|
XR Bone Age Studies
|
Professional
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$25.00 |
| Max. Negotiated Rate |
$609.90 |
| Rate for Payer: Aetna Commercial |
$609.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| Rate for Payer: Aetna Managed Medicare |
$25.00
|
| Rate for Payer: Anthem Medicare Advantage |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.00
|
| 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 |
$25.00
|
| Rate for Payer: Health EOS Commercial |
$584.22
|
| 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: Independent Care Health Plan Medicare |
$25.00
|
| 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: Quartz Medicare Advantage |
$25.00
|
| Rate for Payer: The Alliance Commercial |
$95.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.00
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: WPS Commercial |
$125.00
|
|
|
XR Bone Age Studies
|
Professional
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$659.30 |
| Rate for Payer: Aetna Commercial |
$659.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.84
|
| Rate for Payer: Aetna Managed Medicare |
$16.20
|
| Rate for Payer: Anthem Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.20
|
| 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 |
$16.20
|
| Rate for Payer: Health EOS Commercial |
$631.54
|
| 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: Independent Care Health Plan Medicare |
$16.20
|
| 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: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$61.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$381.70
|
| Rate for Payer: WPS Commercial |
$81.00
|
|
|
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: 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
|
Facility
OP
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.32 |
| Max. Negotiated Rate |
$2,776.00 |
| Rate for Payer: Aetna Commercial |
$624.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.84
|
| Rate for Payer: Aetna Managed Medicare |
$194.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$451.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$347.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$333.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.82
|
| 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: Health EOS Commercial |
$617.66
|
| Rate for Payer: HFN Commercial |
$638.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.50
|
| 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 |
$451.10
|
| Rate for Payer: Quartz Medicare Advantage |
$416.40
|
| Rate for Payer: The Alliance Commercial |
$2,776.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$381.70
|
| Rate for Payer: WPS Commercial |
$514.05
|
|
|
XR Bone Length Adult
|
Professional
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$519.65 |
| Rate for Payer: Aetna Commercial |
$519.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$30.69
|
| Rate for Payer: Anthem Medicare Advantage |
$30.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.69
|
| 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 |
$30.69
|
| Rate for Payer: Health EOS Commercial |
$497.77
|
| 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: Independent Care Health Plan Medicare |
$30.69
|
| 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: Quartz Medicare Advantage |
$30.69
|
| Rate for Payer: The Alliance Commercial |
$116.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.69
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$153.45
|
|
|
XR Bone Length Adult
|
Facility
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$153.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$355.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| 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: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$410.25
|
| 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 |
$355.55
|
| Rate for Payer: Quartz Medicare Advantage |
$328.20
|
| Rate for Payer: The Alliance Commercial |
$2,188.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| 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: 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 Child
|
Professional
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$519.65 |
| Rate for Payer: Aetna Commercial |
$519.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$30.69
|
| Rate for Payer: Anthem Medicare Advantage |
$30.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.69
|
| 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 |
$30.69
|
| Rate for Payer: Health EOS Commercial |
$497.77
|
| 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: Independent Care Health Plan Medicare |
$30.69
|
| 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: Quartz Medicare Advantage |
$30.69
|
| Rate for Payer: The Alliance Commercial |
$116.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.69
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$153.45
|
|
|
XR Bone Length Child
|
Facility
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$153.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$355.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| 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: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$410.25
|
| 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 |
$355.55
|
| Rate for Payer: Quartz Medicare Advantage |
$328.20
|
| Rate for Payer: The Alliance Commercial |
$2,188.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| 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: 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 Studies Scanograms
|
Professional
|
$538.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
627646
|
| Min. Negotiated Rate |
$43.25 |
| Max. Negotiated Rate |
$511.10 |
| Rate for Payer: Aetna Commercial |
$511.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$43.25
|
| Rate for Payer: Anthem Medicare Advantage |
$43.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.25
|
| 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 |
$43.25
|
| Rate for Payer: Health EOS Commercial |
$489.58
|
| 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: Independent Care Health Plan Medicare |
$43.25
|
| 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: Quartz Medicare Advantage |
$43.25
|
| Rate for Payer: The Alliance Commercial |
