|
XR Pelvimetry
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
1537224
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.04 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$360.05
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Pelvis 1 or 2 Views
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
630285
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Pelvis 1 or 2 Views
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
1537228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.04 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$360.05
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Pelvis 1 or 2 Views
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
630285
|
| Min. Negotiated Rate |
$27.75 |
| Max. Negotiated Rate |
$528.58 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| 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 |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$528.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$506.32
|
| Rate for Payer: HFN Commercial |
$528.58
|
| 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 |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$41.62
|
| Rate for Payer: Preferred Network Access Commercial |
$528.58
|
| Rate for Payer: Quartz Beloit One Network |
$244.82
|
| Rate for Payer: Quartz Commercial |
$317.15
|
| 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 |
$306.02
|
| Rate for Payer: WPS Commercial |
$138.74
|
|
|
XR Pelvis 1 or 2 Views
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 72170
|
| Hospital Charge Code |
630285
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| 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 |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| 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 |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| 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 |
$306.02
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Pelvis 1 or 2 Views
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
1537228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna Commercial |
$570.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$19.41
|
| Rate for Payer: Anthem Medicare Advantage |
$19.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.41
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$570.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.41
|
| Rate for Payer: Health EOS Commercial |
$546.07
|
| Rate for Payer: HFN Commercial |
$570.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.41
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$29.11
|
| Rate for Payer: Preferred Network Access Commercial |
$570.08
|
| Rate for Payer: Quartz Beloit One Network |
$264.04
|
| Rate for Payer: Quartz Commercial |
$342.05
|
| Rate for Payer: Quartz Medicare Advantage |
$19.41
|
| Rate for Payer: The Alliance Commercial |
$73.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.41
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
XR Pelvis 1 or 2 Views
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
1537228
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.63 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$168.02
|
| 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 |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.81
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.06
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$360.05
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$390.05
|
| Rate for Payer: Quartz Medicare Advantage |
$360.05
|
| Rate for Payer: The Alliance Commercial |
$77.63
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Pelvis 1 View
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
6182059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.04 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$360.05
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Pelvis 1 View
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
6182059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$77.63 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$168.02
|
| 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 |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.81
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.06
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$360.05
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$390.05
|
| Rate for Payer: Quartz Medicare Advantage |
$360.05
|
| Rate for Payer: The Alliance Commercial |
$77.63
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Pelvis 1 View
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
CPT 72170 TC
|
| Hospital Charge Code |
6182059
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$19.41 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna Commercial |
$570.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$19.41
|
| Rate for Payer: Anthem Medicare Advantage |
$19.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.41
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$570.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.41
|
| Rate for Payer: Health EOS Commercial |
$546.07
|
| Rate for Payer: HFN Commercial |
$570.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.41
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$29.11
|
| Rate for Payer: Preferred Network Access Commercial |
$570.08
|
| Rate for Payer: Quartz Beloit One Network |
$264.04
|
| Rate for Payer: Quartz Commercial |
$342.05
|
| Rate for Payer: Quartz Medicare Advantage |
$19.41
|
| Rate for Payer: The Alliance Commercial |
$73.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.41
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Facility
|
IP
|
$711.00
|
|
|
Service Code
|
CPT 72190 TC
|
| Hospital Charge Code |
1537230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.33 |
| Max. Negotiated Rate |
$680.28 |
| Rate for Payer: Aetna Commercial |
$665.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.90
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$680.28
|
| Rate for Payer: Health EOS Commercial |
$658.10
|
