|
XR Spine Single View Specify Level
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630006
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
XR Spine Single View Specify Level
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630006
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| 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 |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| 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 |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$279.50
|
| 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 |
$236.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
XR Spine Single View Specify Level
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537359
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$268.20
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
XR Spine Single View Specify Level
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537359
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$1,788.00 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.14
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.25
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$268.20
|
| Rate for Payer: The Alliance Commercial |
$1,788.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
XR Spine Thoracic 2 Views
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
5510673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Aetna Commercial |
$608.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$551.26
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$608.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$320.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.60
|
| Rate for Payer: Health EOS Commercial |
$583.31
|
| Rate for Payer: HFN Commercial |
$608.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.79
|
| Rate for Payer: Multiplan Commercial |
$512.80
|
| Rate for Payer: Preferred Network Access Commercial |
$608.95
|
| Rate for Payer: Quartz Beloit One Network |
$282.04
|
| Rate for Payer: Quartz Commercial |
$365.37
|
| Rate for Payer: The Alliance Commercial |
$320.50
|
| Rate for Payer: WEA Trust Commercial |
$352.55
|
| Rate for Payer: WPS Commercial |
$474.79
|
|
|
XR Spine Thoracic 2 Views
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
630002
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$563.35 |
| Rate for Payer: Aetna Commercial |
$563.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.98
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$563.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$296.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.80
|
| Rate for Payer: Health EOS Commercial |
$539.63
|
| Rate for Payer: HFN Commercial |
$563.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.07
|
| Rate for Payer: Multiplan Commercial |
$474.40
|
| Rate for Payer: Preferred Network Access Commercial |
$563.35
|
| Rate for Payer: Quartz Beloit One Network |
$260.92
|
| Rate for Payer: Quartz Commercial |
$338.01
|
| Rate for Payer: The Alliance Commercial |
$296.50
|
| Rate for Payer: WEA Trust Commercial |
$326.15
|
| Rate for Payer: WPS Commercial |
$439.24
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
630002
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$545.56 |
| Rate for Payer: Aetna Commercial |
$533.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.98
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$385.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$296.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$284.64
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.29
|
| 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 |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$545.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$527.77
|
| Rate for Payer: HFN Commercial |
$545.56
|
| 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 |
$474.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$545.56
|
| Rate for Payer: Quartz Beloit One Network |
$290.57
|
| Rate for Payer: Quartz Commercial |
$385.45
|
| 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 |
$326.15
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$439.24
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
5510673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.48 |
| Max. Negotiated Rate |
$2,564.00 |
| Rate for Payer: Aetna Commercial |
$576.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$551.26
|
| Rate for Payer: Aetna Managed Medicare |
$179.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$416.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$320.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.73
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$589.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.70
|
| Rate for Payer: Health EOS Commercial |
$570.49
|
| Rate for Payer: HFN Commercial |
$589.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$480.75
|
| Rate for Payer: Multiplan Commercial |
$512.80
|
| Rate for Payer: NAPHCARE Commercial |
$384.60
|
| Rate for Payer: Preferred Network Access Commercial |
$589.72
|
| Rate for Payer: Quartz Beloit One Network |
$314.09
|
| Rate for Payer: Quartz Commercial |
$416.65
|
| Rate for Payer: Quartz Medicare Advantage |
$384.60
|
| Rate for Payer: The Alliance Commercial |
$2,564.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$352.55
|
| Rate for Payer: WPS Commercial |
$474.79
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
630002
|
| Min. Negotiated Rate |
$290.57 |
| Max. Negotiated Rate |
$545.56 |
| Rate for Payer: Aetna Commercial |
$533.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.29
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$545.56
|
| Rate for Payer: Health EOS Commercial |
$527.77
|
| Rate for Payer: HFN Commercial |
$545.56
|
| Rate for Payer: Multiplan Commercial |
$474.40
|
| Rate for Payer: NAPHCARE Commercial |
$355.80
|
| Rate for Payer: Preferred Network Access Commercial |
