|
X-RAY Knee 4 or More 7356426
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
CPT 73564 26
|
| Hospital Charge Code |
3236193
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Aetna Commercial |
$146.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Medicare Advantage |
$11.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.07
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$146.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.07
|
| Rate for Payer: Health EOS Commercial |
$140.07
|
| Rate for Payer: HFN Commercial |
$146.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.07
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$16.60
|
| Rate for Payer: Preferred Network Access Commercial |
$146.22
|
| Rate for Payer: Quartz Beloit One Network |
$67.72
|
| Rate for Payer: Quartz Commercial |
$87.73
|
| Rate for Payer: Quartz Medicare Advantage |
$11.07
|
| Rate for Payer: The Alliance Commercial |
$42.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.07
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$55.33
|
|
|
X-RAY Knees Standing 73565
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
3209604
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$208.57 |
| Rate for Payer: Aetna Commercial |
$34.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$41.71
|
| Rate for Payer: Anthem Medicare Advantage |
$41.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.71
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$34.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.71
|
| Rate for Payer: Health EOS Commercial |
$33.12
|
| Rate for Payer: HFN Commercial |
$34.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.71
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$62.57
|
| Rate for Payer: Preferred Network Access Commercial |
$34.58
|
| Rate for Payer: Quartz Beloit One Network |
$16.02
|
| Rate for Payer: Quartz Commercial |
$20.75
|
| Rate for Payer: Quartz Medicare Advantage |
$41.71
|
| Rate for Payer: The Alliance Commercial |
$158.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.71
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$208.57
|
|
|
X-RAY Knees Standing 7356526
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
CPT 73565 26
|
| Hospital Charge Code |
3209609
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$60.27 |
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$8.33
|
| Rate for Payer: Anthem Medicare Advantage |
$8.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$60.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.33
|
| Rate for Payer: Health EOS Commercial |
$57.73
|
| Rate for Payer: HFN Commercial |
$60.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.33
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$12.50
|
| Rate for Payer: Preferred Network Access Commercial |
$60.27
|
| Rate for Payer: Quartz Beloit One Network |
$27.91
|
| Rate for Payer: Quartz Commercial |
$36.16
|
| Rate for Payer: Quartz Medicare Advantage |
$8.33
|
| Rate for Payer: The Alliance Commercial |
$31.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.33
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$41.65
|
|
|
X-RAY Lumbar 2-3 Views 7210026
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 72100 26
|
| Hospital Charge Code |
3236237
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$40.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$53.66
|
|
|
X-RAY Lumbar 4 Views 72110
|
Professional
|
Both
|
$108.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
3236247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.42 |
| Max. Negotiated Rate |
$264.68 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.60
|
| Rate for Payer: Aetna Managed Medicare |
$52.94
|
| Rate for Payer: Anthem Medicare Advantage |
$52.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.94
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cash Price |
$32.40
|
| Rate for Payer: Cigna Commercial |
$106.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.94
|
| Rate for Payer: Health EOS Commercial |
$102.21
|
| Rate for Payer: HFN Commercial |
$106.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$178.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.94
|
| Rate for Payer: Multiplan Commercial |
$89.86
|
| Rate for Payer: NAPHCARE Commercial |
$79.40
|
| Rate for Payer: Preferred Network Access Commercial |
$106.70
|
| Rate for Payer: Quartz Beloit One Network |
$49.42
|
| Rate for Payer: Quartz Commercial |
$64.02
|
| Rate for Payer: Quartz Medicare Advantage |
$52.94
|
| Rate for Payer: The Alliance Commercial |
$201.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.94
|
| Rate for Payer: WEA Trust Commercial |
$61.78
|
| Rate for Payer: WPS Commercial |
$264.68
|
|
|
X-RAY Lumbar 4 Views 7211026
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 72110 26
|
| Hospital Charge Code |
3236248
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$110.66 |
| Rate for Payer: Aetna Commercial |
$110.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$12.56
|
| Rate for Payer: Anthem Medicare Advantage |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.56
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$110.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.56
|
| Rate for Payer: Health EOS Commercial |
$106.00
|
| Rate for Payer: HFN Commercial |
$110.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$18.84
|
| Rate for Payer: Preferred Network Access Commercial |
$110.66
|
| Rate for Payer: Quartz Beloit One Network |
$51.25
|
| Rate for Payer: Quartz Commercial |
$66.39
|
| Rate for Payer: Quartz Medicare Advantage |
$12.56
|
| Rate for Payer: The Alliance Commercial |
$47.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.56
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$62.82
|
|
|
X-Ray of Scapula 7301026
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 73010 26
|
| Hospital Charge Code |
3453522
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.01 |
| Max. Negotiated Rate |
$108.68 |
| Rate for Payer: Aetna Commercial |
$108.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$9.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.01
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$108.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.01
|
| Rate for Payer: Health EOS Commercial |
$104.10
|
| Rate for Payer: HFN Commercial |
$108.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.01
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$13.51
|
| Rate for Payer: Preferred Network Access Commercial |
$108.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.34
|
| Rate for Payer: Quartz Commercial |
$65.21
|
| Rate for Payer: Quartz Medicare Advantage |
$9.01
|
| Rate for Payer: The Alliance Commercial |
$34.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.01
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$45.03
|
|
|
X-RAY of Tib/Fib 73590
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
3238224
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.06 |
| Max. Negotiated Rate |
$155.32 |
| Rate for Payer: Aetna Commercial |
$68.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$31.06
|
| Rate for Payer: Anthem Medicare Advantage |
$31.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.06
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$68.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.06