| Rate for Payer: HFN Commercial |
$680.28
|
| Rate for Payer: Multiplan Commercial |
$591.55
|
| Rate for Payer: Preferred Network Access Commercial |
$680.28
|
| Rate for Payer: Quartz Beloit One Network |
$362.33
|
| Rate for Payer: Quartz Commercial |
$443.66
|
| Rate for Payer: WEA Trust Commercial |
$406.69
|
| Rate for Payer: WPS Commercial |
$547.68
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Facility
|
OP
|
$711.00
|
|
|
Service Code
|
CPT 72190 TC
|
| Hospital Charge Code |
1537230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$680.28 |
| Rate for Payer: Aetna Commercial |
$665.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.92
|
| Rate for Payer: Aetna Managed Medicare |
$207.04
|
| 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 |
$391.90
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$680.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$413.80
|
| Rate for Payer: Health EOS Commercial |
$658.10
|
| Rate for Payer: HFN Commercial |
$680.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.58
|
| Rate for Payer: Multiplan Commercial |
$591.55
|
| Rate for Payer: NAPHCARE Commercial |
$443.66
|
| Rate for Payer: Preferred Network Access Commercial |
$680.28
|
| Rate for Payer: Quartz Beloit One Network |
$362.33
|
| Rate for Payer: Quartz Commercial |
$480.64
|
| Rate for Payer: Quartz Medicare Advantage |
$443.66
|
| Rate for Payer: The Alliance Commercial |
$122.89
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$406.69
|
| Rate for Payer: WPS Commercial |
$547.68
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
630281
|
| Min. Negotiated Rate |
$42.93 |
| Max. Negotiated Rate |
$675.79 |
| Rate for Payer: Aetna Commercial |
$675.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| 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 |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$675.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$355.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.93
|
| Rate for Payer: Health EOS Commercial |
$647.34
|
| Rate for Payer: HFN Commercial |
$675.79
|
| 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 |
$569.09
|
| Rate for Payer: NAPHCARE Commercial |
$64.40
|
| Rate for Payer: Preferred Network Access Commercial |
$675.79
|
| Rate for Payer: Quartz Beloit One Network |
$313.00
|
| Rate for Payer: Quartz Commercial |
$405.48
|
| 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 |
$391.25
|
| Rate for Payer: WPS Commercial |
$214.66
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
630281
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$462.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$355.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$341.45
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| 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 |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$398.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| 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 |
$569.09
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$462.38
|
| 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 |
$391.25
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 72190
|
| Hospital Charge Code |
630281
|
| Min. Negotiated Rate |
$348.57 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$426.82
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
XR Pelvis Complete Minimum 3 Views
|
Professional
|
Both
|
$711.00
|
|
|
Service Code
|
CPT 72190 TC
|
| Hospital Charge Code |
1537230
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$702.47 |
| Rate for Payer: Aetna Commercial |
$702.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.92
|
| Rate for Payer: Aetna Managed Medicare |
$30.72
|
| Rate for Payer: Anthem Medicare Advantage |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.72
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cash Price |
$213.30
|
| Rate for Payer: Cigna Commercial |
$702.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.72
|
| Rate for Payer: Health EOS Commercial |
$672.89
|
| Rate for Payer: HFN Commercial |
$702.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$591.55
|
| Rate for Payer: NAPHCARE Commercial |
$46.08
|
| Rate for Payer: Preferred Network Access Commercial |
$702.47
|
| Rate for Payer: Quartz Beloit One Network |
$325.35
|
| Rate for Payer: Quartz Commercial |
$421.48
|
| Rate for Payer: Quartz Medicare Advantage |
$30.72
|
| Rate for Payer: The Alliance Commercial |
$116.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.72
|
| Rate for Payer: WEA Trust Commercial |
$406.69
|
| Rate for Payer: WPS Commercial |
$153.61
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 73540
|
| Hospital Charge Code |
630287
|
| Min. Negotiated Rate |
$308.82 |
| Max. Negotiated Rate |
$579.82 |
| Rate for Payer: Aetna Commercial |
$567.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.03
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$579.82
|
| Rate for Payer: Health EOS Commercial |
$560.91
|
| Rate for Payer: HFN Commercial |
$579.82
|
| Rate for Payer: Multiplan Commercial |
$504.19
|
| Rate for Payer: Preferred Network Access Commercial |
$579.82
|
| Rate for Payer: Quartz Beloit One Network |
$308.82
|
| Rate for Payer: Quartz Commercial |
$378.14
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
|
XR Pelvis + Hips Infant/Child
|
Professional
|
Both
|
$646.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$638.25 |
| Rate for Payer: Aetna Commercial |
$638.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Aetna Managed Medicare |
$30.72
|
| Rate for Payer: Anthem Medicare Advantage |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.72
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$638.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.72
|
| Rate for Payer: Health EOS Commercial |
$611.37
|
| Rate for Payer: HFN Commercial |
$638.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: NAPHCARE Commercial |
$46.08
|
| Rate for Payer: Preferred Network Access Commercial |
$638.25
|
| Rate for Payer: Quartz Beloit One Network |
