|
XR Spine Cervical Flexion + Extension
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
711795
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
XR Spine Cervical Flexion + Extension
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
1537335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$632.32 |
| Rate for Payer: Aetna Commercial |
$632.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.42
|
| Rate for Payer: Aetna Managed Medicare |
$29.06
|
| Rate for Payer: Anthem Medicare Advantage |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.06
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$632.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$332.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.06
|
| Rate for Payer: Health EOS Commercial |
$605.70
|
| Rate for Payer: HFN Commercial |
$632.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.06
|
| Rate for Payer: Multiplan Commercial |
$532.48
|
| Rate for Payer: NAPHCARE Commercial |
$43.59
|
| Rate for Payer: Preferred Network Access Commercial |
$632.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.86
|
| Rate for Payer: Quartz Commercial |
$379.39
|
| Rate for Payer: Quartz Medicare Advantage |
$29.06
|
| Rate for Payer: The Alliance Commercial |
$110.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.06
|
| Rate for Payer: WEA Trust Commercial |
$366.08
|
| Rate for Payer: WPS Commercial |
$145.29
|
|
|
XR Spine Cervical Flexion + Extension
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
711795
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
1537338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$166.82 |
| Max. Negotiated Rate |
$751.09 |
| Rate for Payer: Aetna Commercial |
$734.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.10
|
| Rate for Payer: Aetna Managed Medicare |
$228.59
|
| 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 |
$432.69
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$751.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.87
|
| Rate for Payer: Health EOS Commercial |
$726.60
|
| Rate for Payer: HFN Commercial |
$751.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.30
|
| Rate for Payer: Multiplan Commercial |
$653.12
|
| Rate for Payer: NAPHCARE Commercial |
$489.84
|
| Rate for Payer: Preferred Network Access Commercial |
$751.09
|
| Rate for Payer: Quartz Beloit One Network |
$400.04
|
| Rate for Payer: Quartz Commercial |
$530.66
|
| Rate for Payer: Quartz Medicare Advantage |
$489.84
|
| Rate for Payer: The Alliance Commercial |
$166.82
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$449.02
|
| Rate for Payer: WPS Commercial |
$604.69
|
|
|
XR Spine Cervical Minimum 4 Views
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
1537338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.70 |
| Max. Negotiated Rate |
$775.58 |
| Rate for Payer: Aetna Commercial |
$775.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.10
|
| Rate for Payer: Aetna Managed Medicare |
$41.70
|
| Rate for Payer: Anthem Medicare Advantage |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.70
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$775.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$408.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.70
|
| Rate for Payer: Health EOS Commercial |
$742.92
|
| Rate for Payer: HFN Commercial |
$775.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$653.12
|
| Rate for Payer: NAPHCARE Commercial |
$62.56
|
| Rate for Payer: Preferred Network Access Commercial |
$775.58
|
| Rate for Payer: Quartz Beloit One Network |
$359.22
|
| Rate for Payer: Quartz Commercial |
$465.35
|
| Rate for Payer: Quartz Medicare Advantage |
$41.70
|
| Rate for Payer: The Alliance Commercial |
$158.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.70
|
| Rate for Payer: WEA Trust Commercial |
$449.02
|
| Rate for Payer: WPS Commercial |
$208.52
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
629612
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$748.22 |
| Rate for Payer: Aetna Commercial |
$731.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$699.42
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$528.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$406.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$390.37
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.04
|
| 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 |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$748.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$723.82
|
| Rate for Payer: HFN Commercial |
$748.22
|
| 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 |
$650.62
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$748.22
|
| Rate for Payer: Quartz Beloit One Network |
$398.51
|
| Rate for Payer: Quartz Commercial |
$528.63
|
| 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 |
$447.30
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$602.37
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
1537338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$400.04 |
| Max. Negotiated Rate |
$751.09 |
| Rate for Payer: Aetna Commercial |
$734.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.69
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$751.09
|
| Rate for Payer: Health EOS Commercial |
$726.60
|
| Rate for Payer: HFN Commercial |
$751.09
|
| Rate for Payer: Multiplan Commercial |
$653.12
|
| Rate for Payer: Preferred Network Access Commercial |
$751.09
|
| Rate for Payer: Quartz Beloit One Network |
$400.04
|
| Rate for Payer: Quartz Commercial |
$489.84
|
| Rate for Payer: WEA Trust Commercial |
$449.02
|
| Rate for Payer: WPS Commercial |
$604.69
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
629612
|
| Min. Negotiated Rate |
$398.51 |
| Max. Negotiated Rate |
$748.22 |
| Rate for Payer: Aetna Commercial |
$731.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$699.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.04
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$748.22
|
| Rate for Payer: Health EOS Commercial |
$723.82
|
| Rate for Payer: HFN Commercial |
$748.22
|
| Rate for Payer: Multiplan Commercial |
$650.62
|
| Rate for Payer: Preferred Network Access Commercial |
$748.22
|
| Rate for Payer: Quartz Beloit One Network |
$398.51
|
| Rate for Payer: Quartz Commercial |
$487.97
|
| Rate for Payer: WEA Trust Commercial |
$447.30
|
| Rate for Payer: WPS Commercial |
$602.37
|
|
|
XR Spine Cervical Minimum 4 Views
