|
XR Biliary Drainage Percutaneous
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
2587211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,209.46
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$954.50
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$954.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$954.50
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,550.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$954.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$954.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$954.50
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,991.98
|
| Rate for Payer: Quartz Medicare Advantage |
$954.50
|
| Rate for Payer: The Alliance Commercial |
$3,818.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$954.50
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
2448800
|
| Min. Negotiated Rate |
$1,239.35 |
| Max. Negotiated Rate |
$4,072.14 |
| Rate for Payer: Aetna Commercial |
$3,983.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,877.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.91
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,072.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.99
|
| Rate for Payer: Health EOS Commercial |
$3,939.35
|
| Rate for Payer: HFN Commercial |
$4,072.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,319.68
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.86
|
| Rate for Payer: Quartz Commercial |
$2,877.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.74
|
| Rate for Payer: The Alliance Commercial |
$2,213.12
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
IP
|
$4,256.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
2448800
|
| Min. Negotiated Rate |
$2,168.86 |
| Max. Negotiated Rate |
$4,072.14 |
| Rate for Payer: Aetna Commercial |
$3,983.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.91
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,072.14
|
| Rate for Payer: Health EOS Commercial |
$3,939.35
|
| Rate for Payer: HFN Commercial |
$4,072.14
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.86
|
| Rate for Payer: Quartz Commercial |
$2,655.74
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
XR Biliary Drainage Percutaneous
|
Professional
|
Both
|
$4,256.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
2448800
|
| Min. Negotiated Rate |
$1,947.55 |
| Max. Negotiated Rate |
$4,204.93 |
| Rate for Payer: Aetna Commercial |
$4,204.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,204.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,213.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,655.74
|
| Rate for Payer: Health EOS Commercial |
$4,027.88
|
| Rate for Payer: HFN Commercial |
$4,204.93
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,204.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,947.55
|
| Rate for Payer: Quartz Commercial |
$2,522.96
|
| Rate for Payer: The Alliance Commercial |
$2,213.12
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
XR Biliary Drain Transhep Perc in + out
|
Facility
|
OP
|
$4,580.00
|
|
|
Service Code
|
CPT 75982
|
| Hospital Charge Code |
2448803
|
| Min. Negotiated Rate |
$1,333.70 |
| Max. Negotiated Rate |
$4,382.14 |
| Rate for Payer: Aetna Commercial |
$4,286.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,096.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,333.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,096.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,381.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,286.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,524.50
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$4,382.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,665.56
|
| Rate for Payer: Health EOS Commercial |
$4,239.25
|
| Rate for Payer: HFN Commercial |
$4,382.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,572.40
|
| Rate for Payer: Multiplan Commercial |
$3,810.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,382.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.97
|
| Rate for Payer: Quartz Commercial |
$3,096.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,857.92
|
| Rate for Payer: The Alliance Commercial |
$2,381.60
|
| Rate for Payer: WEA Trust Commercial |
$2,619.76
|
| Rate for Payer: WPS Commercial |
$3,527.97
|
|
|
XR Biliary Drain Transhep Perc in + out
|
Professional
|
Both
|
$4,580.00
|
|
|
Service Code
|
CPT 75982
|
| Hospital Charge Code |
2448803
|
| Min. Negotiated Rate |
$2,095.81 |
| Max. Negotiated Rate |
$4,525.04 |
| Rate for Payer: Aetna Commercial |
$4,525.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,096.35
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$4,525.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,381.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,857.92
|
| Rate for Payer: Health EOS Commercial |
$4,334.51
|
| Rate for Payer: HFN Commercial |
$4,525.04
|
| Rate for Payer: Multiplan Commercial |
$3,810.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,525.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,095.81
|
| Rate for Payer: Quartz Commercial |
$2,715.02
|
| Rate for Payer: The Alliance Commercial |
$2,381.60
|
| Rate for Payer: WEA Trust Commercial |
$2,619.76
|
| Rate for Payer: WPS Commercial |
$3,527.97
|
|
|
XR Biliary Drain Transhep Perc in + out
|
Facility
|
IP
|
$4,580.00
|
|
|
Service Code
|
CPT 75982
|
| Hospital Charge Code |
2448803
|
| Min. Negotiated Rate |
$2,333.97 |
| Max. Negotiated Rate |
$4,382.14 |
| Rate for Payer: Aetna Commercial |
$4,286.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,096.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,524.50
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$4,382.14
|
| Rate for Payer: Health EOS Commercial |
$4,239.25
|
| Rate for Payer: HFN Commercial |
$4,382.14
|
| Rate for Payer: Multiplan Commercial |
$3,810.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,382.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.97
|
