44
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.44
|
| Rate for Payer: Health EOS Commercial |
$100.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Preferred Network Access Commercial |
$104.50
|
| Rate for Payer: Quartz Beloit One Network |
$48.40
|
| Rate for Payer: Quartz Commercial |
$62.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8.44
|
| Rate for Payer: The Alliance Commercial |
$32.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$42.20
|
|
|
X-RAY of Tib/Fib 73590
|
Professional
|
$69.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
3238224
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$152.10 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Aetna Managed Medicare |
$30.42
|
| Rate for Payer: Anthem Medicare Advantage |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.42
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$65.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.42
|
| Rate for Payer: Health EOS Commercial |
$62.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.42
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$65.55
|
| Rate for Payer: Quartz Beloit One Network |
$30.36
|
| Rate for Payer: Quartz Commercial |
$39.33
|
| Rate for Payer: Quartz Medicare Advantage |
$30.42
|
| Rate for Payer: The Alliance Commercial |
$115.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.42
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$152.10
|
|
|
X-RAY of Tib/Fib 7359026
|
Professional
|
$100.00
|
|
|
Service Code
|
CPT 73590 26
|
| Hospital Charge Code |
3238225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.46 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Aetna Managed Medicare |
$7.46
|
| Rate for Payer: Anthem Medicare Advantage |
$7.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.46
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.46
|
| Rate for Payer: Health EOS Commercial |
$91.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.46
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Preferred Network Access Commercial |
$95.00
|
| Rate for Payer: Quartz Beloit One Network |
$44.00
|
| Rate for Payer: Quartz Commercial |
$57.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7.46
|
| Rate for Payer: The Alliance Commercial |
$28.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.46
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$37.30
|
|
|
X-RAY of Wrist 2 Views 73100
|
Professional
|
$50.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
3238246
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.00 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna Commercial |
$47.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Managed Medicare |
$32.68
|
| Rate for Payer: Anthem Medicare Advantage |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.68
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.68
|
| Rate for Payer: Health EOS Commercial |
$45.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.68
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.50
|
| Rate for Payer: Quartz Beloit One Network |
$22.00
|
| Rate for Payer: Quartz Commercial |
$28.50
|
| Rate for Payer: Quartz Medicare Advantage |
$32.68
|
| Rate for Payer: The Alliance Commercial |
$124.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.68
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$163.40
|
|
|
X-RAY of Wrist 2 Views 7310026
|
Professional
|
$104.00
|
|
|
Service Code
|
CPT 73100 26
|
| Hospital Charge Code |
3238247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$29.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$38.90
|
|
|
X-RAY Pelvis 1 or 2 Views 72170
|
Professional
|
$83.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
3209615
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.90 |
| Max. Negotiated Rate |
$134.50 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$26.90
|
| Rate for Payer: Anthem Medicare Advantage |
$26.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.90
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.90
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: Quartz Medicare Advantage |
$26.90
|
| Rate for Payer: The Alliance Commercial |
$102.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.90
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$134.50
|
|
|
X-RAY Pelvis 1 or 2 Views 7217026
|
Professional
|
$162.00
|
|
|
Service Code
|
CPT 72170 26
|
| Hospital Charge Code |
3209620
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.12 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$8.12
|
| Rate for Payer: Anthem Medicare Advantage |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.12
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$153.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.12
|
| Rate for Payer: Health EOS Commercial |
$147.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.12
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.90
|
| Rate for Payer: Quartz Beloit One Network |
$71.28
|
| Rate for Payer: Quartz Commercial |
$92.34
|
| Rate for Payer: Quartz Medicare Advantage |
$8.12
|
| Rate for Payer: The Alliance Commercial |
$30.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.12
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$40.60
|
|
|
X-RAY Pelvis Complete Minimum 3 Views 72190
|
Professional
|
$269.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
4568644
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Aetna Commercial |
$255.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$40.88
|
| Rate for Payer: Anthem Medicare Advantage |
$40.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.88
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$255.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.88
|
| Rate for Payer: Health EOS Commercial |
$244.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.88
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Preferred Network Access Commercial |
$255.55
|
| Rate for Payer: Quartz Beloit One Network |
$118.36
|
| Rate for Payer: Quartz Commercial |
$153.33
|
| Rate for Payer: Quartz Medicare Advantage |
$40.88
|
| Rate for Payer: The Alliance Commercial |
$155.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.88
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$204.40
|
|
|
X-RAY Pelvis Complete Minimum 3 Views 7219026
|
Professional
|
$269.00
|
|
|
Service Code
|
CPT 72190 26
|
| Hospital Charge Code |
4616760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.80 |
| Max. Negotiated Rate |
$255.55 |
| Rate for Payer: Aetna Commercial |
$255.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$11.80
|
| Rate for Payer: Anthem Medicare Advantage |
$11.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.80
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$255.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.80
|
| Rate for Payer: Health EOS Commercial |
$244.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.80
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: Preferred Network Access Commercial |
$255.55
|
| Rate for Payer: Quartz Beloit One Network |
$118.36
|
| Rate for Payer: Quartz Commercial |
$153.33
|
| Rate for Payer: Quartz Medicare Advantage |
$11.80
|
| Rate for Payer: The Alliance Commercial |
$44.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.80
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$59.00
|
|