|
| Rate for Payer: Health EOS Commercial |
$65.30
|
| Rate for Payer: HFN Commercial |
$68.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.06
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$46.60
|
| Rate for Payer: Preferred Network Access Commercial |
$68.17
|
| Rate for Payer: Quartz Beloit One Network |
$31.57
|
| Rate for Payer: Quartz Commercial |
$40.90
|
| Rate for Payer: Quartz Medicare Advantage |
$31.06
|
| Rate for Payer: The Alliance Commercial |
$118.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$155.32
|
|
|
X-RAY of Tib/Fib 7359026
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 73590 26
|
| Hospital Charge Code |
3238225
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.66 |
| 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 |
$7.66
|
| Rate for Payer: Anthem Medicare Advantage |
$7.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.66
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| 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 |
$7.66
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.66
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.50
|
| 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 |
$7.66
|
| Rate for Payer: The Alliance Commercial |
$29.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.66
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$38.32
|
|
|
X-RAY of Wrist 2 Views 73100
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 73100
|
| Hospital Charge Code |
3238246
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$170.30 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$34.06
|
| Rate for Payer: Anthem Medicare Advantage |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.06
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.06
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.06
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$51.09
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: Quartz Medicare Advantage |
$34.06
|
| Rate for Payer: The Alliance Commercial |
$129.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.06
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$170.30
|
|
|
X-RAY of Wrist 2 Views 7310026
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 73100 26
|
| Hospital Charge Code |
3238247
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$8.33
|
| Rate for Payer: Anthem Medicare Advantage |
$8.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.33
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.33
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.33
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$12.50
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8.33
|
| Rate for Payer: The Alliance Commercial |
$31.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.33
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$41.65
|
|
|
X-RAY Pelvis 1 or 2 Views 72170
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
3209615
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$27.75
|
| Rate for Payer: Anthem Medicare Advantage |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$41.62
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$27.75
|
| Rate for Payer: The Alliance Commercial |
$105.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.75
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$138.74
|
|
|
X-RAY Pelvis 1 or 2 Views 7217026
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 72170 26
|
| Hospital Charge Code |
3209620
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$41.70
|
|
|
X-RAY Pelvis Complete Minimum 3 Views 72190
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
4568644
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$265.77 |
| Rate for Payer: Aetna Commercial |
$265.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$42.93
|
| Rate for Payer: Anthem Medicare Advantage |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.93
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$265.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.93
|
| Rate for Payer: Health EOS Commercial |
$254.58
|
| Rate for Payer: HFN Commercial |
$265.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.93
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$64.40
|
| Rate for Payer: Preferred Network Access Commercial |
$265.77
|
| Rate for Payer: Quartz Beloit One Network |
$123.09
|
| Rate for Payer: Quartz Commercial |
$159.46
|
| Rate for Payer: Quartz Medicare Advantage |
$42.93
|
| Rate for Payer: The Alliance Commercial |
$163.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.93
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$214.66
|
|
|
X-RAY Pelvis Complete Minimum 3 Views 7219026
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
CPT 72190 26
|
| Hospital Charge Code |
4616760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.21 |
| Max. Negotiated Rate |
$265.77 |
| Rate for Payer: Aetna Commercial |
$265.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$12.21
|
| Rate for Payer: Anthem Medicare Advantage |
$12.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.21
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$265.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.21
|
| Rate for Payer: Health EOS Commercial |
$254.58
|
| Rate for Payer: HFN Commercial |
$265.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.21
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$18.31
|
| Rate for Payer: Preferred Network Access Commercial |
$265.77
|
| Rate for Payer: Quartz Beloit One Network |
$123.09
|
| Rate for Payer: Quartz Commercial |
$159.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12.21
|
| Rate for Payer: The Alliance Commercial |
$46.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.21
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$61.05
|
|
|
X-RAY Sacrum & Coccyx 2 View 72220
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
3209626
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$158.70 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| 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 |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.74
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.74
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$47.61
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.74
|
| Rate for Payer: The Alliance Commercial |
$120.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.74
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$158.70
|
|
|
X-RAY Sacrum & Coccyx 2 View 7222026
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
CPT 72220 26
|
| Hospital Charge Code |
3209631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$157.09 |
| Rate for Payer: Aetna Commercial |
$157.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$157.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$150.48
|
| Rate for Payer: HFN Commercial |
$157.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$157.09
|
| Rate for Payer: Quartz Beloit One Network |
$72.76
|
| Rate for Payer: Quartz Commercial |
$94.26
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$41.70
|
|
|
X-RAY Shoulder 1 View 7302026
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
CPT 73020 26
|
| Hospital Charge Code |
3209642