|
Professional
|
Both
|
$782.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
629612
|
| Min. Negotiated Rate |
$54.61 |
| Max. Negotiated Rate |
$772.62 |
| Rate for Payer: Aetna Commercial |
$772.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$699.42
|
| Rate for Payer: Aetna Managed Medicare |
$54.61
|
| Rate for Payer: Anthem Medicare Advantage |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.61
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$772.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$406.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.61
|
| Rate for Payer: Health EOS Commercial |
$740.08
|
| Rate for Payer: HFN Commercial |
$772.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$186.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.61
|
| Rate for Payer: Multiplan Commercial |
$650.62
|
| Rate for Payer: NAPHCARE Commercial |
$81.92
|
| Rate for Payer: Preferred Network Access Commercial |
$772.62
|
| Rate for Payer: Quartz Beloit One Network |
$357.84
|
| Rate for Payer: Quartz Commercial |
$463.57
|
| Rate for Payer: Quartz Medicare Advantage |
$54.61
|
| Rate for Payer: The Alliance Commercial |
$207.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.61
|
| Rate for Payer: WEA Trust Commercial |
$447.30
|
| Rate for Payer: WPS Commercial |
$273.05
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| Min. Negotiated Rate |
$62.31 |
| Max. Negotiated Rate |
$1,124.34 |
| Rate for Payer: Aetna Commercial |
$1,124.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Aetna Managed Medicare |
$62.31
|
| Rate for Payer: Anthem Medicare Advantage |
$62.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.31
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,124.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$591.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.31
|
| Rate for Payer: Health EOS Commercial |
$1,077.00
|
| Rate for Payer: HFN Commercial |
$1,124.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$218.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.31
|
| Rate for Payer: Multiplan Commercial |
$946.82
|
| Rate for Payer: NAPHCARE Commercial |
$93.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,124.34
|
| Rate for Payer: Quartz Beloit One Network |
$520.75
|
| Rate for Payer: Quartz Commercial |
$674.61
|
| Rate for Payer: Quartz Medicare Advantage |
$62.31
|
| Rate for Payer: The Alliance Commercial |
$236.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.31
|
| Rate for Payer: WEA Trust Commercial |
$650.94
|
| Rate for Payer: WPS Commercial |
$311.53
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
1537340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$192.11 |
| Max. Negotiated Rate |
$1,417.02 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Aetna Managed Medicare |
$431.27
|
| 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 |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$861.94
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,155.18
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: NAPHCARE Commercial |
$924.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$1,001.16
|
| Rate for Payer: Quartz Medicare Advantage |
$924.14
|
| Rate for Payer: The Alliance Commercial |
$192.11
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
1537340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$754.72 |
| Max. Negotiated Rate |
$1,417.02 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$924.14
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| Min. Negotiated Rate |
$579.92 |
| Max. Negotiated Rate |
$1,088.84 |
| Rate for Payer: Aetna Commercial |
$1,065.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.27
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,088.84
|
| Rate for Payer: Health EOS Commercial |
$1,053.33
|
| Rate for Payer: HFN Commercial |
$1,088.84
|
| Rate for Payer: Multiplan Commercial |
$946.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.84
|
| Rate for Payer: Quartz Beloit One Network |
$579.92
|
| Rate for Payer: Quartz Commercial |
$710.11
|
| Rate for Payer: WEA Trust Commercial |
$650.94
|
| Rate for Payer: WPS Commercial |
$876.60
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,088.84 |
| Rate for Payer: Aetna Commercial |
$1,065.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.09
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.27
|
| 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 |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,088.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,053.33
|
| Rate for Payer: HFN Commercial |
$1,088.84
|
| 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 |
$946.82
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.84
|
| Rate for Payer: Quartz Beloit One Network |
$579.92
|
| Rate for Payer: Quartz Commercial |
$769.29
|
| 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 |
$650.94
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$876.60
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
1537340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$1,463.23 |
| Rate for Payer: Aetna Commercial |
$1,463.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Aetna Managed Medicare |
$48.03
|
| Rate for Payer: Anthem Medicare Advantage |
$48.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.03
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,463.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$770.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.03
|
| Rate for Payer: Health EOS Commercial |
$1,401.62
|
| Rate for Payer: HFN Commercial |
$1,463.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.03
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: NAPHCARE Commercial |
$72.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,463.23
|
| Rate for Payer: Quartz Beloit One Network |
$677.71
|
| Rate for Payer: Quartz Commercial |
$877.94
|
| Rate for Payer: Quartz Medicare Advantage |
$48.03
|
| Rate for Payer: The Alliance Commercial |
$182.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.03
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$240.14
|
|
|
XR Spine Entire Survey AP/Lat
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 72084 TC
|
| Hospital Charge Code |
1537342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.33 |
| Max. Negotiated Rate |
$1,165.38 |
| Rate for Payer: Aetna Commercial |
$1,140.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$354.68
|
