|
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 |
$219.80 |
| Max. Negotiated Rate |
$3,140.00 |
| Rate for Payer: Aetna Commercial |
$706.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.10
|
| Rate for Payer: Aetna Managed Medicare |
$219.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$510.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.05
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$722.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.29
|
| Rate for Payer: Health EOS Commercial |
$698.65
|
| Rate for Payer: HFN Commercial |
$722.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.75
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: NAPHCARE Commercial |
$471.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.20
|
| Rate for Payer: Quartz Beloit One Network |
$384.65
|
| Rate for Payer: Quartz Commercial |
$510.25
|
| Rate for Payer: Quartz Medicare Advantage |
$471.00
|
| Rate for Payer: The Alliance Commercial |
$3,140.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$431.75
|
| Rate for Payer: WPS Commercial |
$581.45
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
629612
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$719.44 |
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.52
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$508.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$391.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$375.36
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$719.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$695.98
|
| Rate for Payer: HFN Commercial |
$719.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$719.44
|
| Rate for Payer: Quartz Beloit One Network |
$383.18
|
| Rate for Payer: Quartz Commercial |
$508.30
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$430.10
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$579.23
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
629612
|
| Min. Negotiated Rate |
$383.18 |
| Max. Negotiated Rate |
$719.44 |
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.46
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$719.44
|
| Rate for Payer: Health EOS Commercial |
$695.98
|
| Rate for Payer: HFN Commercial |
$719.44
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: NAPHCARE Commercial |
$469.20
|
| Rate for Payer: Preferred Network Access Commercial |
$719.44
|
| Rate for Payer: Quartz Beloit One Network |
$383.18
|
| Rate for Payer: Quartz Commercial |
$469.20
|
| Rate for Payer: WEA Trust Commercial |
$430.10
|
| Rate for Payer: WPS Commercial |
$579.23
|
|
|
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 |
$132.62 |
| Max. Negotiated Rate |
$745.75 |
| Rate for Payer: Aetna Commercial |
$745.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.10
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$745.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$392.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$471.00
|
| Rate for Payer: Health EOS Commercial |
$714.35
|
| Rate for Payer: HFN Commercial |
$745.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.62
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: Preferred Network Access Commercial |
$745.75
|
| Rate for Payer: Quartz Beloit One Network |
$345.40
|
| Rate for Payer: Quartz Commercial |
$447.45
|
| Rate for Payer: The Alliance Commercial |
$392.50
|
| Rate for Payer: WEA Trust Commercial |
$431.75
|
| Rate for Payer: WPS Commercial |
$581.45
|
|
|
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 |
$384.65 |
| Max. Negotiated Rate |
$722.20 |
| Rate for Payer: Aetna Commercial |
$706.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.05
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$722.20
|
| Rate for Payer: Health EOS Commercial |
$698.65
|
| Rate for Payer: HFN Commercial |
$722.20
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: NAPHCARE Commercial |
$471.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.20
|
| Rate for Payer: Quartz Beloit One Network |
$384.65
|
| Rate for Payer: Quartz Commercial |
$471.00
|
| Rate for Payer: WEA Trust Commercial |
$431.75
|
| Rate for Payer: WPS Commercial |
$581.45
|
|
|
XR Spine Cervical Minimum 4 Views
|
Professional
|
Both
|
$782.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
629612
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Aetna Commercial |
$742.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.52
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.20
|
| Rate for Payer: Health EOS Commercial |
$711.62
|
| Rate for Payer: HFN Commercial |
$742.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.01
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Preferred Network Access Commercial |
$742.90
|
| Rate for Payer: Quartz Beloit One Network |
$344.08
|
| Rate for Payer: Quartz Commercial |
$445.74
|
| Rate for Payer: The Alliance Commercial |
$391.00
|
| Rate for Payer: WEA Trust Commercial |
$430.10
|
| Rate for Payer: WPS Commercial |
$579.23
|
|
|
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 |
$725.69 |
| Max. Negotiated Rate |
$1,362.52 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$888.60
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
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 |
$160.47 |
| Max. Negotiated Rate |
$1,406.95 |
| Rate for Payer: Aetna Commercial |
$1,406.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,406.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$740.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$888.60
|
| Rate for Payer: Health EOS Commercial |
$1,347.71
|
| Rate for Payer: HFN Commercial |
$1,406.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$160.47
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.95
|
| Rate for Payer: Quartz Beloit One Network |
$651.64
|
| Rate for Payer: Quartz Commercial |
$844.17
|
| Rate for Payer: The Alliance Commercial |
$740.50
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$5,924.00 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Aetna Managed Medicare |
$414.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$962.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$740.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$710.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.75
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$962.65
|
| Rate for Payer: Quartz Medicare Advantage |
$888.60
|
| Rate for Payer: The Alliance Commercial |
$5,924.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Aetna Commercial |
$1,081.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.68
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,081.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$569.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$682.80
|
| Rate for Payer: Health EOS Commercial |
$1,035.58
|
| Rate for Payer: HFN Commercial |
$1,081.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.56
|
| Rate for Payer: Multiplan Commercial |
$910.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,081.10
|
| Rate for Payer: Quartz Beloit One Network |
$500.72
|
| Rate for Payer: Quartz Commercial |
$648.66
|
| Rate for Payer: The Alliance Commercial |
$569.00
|
| Rate for Payer: WEA Trust Commercial |
$625.90
|
| Rate for Payer: WPS Commercial |
$842.92
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| Min. Negotiated Rate |
$557.62 |
| Max. Negotiated Rate |
$1,046.96 |
| Rate for Payer: Aetna Commercial |