$164.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.25
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$216.25
|
|
|
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: 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 Studies Scanograms
|
Professional
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
1536893
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.69 |
| Max. Negotiated Rate |
$519.65 |
| Rate for Payer: Aetna Commercial |
$519.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$30.69
|
| Rate for Payer: Anthem Medicare Advantage |
$30.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.69
|
| 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 |
$30.69
|
| Rate for Payer: Health EOS Commercial |
$497.77
|
| 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: Independent Care Health Plan Medicare |
$30.69
|
| 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: Quartz Medicare Advantage |
$30.69
|
| Rate for Payer: The Alliance Commercial |
$116.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.69
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$153.45
|
|
|
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: 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
OP
|
$538.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
627646
|
| Min. Negotiated Rate |
$67.56 |
| 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 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 |
$67.56
|
| 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
|
Facility
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
1536893
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$153.16 |
| Max. Negotiated Rate |
$2,188.00 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Aetna Managed Medicare |
$153.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$355.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$273.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$262.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| 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: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$410.25
|
| 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 |
$355.55
|
| Rate for Payer: Quartz Medicare Advantage |
$328.20
|
| Rate for Payer: The Alliance Commercial |
$2,188.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
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: 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)
|
Professional
|
$1,426.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
627658
|
| Min. Negotiated Rate |
$96.22 |
| 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: Aetna Managed Medicare |
$96.22
|
| Rate for Payer: Anthem Medicare Advantage |
$96.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.22
|
| 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 |
$96.22
|
| Rate for Payer: Health EOS Commercial |
$1,297.66
|
| 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: Independent Care Health Plan Medicare |
$96.22
|
| 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: Quartz Medicare Advantage |
$96.22
|
| Rate for Payer: The Alliance Commercial |
$365.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.22
|
| Rate for Payer: WEA Trust Commercial |
$784.30
|
| Rate for Payer: WPS Commercial |
$481.10
|
|
|
XR Bone Survey Complete (Mets)
|
Professional
|
$1,539.00
|
|
|
Service Code
|
CPT 77075 TC
|
| Hospital Charge Code |
1536895
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.72 |
| 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: Aetna Managed Medicare |
$70.72
|
| Rate for Payer: Anthem Medicare Advantage |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.72
|
| 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 |
$70.72
|
| Rate for Payer: Health EOS Commercial |
$1,400.49
|
| 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: Independent Care Health Plan Medicare |
$70.72
|
| 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: Quartz Medicare Advantage |
$70.72
|
| Rate for Payer: The Alliance Commercial |
$268.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.72
|
| Rate for Payer: WEA Trust Commercial |
$846.45
|
| Rate for Payer: WPS Commercial |
$353.60
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$6,156.00 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,323.54
|
| Rate for Payer: Aetna Managed Medicare |
$430.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,000.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$769.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$738.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$815.67
|
| 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: Health EOS Commercial |
$1,369.71
|
| Rate for Payer: HFN Commercial |
$1,415.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.25
|
| 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 |
$1,000.35
|
| Rate for Payer: Quartz Medicare Advantage |
$923.40
|
| Rate for Payer: The Alliance Commercial |
$6,156.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| 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 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 |
$407.72
|
| 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)
|
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: 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
OP
|
$696.00
|
|
|
Service Code
|
CPT 77076 TC
|
| Hospital Charge Code |
1536897
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$194.88 |
| Max. Negotiated Rate |
$2,784.00 |
| Rate for Payer: Aetna Commercial |
$626.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Aetna Managed Medicare |
$194.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$452.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.88
|
| 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: Health EOS Commercial |
$619.44
|
| Rate for Payer: HFN Commercial |
$640.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$522.00
|
| 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 |
$452.40
|
| Rate for Payer: Quartz Medicare Advantage |
$417.60
|
| Rate for Payer: The Alliance Commercial |
$2,784.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
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: 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
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: 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
|
|
