|
XR Spine Lumbosacral 2 or 3 Views
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
5510674
|
|
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 |
5510674
|
|
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
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| 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 Lumbosacral 2 or 3 Views
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| 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 Lumbosacral 2 or 3 Views
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
5510674
|
|
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 Complete w/ Bending
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 72114 TC
|
| Hospital Charge Code |
1537351
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$5,468.00 |
| Rate for Payer: Aetna Commercial |
$1,230.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.62
|
| Rate for Payer: Aetna Managed Medicare |
$382.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$888.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$683.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$656.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.51
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cigna Commercial |
$1,257.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$764.97
|
| Rate for Payer: Health EOS Commercial |
$1,216.63
|
| Rate for Payer: HFN Commercial |
$1,257.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,025.25
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: NAPHCARE Commercial |
$820.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,257.64
|
| Rate for Payer: Quartz Beloit One Network |
$669.83
|
| Rate for Payer: Quartz Commercial |
$888.55
|
| Rate for Payer: Quartz Medicare Advantage |
$820.20
|
| Rate for Payer: The Alliance Commercial |
$5,468.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$751.85
|
| Rate for Payer: WPS Commercial |
$1,012.54
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
630028
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,163.80 |
| Rate for Payer: Aetna Commercial |
$1,138.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.90
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.20
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.45
|
| 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 |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,163.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,125.85
|
| Rate for Payer: HFN Commercial |
$1,163.80
|
| 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 |
$1,012.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.80
|
| Rate for Payer: Quartz Beloit One Network |
$619.85
|
| Rate for Payer: Quartz Commercial |
$822.25
|
| 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 |
$695.75
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$936.99
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
CPT 72114 TC
|
| Hospital Charge Code |
1537351
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.31 |
| Max. Negotiated Rate |
$1,298.65 |
| Rate for Payer: Aetna Commercial |
$1,298.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.62
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cigna Commercial |
$1,298.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$683.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.20
|
| Rate for Payer: Health EOS Commercial |
$1,243.97
|
| Rate for Payer: HFN Commercial |
$1,298.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$159.31
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,298.65
|
| Rate for Payer: Quartz Beloit One Network |
$601.48
|
| Rate for Payer: Quartz Commercial |
$779.19
|
| Rate for Payer: The Alliance Commercial |
$683.50
|
| Rate for Payer: WEA Trust Commercial |
$751.85
|
| Rate for Payer: WPS Commercial |
$1,012.54
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
630028
|
| Min. Negotiated Rate |
$619.85 |
| Max. Negotiated Rate |
$1,163.80 |
| Rate for Payer: Aetna Commercial |
$1,138.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.45
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,163.80
|
| Rate for Payer: Health EOS Commercial |
$1,125.85
|
| Rate for Payer: HFN Commercial |
$1,163.80
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: NAPHCARE Commercial |
$759.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.80
|
| Rate for Payer: Quartz Beloit One Network |
$619.85
|
| Rate for Payer: Quartz Commercial |
$759.00
|
| Rate for Payer: WEA Trust Commercial |
$695.75
|
| Rate for Payer: WPS Commercial |
$936.99
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
630028
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$1,201.75 |
| Rate for Payer: Aetna Commercial |
$1,201.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.90
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,201.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$632.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$759.00
|
| Rate for Payer: Health EOS Commercial |
$1,151.15
|
| Rate for Payer: HFN Commercial |
$1,201.75
|
| 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 |
$1,012.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.75
|
| Rate for Payer: Quartz Beloit One Network |
$556.60
|
| Rate for Payer: Quartz Commercial |
$721.05
|
| Rate for Payer: The Alliance Commercial |
$632.50
|
| Rate for Payer: WEA Trust Commercial |
$695.75
|
| Rate for Payer: WPS Commercial |
$936.99
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 72114 TC
|
| Hospital Charge Code |
1537351
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$669.83 |
| Max. Negotiated Rate |
$1,257.64 |
| Rate for Payer: Aetna Commercial |
$1,230.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.51
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cigna Commercial |
$1,257.64
|
| Rate for Payer: Health EOS Commercial |
$1,216.63
|
| Rate for Payer: HFN Commercial |
$1,257.64
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: NAPHCARE Commercial |