| Rate for Payer: Quartz Commercial |
$2,857.92
|
| Rate for Payer: WEA Trust Commercial |
$2,619.76
|
| Rate for Payer: WPS Commercial |
$3,527.97
|
|
|
XR Biliary Drain Transhep Perc w/ Cont
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
3072724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Aetna Managed Medicare |
$1,288.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,209.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.93
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,452.28
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: NAPHCARE Commercial |
$2,761.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,991.98
|
| Rate for Payer: Quartz Medicare Advantage |
$2,761.82
|
| Rate for Payer: The Alliance Commercial |
$2,301.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Drain Transhep Perc w/ Cont
|
Professional
|
Both
|
$4,426.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
3072724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,025.34 |
| Max. Negotiated Rate |
$4,372.89 |
| Rate for Payer: Aetna Commercial |
$4,372.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,372.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,301.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,761.82
|
| Rate for Payer: Health EOS Commercial |
$4,188.77
|
| Rate for Payer: HFN Commercial |
$4,372.89
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,372.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,025.34
|
| Rate for Payer: Quartz Commercial |
$2,623.73
|
| Rate for Payer: The Alliance Commercial |
$2,301.52
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Drain Transhep Perc w/ Cont
|
Facility
|
IP
|
$4,426.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
3072724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,255.49 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,761.82
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Duct Calculus Removal
|
Professional
|
Both
|
$2,578.00
|
|
|
Service Code
|
CPT 74327
|
| Hospital Charge Code |
627616
|
| Min. Negotiated Rate |
$1,179.69 |
| Max. Negotiated Rate |
$2,547.06 |
| Rate for Payer: Aetna Commercial |
$2,547.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,340.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,608.67
|
| Rate for Payer: Health EOS Commercial |
$2,439.82
|
| Rate for Payer: HFN Commercial |
$2,547.06
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,547.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.69
|
| Rate for Payer: Quartz Commercial |
$1,528.24
|
| Rate for Payer: The Alliance Commercial |
$1,340.56
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
XR Biliary Duct Calculus Removal
|
Facility
|
IP
|
$2,578.00
|
|
|
Service Code
|
CPT 74327
|
| Hospital Charge Code |
627616
|
| Min. Negotiated Rate |
$1,313.75 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,608.67
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
XR Biliary Duct Calculus Removal
|
Facility
|
OP
|
$2,578.00
|
|
|
Service Code
|
CPT 74327
|
| Hospital Charge Code |
627616
|
| Min. Negotiated Rate |
$750.71 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Aetna Managed Medicare |
$750.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,742.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,340.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,286.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,500.40
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,010.84
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,608.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,742.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,608.67
|
| Rate for Payer: The Alliance Commercial |
$1,340.56
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
XR Bone Age Studies
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$685.67 |
| Rate for Payer: Aetna Commercial |
$685.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Aetna Managed Medicare |
$16.08
|
| Rate for Payer: Anthem Medicare Advantage |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.08
|
| 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 |
$685.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$360.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.08
|
| Rate for Payer: Health EOS Commercial |
$656.80
|
| Rate for Payer: HFN Commercial |
$685.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: NAPHCARE Commercial |
$24.12
|
| Rate for Payer: Preferred Network Access Commercial |
$685.67
|
| Rate for Payer: Quartz Beloit One Network |
$317.57
|
| Rate for Payer: Quartz Commercial |
$411.40
|
| Rate for Payer: Quartz Medicare Advantage |
$16.08
|
| Rate for Payer: The Alliance Commercial |
$61.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.08
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$80.39
|
|
|
XR Bone Age Studies
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$327.16 |
| Max. Negotiated Rate |
$614.27 |
| Rate for Payer: Aetna Commercial |
$600.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.87
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$614.27
|
| Rate for Payer: Health EOS Commercial |
$594.24
|
| Rate for Payer: HFN Commercial |
$614.27
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: Preferred Network Access Commercial |
$614.27
|
| Rate for Payer: Quartz Beloit One Network |
$327.16
|
| Rate for Payer: Quartz Commercial |
$400.61
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
XR Bone Age Studies
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Aetna Managed Medicare |
$202.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.53
|
| 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 |
$664.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.91
|
| Rate for Payer: Health EOS Commercial |
$642.37
|
| Rate for Payer: HFN Commercial |
$664.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$541.32
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: NAPHCARE Commercial |
$433.06
|