$295.61
|
| Rate for Payer: Quartz Commercial |
$382.95
|
| Rate for Payer: Quartz Medicare Advantage |
$30.72
|
| Rate for Payer: The Alliance Commercial |
$116.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.72
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$153.61
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Aetna Managed Medicare |
$188.12
|
| 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 |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.97
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.88
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: NAPHCARE Commercial |
$403.10
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$436.70
|
| Rate for Payer: Quartz Medicare Advantage |
$403.10
|
| Rate for Payer: The Alliance Commercial |
$122.89
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 73521 TC
|
| Hospital Charge Code |
1537226
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$403.10
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
XR Pelvis + Hips Infant/Child
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
CPT 73540
|
| Hospital Charge Code |
630287
|
| Min. Negotiated Rate |
$277.31 |
| Max. Negotiated Rate |
$598.73 |
| Rate for Payer: Aetna Commercial |
$598.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$598.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.14
|
| Rate for Payer: Health EOS Commercial |
$573.52
|
| Rate for Payer: HFN Commercial |
$598.73
|
| Rate for Payer: Multiplan Commercial |
$504.19
|
| Rate for Payer: Preferred Network Access Commercial |
$598.73
|
| Rate for Payer: Quartz Beloit One Network |
$277.31
|
| Rate for Payer: Quartz Commercial |
$359.24
|
| Rate for Payer: The Alliance Commercial |
$315.12
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
|
XR Pelvis + Hips Infant/Child
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 73540
|
| Hospital Charge Code |
630287
|
| Min. Negotiated Rate |
$176.47 |
| Max. Negotiated Rate |
$579.82 |
| Rate for Payer: Aetna Commercial |
$567.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.01
|
| Rate for Payer: Aetna Managed Medicare |
$176.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$409.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$315.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$302.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.03
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$579.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.69
|
| Rate for Payer: Health EOS Commercial |
$560.91
|
| Rate for Payer: HFN Commercial |
$579.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.68
|
| Rate for Payer: Multiplan Commercial |
$504.19
|
| Rate for Payer: NAPHCARE Commercial |
$378.14
|
| Rate for Payer: Preferred Network Access Commercial |
$579.82
|
| Rate for Payer: Quartz Beloit One Network |
$308.82
|
| Rate for Payer: Quartz Commercial |
$409.66
|
| Rate for Payer: Quartz Medicare Advantage |
$378.14
|
| Rate for Payer: The Alliance Commercial |
$315.12
|
| Rate for Payer: WEA Trust Commercial |
$346.63
|
| Rate for Payer: WPS Commercial |
$466.80
|
|
|
XR PICC Line Placement
|
Facility
|
IP
|
$2,506.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2587247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,277.06 |
| Max. Negotiated Rate |
$2,397.74 |
| Rate for Payer: Aetna Commercial |
$2,345.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.31
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,397.74
|
| Rate for Payer: Health EOS Commercial |
$2,319.55
|
| Rate for Payer: HFN Commercial |
$2,397.74
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.06
|
| Rate for Payer: Quartz Commercial |
$1,563.74
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: WPS Commercial |
$1,930.37
|
|
|
XR PICC Line Placement
|
Professional
|
Both
|
$2,506.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2587247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.24 |
| Max. Negotiated Rate |
$2,475.93 |
| Rate for Payer: Aetna Commercial |
$2,475.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Aetna Managed Medicare |
$70.24
|
| Rate for Payer: Anthem Medicare Advantage |
$70.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.24
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,475.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$320.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.24
|
| Rate for Payer: Health EOS Commercial |
$2,371.68
|
| Rate for Payer: HFN Commercial |
$2,475.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.24
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: NAPHCARE Commercial |
$105.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,475.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,146.75
|
| Rate for Payer: Quartz Commercial |
$1,485.56
|
| Rate for Payer: Quartz Medicare Advantage |
$70.24
|
| Rate for Payer: The Alliance Commercial |
$298.53
|
| Rate for Payer: United Healthcare Medicaid |
$320.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.24
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: WPS Commercial |
$316.09
|
|
|
XR PICC Line Placement
|
Facility
|
OP
|
$2,506.00
|
|
|
Service Code
|
CPT 36573
|
| Hospital Charge Code |
2587247
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Commercial |
$2,345.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,241.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,694.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,303.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,381.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cash Price |
$751.80
|
| Rate for Payer: Cigna Commercial |
$2,397.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$2,319.55
|
| Rate for Payer: HFN Commercial |
$2,397.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$2,084.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,397.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.06
|
| Rate for Payer: Quartz Commercial |
$1,694.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,433.43
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$1,930.37
|
|