$820.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,257.64
|
| Rate for Payer: Quartz Beloit One Network |
$669.83
|
| Rate for Payer: Quartz Commercial |
$820.20
|
| Rate for Payer: WEA Trust Commercial |
$751.85
|
| Rate for Payer: WPS Commercial |
$1,012.54
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
|
IP
|
$918.00
|
|
|
Service Code
|
CPT 72110 TC
|
| Hospital Charge Code |
1537353
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$449.82 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna Commercial |
$826.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.54
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$844.56
|
| Rate for Payer: Health EOS Commercial |
$817.02
|
| Rate for Payer: HFN Commercial |
$844.56
|
| Rate for Payer: Multiplan Commercial |
$734.40
|
| Rate for Payer: NAPHCARE Commercial |
$550.80
|
| Rate for Payer: Preferred Network Access Commercial |
$844.56
|
| Rate for Payer: Quartz Beloit One Network |
$449.82
|
| Rate for Payer: Quartz Commercial |
$550.80
|
| Rate for Payer: WEA Trust Commercial |
$504.90
|
| Rate for Payer: WPS Commercial |
$679.96
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
630022
|
| Min. Negotiated Rate |
$460.60 |
| Max. Negotiated Rate |
$864.80 |
| Rate for Payer: Aetna Commercial |
$846.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$808.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.20
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$864.80
|
| Rate for Payer: Health EOS Commercial |
$836.60
|
| Rate for Payer: HFN Commercial |
$864.80
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: NAPHCARE Commercial |
$564.00
|
| Rate for Payer: Preferred Network Access Commercial |
$864.80
|
| Rate for Payer: Quartz Beloit One Network |
$460.60
|
| Rate for Payer: Quartz Commercial |
$564.00
|
| Rate for Payer: WEA Trust Commercial |
$517.00
|
| Rate for Payer: WPS Commercial |
$696.26
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
|
OP
|
$918.00
|
|
|
Service Code
|
CPT 72110 TC
|
| Hospital Charge Code |
1537353
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$257.04 |
| Max. Negotiated Rate |
$3,672.00 |
| Rate for Payer: Aetna Commercial |
$826.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.48
|
| Rate for Payer: Aetna Managed Medicare |
$257.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.54
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$844.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$513.71
|
| Rate for Payer: Health EOS Commercial |
$817.02
|
| Rate for Payer: HFN Commercial |
$844.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$688.50
|
| Rate for Payer: Multiplan Commercial |
$734.40
|
| Rate for Payer: NAPHCARE Commercial |
$550.80
|
| Rate for Payer: Preferred Network Access Commercial |
$844.56
|
| Rate for Payer: Quartz Beloit One Network |
$449.82
|
| Rate for Payer: Quartz Commercial |
$596.70
|
| Rate for Payer: Quartz Medicare Advantage |
$550.80
|
| Rate for Payer: The Alliance Commercial |
$3,672.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$504.90
|
| Rate for Payer: WPS Commercial |
$679.96
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
630022
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$864.80 |
| Rate for Payer: Aetna Commercial |
$846.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$808.40
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$611.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$470.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$451.20
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.20
|
| 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 |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$864.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$526.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$836.60
|
| Rate for Payer: HFN Commercial |
$864.80
|
| 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 |
$752.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$864.80
|
| Rate for Payer: Quartz Beloit One Network |
$460.60
|
| Rate for Payer: Quartz Commercial |
$611.00
|
| 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 |
$517.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$696.26
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
630022
|
| Min. Negotiated Rate |
$171.98 |
| Max. Negotiated Rate |
$893.00 |
| Rate for Payer: Aetna Commercial |
$893.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$808.40
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$893.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$470.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$564.00
|
| Rate for Payer: Health EOS Commercial |
$855.40
|
| Rate for Payer: HFN Commercial |
$893.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.98
|
| Rate for Payer: Multiplan Commercial |
$752.00
|
| Rate for Payer: Preferred Network Access Commercial |
$893.00
|
| Rate for Payer: Quartz Beloit One Network |
$413.60
|
| Rate for Payer: Quartz Commercial |
$535.80
|
| Rate for Payer: The Alliance Commercial |
$470.00
|
| Rate for Payer: WEA Trust Commercial |
$517.00
|
| Rate for Payer: WPS Commercial |
$696.26
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
CPT 72110 TC
|
| Hospital Charge Code |
1537353
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$128.00 |
| Max. Negotiated Rate |
$872.10 |
| Rate for Payer: Aetna Commercial |
$872.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$789.48
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$872.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$459.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$550.80
|
| Rate for Payer: Health EOS Commercial |
$835.38
|
| Rate for Payer: HFN Commercial |
$872.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.00
|
| Rate for Payer: Multiplan Commercial |
$734.40
|
| Rate for Payer: Preferred Network Access Commercial |
$872.10
|
| Rate for Payer: Quartz Beloit One Network |
$403.92
|