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.31 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$58.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Aetna Managed Medicare |
$7.31
|
| Rate for Payer: Anthem Medicare Advantage |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.31
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$58.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.31
|
| Rate for Payer: Health EOS Commercial |
$55.84
|
| Rate for Payer: HFN Commercial |
$58.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.31
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$10.97
|
| Rate for Payer: Preferred Network Access Commercial |
$58.29
|
| Rate for Payer: Quartz Beloit One Network |
$27.00
|
| Rate for Payer: Quartz Commercial |
$34.98
|
| Rate for Payer: Quartz Medicare Advantage |
$7.31
|
| Rate for Payer: The Alliance Commercial |
$27.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.31
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$36.56
|
|
|
X-Ray Spine Scoliosis Study Standing 72081
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
5294616
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$464.36 |
| Rate for Payer: Aetna Commercial |
$464.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$43.62
|
| Rate for Payer: Anthem Medicare Advantage |
$43.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.62
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$464.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.62
|
| Rate for Payer: Health EOS Commercial |
$444.81
|
| Rate for Payer: HFN Commercial |
$464.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.62
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$65.43
|
| Rate for Payer: Preferred Network Access Commercial |
$464.36
|
| Rate for Payer: Quartz Beloit One Network |
$215.07
|
| Rate for Payer: Quartz Commercial |
$278.62
|
| Rate for Payer: Quartz Medicare Advantage |
$43.62
|
| Rate for Payer: The Alliance Commercial |
$165.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.62
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$218.09
|
|
|
X-Ray Spine Scoliosis Study Standing 7208126
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 72081 26
|
| Hospital Charge Code |
5294617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.56 |
| Max. Negotiated Rate |
$121.52 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$12.56
|
| Rate for Payer: Anthem Medicare Advantage |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.56
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.56
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.56
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$18.84
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: Quartz Medicare Advantage |
$12.56
|
| Rate for Payer: The Alliance Commercial |
$47.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.56
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$62.82
|
|
|
XRAY Sternoclavicular Joint(s) 71130
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
4616757
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$205.61 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$41.12
|
| Rate for Payer: Anthem Medicare Advantage |
$41.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.12
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.12
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$146.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.12
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$61.68
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$41.12
|
| Rate for Payer: The Alliance Commercial |
$156.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.12
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$205.61
|
|
|
XRAY sternoclavicular Joint(s) 7113026
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 71130 26
|
| Hospital Charge Code |
4616758
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$10.40
|
| Rate for Payer: Anthem Medicare Advantage |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.40
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.40
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.40
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10.40
|
| Rate for Payer: The Alliance Commercial |
$39.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.40
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$52.00
|
|
|
X-RAYS, TRANSCATH THERAPY 7589426
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
CPT 75894 26
|
| Hospital Charge Code |
3015295
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$119.48 |
| Max. Negotiated Rate |
$786.45 |
| Rate for Payer: Aetna Commercial |
$786.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$711.94
|
| Rate for Payer: Aetna Managed Medicare |
$119.48
|
| Rate for Payer: Anthem Medicare Advantage |
$119.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.48
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$786.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$413.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.48
|
| Rate for Payer: Health EOS Commercial |
$753.33
|
| Rate for Payer: HFN Commercial |
$786.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$238.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$238.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.48
|
| Rate for Payer: Multiplan Commercial |
$662.27
|
| Rate for Payer: NAPHCARE Commercial |
$179.21
|
| Rate for Payer: Preferred Network Access Commercial |
$786.45
|
| Rate for Payer: Quartz Beloit One Network |
$364.25
|
| Rate for Payer: Quartz Commercial |
$471.87
|
| Rate for Payer: Quartz Medicare Advantage |
$119.48
|
| Rate for Payer: The Alliance Commercial |
$454.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.48
|
| Rate for Payer: WEA Trust Commercial |
$455.31
|
| Rate for Payer: WPS Commercial |
$597.38
|
|
|
X-RAY Thoracic Spine 2 View 7207026
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
CPT 72070 26
|
| Hospital Charge Code |
3238180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$92.87 |
| Rate for Payer: Aetna Commercial |
$92.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$92.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$88.96
|
| Rate for Payer: HFN Commercial |
$92.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$14.57
|
| Rate for Payer: Preferred Network Access Commercial |
$92.87
|
| Rate for Payer: Quartz Beloit One Network |
$43.01
|
| Rate for Payer: Quartz Commercial |
$55.72
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$36.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$48.57
|
|
|
X-RAY Thoracic Spine 3 View 72072
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
3238191
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$192.35 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| 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 |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| 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 |
$38.47
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| 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 |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$57.70
|
| 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 |
$38.47
|
| Rate for Payer: The Alliance Commercial |
$146.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.47
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$192.35
|
|