| Rate for Payer: Preferred Network Access Commercial |
$664.02
|
| Rate for Payer: Quartz Beloit One Network |
$353.66
|
| Rate for Payer: Quartz Commercial |
$469.14
|
| Rate for Payer: Quartz Medicare Advantage |
$433.06
|
| Rate for Payer: The Alliance Commercial |
$64.31
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$534.59
|
|
|
XR Bone Age Studies
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$614.27 |
| Rate for Payer: Aetna Commercial |
$600.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$433.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$333.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$320.49
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$614.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$594.24
|
| Rate for Payer: HFN Commercial |
$614.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$614.27
|
| Rate for Payer: Quartz Beloit One Network |
$327.16
|
| Rate for Payer: Quartz Commercial |
$433.99
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
XR Bone Age Studies
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$634.30 |
| Rate for Payer: Aetna Commercial |
$634.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Aetna Managed Medicare |
$25.12
|
| Rate for Payer: Anthem Medicare Advantage |
$25.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.12
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$634.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$333.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.12
|
| Rate for Payer: Health EOS Commercial |
$607.59
|
| Rate for Payer: HFN Commercial |
$634.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.12
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: NAPHCARE Commercial |
$37.67
|
| Rate for Payer: Preferred Network Access Commercial |
$634.30
|
| Rate for Payer: Quartz Beloit One Network |
$293.78
|
| Rate for Payer: Quartz Commercial |
$380.58
|
| Rate for Payer: Quartz Medicare Advantage |
$25.12
|
| Rate for Payer: The Alliance Commercial |
$95.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.12
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$125.58
|
|
|
XR Bone Age Studies
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$353.66 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.53
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$664.02
|
| Rate for Payer: Health EOS Commercial |
$642.37
|
| Rate for Payer: HFN Commercial |
$664.02
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: Preferred Network Access Commercial |
$664.02
|
| Rate for Payer: Quartz Beloit One Network |
$353.66
|
| Rate for Payer: Quartz Commercial |
$433.06
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$534.59
|
|
|
XR Bone Length Adult
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$159.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| 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 |
$523.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.35
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.66
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$341.33
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$369.77
|
| Rate for Payer: Quartz Medicare Advantage |
$341.33
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Adult
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$341.33
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Adult
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$540.44 |
| Rate for Payer: Aetna Commercial |
$540.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$33.05
|
| Rate for Payer: Anthem Medicare Advantage |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.05
|
| 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 |
$540.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.05
|
| Rate for Payer: Health EOS Commercial |
$517.68
|
| Rate for Payer: HFN Commercial |
$540.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.05
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$49.58
|
| Rate for Payer: Preferred Network Access Commercial |
$540.44
|
| Rate for Payer: Quartz Beloit One Network |
$250.31
|
| Rate for Payer: Quartz Commercial |
$324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$33.05
|
| Rate for Payer: The Alliance Commercial |
$125.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.05
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$165.26
|
|
|
XR Bone Length Child
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$341.33
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Child
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$159.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| 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 |
$523.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.35
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.66
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$341.33
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$369.77
|
| Rate for Payer: Quartz Medicare Advantage |
$341.33
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Child
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$540.44 |
| Rate for Payer: Aetna Commercial |
$540.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$33.05
|
| Rate for Payer: Anthem Medicare Advantage |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.05
|
| 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 |
$540.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.05
|
| Rate for Payer: Health EOS Commercial |
$517.68
|
| Rate for Payer: HFN Commercial |
$540.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.05
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$49.58
|
| Rate for Payer: Preferred Network Access Commercial |
$540.44
|
| Rate for Payer: Quartz Beloit One Network |
$250.31
|
| Rate for Payer: Quartz Commercial |
$324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$33.05
|
| Rate for Payer: The Alliance Commercial |
$125.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.05
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$165.26
|
|