$545.56
|
| Rate for Payer: Quartz Beloit One Network |
$290.57
|
| Rate for Payer: Quartz Commercial |
$355.80
|
| Rate for Payer: WEA Trust Commercial |
$326.15
|
| Rate for Payer: WPS Commercial |
$439.24
|
|
|
XR Spine Thoracic 2 Views
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
1537361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.79 |
| Max. Negotiated Rate |
$608.95 |
| Rate for Payer: Aetna Commercial |
$608.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$551.26
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$608.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$320.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.60
|
| Rate for Payer: Health EOS Commercial |
$583.31
|
| Rate for Payer: HFN Commercial |
$608.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.79
|
| Rate for Payer: Multiplan Commercial |
$512.80
|
| Rate for Payer: Preferred Network Access Commercial |
$608.95
|
| Rate for Payer: Quartz Beloit One Network |
$282.04
|
| Rate for Payer: Quartz Commercial |
$365.37
|
| Rate for Payer: The Alliance Commercial |
$320.50
|
| Rate for Payer: WEA Trust Commercial |
$352.55
|
| Rate for Payer: WPS Commercial |
$474.79
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
1537361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$314.09 |
| Max. Negotiated Rate |
$589.72 |
| Rate for Payer: Aetna Commercial |
$576.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$551.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.73
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$589.72
|
| Rate for Payer: Health EOS Commercial |
$570.49
|
| Rate for Payer: HFN Commercial |
$589.72
|
| Rate for Payer: Multiplan Commercial |
$512.80
|
| Rate for Payer: NAPHCARE Commercial |
$384.60
|
| Rate for Payer: Preferred Network Access Commercial |
$589.72
|
| Rate for Payer: Quartz Beloit One Network |
$314.09
|
| Rate for Payer: Quartz Commercial |
$384.60
|
| Rate for Payer: WEA Trust Commercial |
$352.55
|
| Rate for Payer: WPS Commercial |
$474.79
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
5510673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$314.09 |
| Max. Negotiated Rate |
$589.72 |
| Rate for Payer: Aetna Commercial |
$576.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$551.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.73
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$589.72
|
| Rate for Payer: Health EOS Commercial |
$570.49
|
| Rate for Payer: HFN Commercial |
$589.72
|
| Rate for Payer: Multiplan Commercial |
$512.80
|
| Rate for Payer: NAPHCARE Commercial |
$384.60
|
| Rate for Payer: Preferred Network Access Commercial |
$589.72
|
| Rate for Payer: Quartz Beloit One Network |
$314.09
|
| Rate for Payer: Quartz Commercial |
$384.60
|
| Rate for Payer: WEA Trust Commercial |
$352.55
|
| Rate for Payer: WPS Commercial |
$474.79
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
1537361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$179.48 |
| Max. Negotiated Rate |
$2,564.00 |
| Rate for Payer: Aetna Commercial |
$576.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$551.26
|
| Rate for Payer: Aetna Managed Medicare |
$179.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$416.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$320.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.73
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$589.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.70
|
| Rate for Payer: Health EOS Commercial |
$570.49
|
| Rate for Payer: HFN Commercial |
$589.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$480.75
|
| Rate for Payer: Multiplan Commercial |
$512.80
|
| Rate for Payer: NAPHCARE Commercial |
$384.60
|
| Rate for Payer: Preferred Network Access Commercial |
$589.72
|
| Rate for Payer: Quartz Beloit One Network |
$314.09
|
| Rate for Payer: Quartz Commercial |
$416.65
|
| Rate for Payer: Quartz Medicare Advantage |
$384.60
|
| Rate for Payer: The Alliance Commercial |
$2,564.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$352.55
|
| Rate for Payer: WPS Commercial |
$474.79
|
|
|
XR Spine Thoracic 3 Views
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
629997
|
| Min. Negotiated Rate |
$132.34 |
| Max. Negotiated Rate |
$700.15 |
| Rate for Payer: Aetna Commercial |
$700.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.82
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$700.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$368.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.20
|
| Rate for Payer: Health EOS Commercial |
$670.67
|
| Rate for Payer: HFN Commercial |
$700.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.34
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: Preferred Network Access Commercial |
$700.15
|
| Rate for Payer: Quartz Beloit One Network |
$324.28
|
| Rate for Payer: Quartz Commercial |
$420.09
|
| Rate for Payer: The Alliance Commercial |
$368.50
|
| Rate for Payer: WEA Trust Commercial |
$405.35
|
| Rate for Payer: WPS Commercial |
$545.90
|
|
|
XR Spine Thoracic 3 Views
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 72072 TC
|
| Hospital Charge Code |
1537363
|
|
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 Thoracic 3 Views
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
629997
|
| Min. Negotiated Rate |
$361.13 |
| Max. Negotiated Rate |
$678.04 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.61
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$678.04
|
| Rate for Payer: Health EOS Commercial |
$655.93
|
| Rate for Payer: HFN Commercial |
$678.04
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: NAPHCARE Commercial |
$442.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.04
|
| Rate for Payer: Quartz Beloit One Network |
$361.13
|
| Rate for Payer: Quartz Commercial |
$442.20
|
| Rate for Payer: WEA Trust Commercial |
$405.35
|
| Rate for Payer: WPS Commercial |
$545.90
|
|
|
XR Spine Thoracic 3 Views