$1,024.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.14
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,046.96
|
| Rate for Payer: Health EOS Commercial |
$1,012.82
|
| Rate for Payer: HFN Commercial |
$1,046.96
|
| Rate for Payer: Multiplan Commercial |
$910.40
|
| Rate for Payer: NAPHCARE Commercial |
$682.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.96
|
| Rate for Payer: Quartz Beloit One Network |
$557.62
|
| Rate for Payer: Quartz Commercial |
$682.80
|
| Rate for Payer: WEA Trust Commercial |
$625.90
|
| Rate for Payer: WPS Commercial |
$842.92
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,046.96 |
| Rate for Payer: Aetna Commercial |
$1,024.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$739.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$569.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$546.24
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,046.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,012.82
|
| Rate for Payer: HFN Commercial |
$1,046.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$910.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.96
|
| Rate for Payer: Quartz Beloit One Network |
$557.62
|
| Rate for Payer: Quartz Commercial |
$739.70
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$625.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$842.92
|
|
|
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 |
$596.82 |
| Max. Negotiated Rate |
$1,120.56 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.54
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$730.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$730.80
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
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 |
$261.43 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Aetna Commercial |
$1,157.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,157.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$609.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.80
|
| Rate for Payer: Health EOS Commercial |
$1,108.38
|
| Rate for Payer: HFN Commercial |
$1,157.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.43
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.10
|
| Rate for Payer: Quartz Beloit One Network |
$535.92
|
| Rate for Payer: Quartz Commercial |
$694.26
|
| Rate for Payer: The Alliance Commercial |
$609.00
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
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 |
$301.00 |
| Max. Negotiated Rate |
$4,872.00 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Aetna Managed Medicare |
$341.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$791.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$609.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$584.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.54
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.59
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$913.50
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$730.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$791.70
|
| Rate for Payer: Quartz Medicare Advantage |
$730.80
|
| Rate for Payer: The Alliance Commercial |
$4,872.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$623.76 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.44
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$440.70
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$332.22 |
| Max. Negotiated Rate |
$623.76 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$406.80
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$406.80
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
XR Spine Lumbar Flexion + Extension
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$134.56 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna Commercial |
$644.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$644.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$339.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.80
|
| Rate for Payer: Health EOS Commercial |
$616.98
|
| Rate for Payer: HFN Commercial |
$644.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.56
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: Preferred Network Access Commercial |
$644.10
|
| Rate for Payer: Quartz Beloit One Network |
$298.32
|
| Rate for Payer: Quartz Commercial |
$386.46
|
| Rate for Payer: The Alliance Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
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 |
$100.15 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$551.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.00
|
| Rate for Payer: Health EOS Commercial |
$527.80
|
| Rate for Payer: HFN Commercial |
$551.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.15
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$551.00
|
| Rate for Payer: Quartz Beloit One Network |
$255.20
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$290.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
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 |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
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 |
$162.40 |
| Max. Negotiated Rate |
$2,320.00 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$162.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$377.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$290.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$278.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.57
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$435.00
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$348.00
|
| Rate for Payer: The Alliance Commercial |
$2,320.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
1537347
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna Commercial |
$695.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$695.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$366.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.20
|
| Rate for Payer: Health EOS Commercial |
$666.12
|
| Rate for Payer: HFN Commercial |
$695.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$96.65
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Preferred Network Access Commercial |
$695.40
|
| Rate for Payer: Quartz Beloit One Network |
$322.08
|
| Rate for Payer: Quartz Commercial |
$417.24
|
| Rate for Payer: The Alliance Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
1537347
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$673.44 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$439.20
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
1537347
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$204.96 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Aetna Managed Medicare |
$204.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$475.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$366.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$351.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.63
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549.00
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$475.80
|
| Rate for Payer: Quartz Medicare Advantage |
$439.20
|
| Rate for Payer: The Alliance Commercial |
$2,928.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$623.76 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.44
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$440.70
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