| Rate for Payer: Quartz Commercial |
$523.26
|
| Rate for Payer: The Alliance Commercial |
$459.00
|
| Rate for Payer: WEA Trust Commercial |
$504.90
|
| Rate for Payer: WPS Commercial |
$679.96
|
|
|
XR Spine Scoliosis Study Standing
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
630017
|
| Min. Negotiated Rate |
$142.97 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Aetna Commercial |
$570.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$570.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.60
|
| Rate for Payer: Health EOS Commercial |
$546.91
|
| Rate for Payer: HFN Commercial |
$570.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.97
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: Preferred Network Access Commercial |
$570.95
|
| Rate for Payer: Quartz Beloit One Network |
$264.44
|
| Rate for Payer: Quartz Commercial |
$342.57
|
| Rate for Payer: The Alliance Commercial |
$300.50
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 72081 TC
|
| Hospital Charge Code |
1537355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$344.50
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$598.00
|
| Rate for Payer: Health EOS Commercial |
$578.50
|
| Rate for Payer: HFN Commercial |
$598.00
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: NAPHCARE Commercial |
$390.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.00
|
| Rate for Payer: Quartz Beloit One Network |
$318.50
|
| Rate for Payer: Quartz Commercial |
$390.00
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
|
XR Spine Scoliosis Study Standing
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
CPT 72081 TC
|
| Hospital Charge Code |
1537355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.98 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$617.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.00
|
| Rate for Payer: Health EOS Commercial |
$591.50
|
| Rate for Payer: HFN Commercial |
$617.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.98
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: Preferred Network Access Commercial |
$617.50
|
| Rate for Payer: Quartz Beloit One Network |
$286.00
|
| Rate for Payer: Quartz Commercial |
$370.50
|
| Rate for Payer: The Alliance Commercial |
$325.00
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
630017
|
| Min. Negotiated Rate |
$294.49 |
| Max. Negotiated Rate |
$552.92 |
| Rate for Payer: Aetna Commercial |
$540.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.53
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$552.92
|
| Rate for Payer: Health EOS Commercial |
$534.89
|
| Rate for Payer: HFN Commercial |
$552.92
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: NAPHCARE Commercial |
$360.60
|
| Rate for Payer: Preferred Network Access Commercial |
$552.92
|
| Rate for Payer: Quartz Beloit One Network |
$294.49
|
| Rate for Payer: Quartz Commercial |
$360.60
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
630017
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$552.92 |
| Rate for Payer: Aetna Commercial |
$540.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$300.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.48
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$552.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$534.89
|
| Rate for Payer: HFN Commercial |
$552.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$552.92
|
| Rate for Payer: Quartz Beloit One Network |
$294.49
|
| Rate for Payer: Quartz Commercial |
$390.65
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 72081 TC
|
| Hospital Charge Code |
1537355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Aetna Managed Medicare |
$182.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$422.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$325.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$344.50
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$598.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.74
|
| Rate for Payer: Health EOS Commercial |
$578.50
|
| Rate for Payer: HFN Commercial |
$598.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.50
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: NAPHCARE Commercial |
$390.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.00
|
| Rate for Payer: Quartz Beloit One Network |
$318.50
|
| Rate for Payer: Quartz Commercial |
$422.50
|
| Rate for Payer: Quartz Medicare Advantage |
$390.00
|
| Rate for Payer: The Alliance Commercial |
$2,600.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
|
XR Spine Single View Specify Level
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630006
|
| Min. Negotiated Rate |
$83.10 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$408.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.00
|
| Rate for Payer: Health EOS Commercial |
$391.30
|
| Rate for Payer: HFN Commercial |
$408.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.10
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Preferred Network Access Commercial |
$408.50
|
| Rate for Payer: Quartz Beloit One Network |
$189.20
|
| Rate for Payer: Quartz Commercial |
$245.10
|
| Rate for Payer: The Alliance Commercial |
$215.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
XR Spine Single View Specify Level
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537359
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$424.65 |
| Rate for Payer: Aetna Commercial |
$424.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$424.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.20
|
| Rate for Payer: Health EOS Commercial |
$406.77
|
| Rate for Payer: HFN Commercial |
$424.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.06
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$424.65
|
| Rate for Payer: Quartz Beloit One Network |
$196.68
|
| Rate for Payer: Quartz Commercial |
$254.79
|
| Rate for Payer: The Alliance Commercial |
$223.50
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