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
CPT 72072 TC
|
| Hospital Charge Code |
1537363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.36 |
| 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 |
$94.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.36
|
| 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 Thoracic 3 Views
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 72072 TC
|
| Hospital Charge Code |
1537363
|
|
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 Thoracic 3 Views
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
629997
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$678.04 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$479.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$368.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$353.76
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.61
|
| 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 |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$678.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$412.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$655.93
|
| Rate for Payer: HFN Commercial |
$678.04
|
| 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 |
$589.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$678.04
|
| Rate for Payer: Quartz Beloit One Network |
$361.13
|
| Rate for Payer: Quartz Commercial |
$479.05
|
| 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 |
$405.35
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$545.90
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT 72074 TC
|
| Hospital Charge Code |
1537365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$212.52 |
| Max. Negotiated Rate |
$3,036.00 |
| Rate for Payer: Aetna Commercial |
$683.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.74
|
| Rate for Payer: Aetna Managed Medicare |
$212.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$493.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.27
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$698.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.74
|
| Rate for Payer: Health EOS Commercial |
$675.51
|
| Rate for Payer: HFN Commercial |
$698.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.25
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: NAPHCARE Commercial |
$455.40
|
| Rate for Payer: Preferred Network Access Commercial |
$698.28
|
| Rate for Payer: Quartz Beloit One Network |
$371.91
|
| Rate for Payer: Quartz Commercial |
$493.35
|
| Rate for Payer: Quartz Medicare Advantage |
$455.40
|
| Rate for Payer: The Alliance Commercial |
$3,036.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$417.45
|
| Rate for Payer: WPS Commercial |
$562.19
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
629994
|
| Min. Negotiated Rate |
$151.05 |
| Max. Negotiated Rate |
$693.50 |
| Rate for Payer: Aetna Commercial |
$693.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$693.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$365.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.00
|
| Rate for Payer: Health EOS Commercial |
$664.30
|
| Rate for Payer: HFN Commercial |
$693.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.05
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: Preferred Network Access Commercial |
$693.50
|
| Rate for Payer: Quartz Beloit One Network |
$321.20
|
| Rate for Payer: Quartz Commercial |
$416.10
|
| Rate for Payer: The Alliance Commercial |
$365.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
629994
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$671.60 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$474.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$365.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$350.40
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| 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 |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| 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 |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$474.50
|
| 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 |
$401.50
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
629994
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$671.60 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$438.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
CPT 72074 TC
|
| Hospital Charge Code |
1537365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$109.47 |
| Max. Negotiated Rate |
$721.05 |
| Rate for Payer: Aetna Commercial |
$721.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.74
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$721.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.40
|
| Rate for Payer: Health EOS Commercial |
$690.69
|
| Rate for Payer: HFN Commercial |
$721.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.47
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$721.05
|
| Rate for Payer: Quartz Beloit One Network |
$333.96
|
| Rate for Payer: Quartz Commercial |
$432.63
|
| Rate for Payer: The Alliance Commercial |
$379.50
|
| Rate for Payer: WEA Trust Commercial |
$417.45
|
| Rate for Payer: WPS Commercial |
$562.19
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT 72074 TC
|
| Hospital Charge Code |
1537365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$371.91 |
| Max. Negotiated Rate |
$698.28 |
| Rate for Payer: Aetna Commercial |
$683.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.27
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$698.28
|
| Rate for Payer: Health EOS Commercial |
$675.51
|
| Rate for Payer: HFN Commercial |
$698.28
|
| Rate for Payer: Multiplan Commercial |
$607.20
|
| Rate for Payer: NAPHCARE Commercial |
$455.40
|
| Rate for Payer: Preferred Network Access Commercial |
$698.28
|
| Rate for Payer: Quartz Beloit One Network |
$371.91
|
| Rate for Payer: Quartz Commercial |
$455.40
|
| Rate for Payer: WEA Trust Commercial |
$417.45
|
| Rate for Payer: WPS Commercial |
$562.19
|
|