| 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 |
$671.36
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,165.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$708.88
|
| Rate for Payer: Health EOS Commercial |
$1,127.38
|
| Rate for Payer: HFN Commercial |
$1,165.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$950.04
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$760.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.38
|
| Rate for Payer: Quartz Beloit One Network |
$620.69
|
| Rate for Payer: Quartz Commercial |
$823.37
|
| Rate for Payer: Quartz Medicare Advantage |
$760.03
|
| Rate for Payer: The Alliance Commercial |
$312.33
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$938.23
|
|
|
XR Spine Entire Survey AP/Lat
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
CPT 72084 TC
|
| Hospital Charge Code |
1537342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.08 |
| Max. Negotiated Rate |
$1,203.38 |
| Rate for Payer: Aetna Commercial |
$1,203.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$78.08
|
| Rate for Payer: Anthem Medicare Advantage |
$78.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.08
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,203.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$633.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.08
|
| Rate for Payer: Health EOS Commercial |
$1,152.72
|
| Rate for Payer: HFN Commercial |
$1,203.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.08
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$117.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.38
|
| Rate for Payer: Quartz Beloit One Network |
$557.36
|
| Rate for Payer: Quartz Commercial |
$722.03
|
| Rate for Payer: Quartz Medicare Advantage |
$78.08
|
| Rate for Payer: The Alliance Commercial |
$296.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.08
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$390.42
|
|
|
XR Spine Entire Survey AP/Lat
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 72084 TC
|
| Hospital Charge Code |
1537342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$620.69 |
| Max. Negotiated Rate |
$1,165.38 |
| Rate for Payer: Aetna Commercial |
$1,140.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.36
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,165.38
|
| Rate for Payer: Health EOS Commercial |
$1,127.38
|
| Rate for Payer: HFN Commercial |
$1,165.38
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.38
|
| Rate for Payer: Quartz Beloit One Network |
$620.69
|
| Rate for Payer: Quartz Commercial |
$760.03
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$938.23
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$345.51 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$423.07
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.46
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| 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 |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| 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 |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$458.33
|
| 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 |
$387.82
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
XR Spine Lumbar Flexion + Extension
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$669.86 |
| Rate for Payer: Aetna Commercial |
$669.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$40.12
|
| Rate for Payer: Anthem Medicare Advantage |
$40.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.12
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$669.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$352.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.12
|
| Rate for Payer: Health EOS Commercial |
$641.66
|
| Rate for Payer: HFN Commercial |
$669.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$139.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.12
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$60.18
|
| Rate for Payer: Preferred Network Access Commercial |
$669.86
|
| Rate for Payer: Quartz Beloit One Network |
$310.25
|
| Rate for Payer: Quartz Commercial |
$401.92
|
| Rate for Payer: Quartz Medicare Advantage |
$40.12
|
| Rate for Payer: The Alliance Commercial |
$152.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.12
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$200.62
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
1537344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
XR Spine Lumbar Flexion + Extension
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
1537344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$573.04 |
| Rate for Payer: Aetna Commercial |
$573.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$31.05
|
| Rate for Payer: Anthem Medicare Advantage |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.05
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$573.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.05
|
| Rate for Payer: Health EOS Commercial |
$548.91
|
| Rate for Payer: HFN Commercial |
$573.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$104.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$46.58
|
| Rate for Payer: Preferred Network Access Commercial |
$573.04
|
| Rate for Payer: Quartz Beloit One Network |
$265.41
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: Quartz Medicare Advantage |
$31.05
|
| Rate for Payer: The Alliance Commercial |
$118.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.05
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$155.27
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
1537344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$168.90
|
| 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 |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.56
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$452.40
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| Rate for Payer: Quartz Medicare Advantage |
$361.92
|
| Rate for Payer: The Alliance Commercial |
$124.22
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.46
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| 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 |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| 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 |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$458.33
|
| 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 |
$387.82
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
