|
CT Spine Lumbar w/o Contrast
|
Facility
OP
|
$3,198.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
630056
|
| Min. Negotiated Rate |
$2.88 |
| Max. Negotiated Rate |
$2,942.16 |
| Rate for Payer: Aetna Commercial |
$2,878.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,750.28
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,078.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,599.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,535.04
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,694.94
|
| 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 |
$959.40
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cigna Commercial |
$2,942.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,846.22
|
| Rate for Payer: HFN Commercial |
$2,942.16
|
| 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 |
$2,558.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,942.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,567.02
|
| Rate for Payer: Quartz Commercial |
$2,078.70
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$2.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,758.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$2,368.76
|
|
|
CT Spine Lumbar w/o Contrast
|
Facility
OP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
1241270
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$584.43 |
| Max. Negotiated Rate |
$14,968.00 |
| Rate for Payer: Aetna Commercial |
$3,367.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,218.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,047.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,983.26
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,442.64
|
| Rate for Payer: Health EOS Commercial |
$3,330.38
|
| Rate for Payer: HFN Commercial |
$3,442.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,806.50
|
| Rate for Payer: Multiplan Commercial |
$2,993.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,245.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,442.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,833.58
|
| Rate for Payer: Quartz Commercial |
$2,432.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,245.20
|
| Rate for Payer: The Alliance Commercial |
$14,968.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,058.10
|
| Rate for Payer: WPS Commercial |
$584.43
|
|
|
CT Spine Lumbar w/o Contrast
|
Professional
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
1241270
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$3,554.90 |
| Rate for Payer: Aetna Commercial |
$3,554.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,218.12
|
| Rate for Payer: Aetna Managed Medicare |
$83.49
|
| Rate for Payer: Anthem Medicare Advantage |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.49
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,554.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,871.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.49
|
| Rate for Payer: Health EOS Commercial |
$3,405.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$309.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.49
|
| Rate for Payer: Multiplan Commercial |
$2,993.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,554.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,646.48
|
| Rate for Payer: Quartz Commercial |
$2,132.94
|
| Rate for Payer: Quartz Medicare Advantage |
$83.49
|
| Rate for Payer: The Alliance Commercial |
$317.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.49
|
| Rate for Payer: WEA Trust Commercial |
$2,058.10
|
| Rate for Payer: WPS Commercial |
$417.45
|
|
|
CT Spine Lumbar w/o Contrast
|
Facility
IP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
1241270
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,833.58 |
| Max. Negotiated Rate |
$3,442.64 |
| Rate for Payer: Aetna Commercial |
$3,367.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,983.26
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,442.64
|
| Rate for Payer: Health EOS Commercial |
$3,330.38
|
| Rate for Payer: HFN Commercial |
$3,442.64
|
| Rate for Payer: Multiplan Commercial |
$2,993.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,245.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,442.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,833.58
|
| Rate for Payer: Quartz Commercial |
$2,245.20
|
| Rate for Payer: WEA Trust Commercial |
$2,058.10
|
| Rate for Payer: WPS Commercial |
$2,771.70
|
|
|
CT Spine Lumbar w/ + w/o Contrast
|
Facility
IP
|
$5,148.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
630049
|
| Min. Negotiated Rate |
$2,522.52 |
| Max. Negotiated Rate |
$4,736.16 |
| Rate for Payer: Aetna Commercial |
$4,633.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,728.44
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,736.16
|
| Rate for Payer: Health EOS Commercial |
$4,581.72
|
| Rate for Payer: HFN Commercial |
$4,736.16
|
| Rate for Payer: Multiplan Commercial |
$4,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,088.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,736.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,522.52
|
| Rate for Payer: Quartz Commercial |
$3,088.80
|
| Rate for Payer: WEA Trust Commercial |
$2,831.40
|
| Rate for Payer: WPS Commercial |
$3,813.12
|
|
|
CT Spine Lumbar w/ + w/o Contrast
|
Facility
IP
|
$5,052.00
|
|
|
Service Code
|
CPT 72133 TC
|
| Hospital Charge Code |
1241266
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,475.48 |
| Max. Negotiated Rate |
$4,647.84 |
| Rate for Payer: Aetna Commercial |
$4,546.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,677.56
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,647.84
|
| Rate for Payer: Health EOS Commercial |
$4,496.28
|
| Rate for Payer: HFN Commercial |
$4,647.84
|
| Rate for Payer: Multiplan Commercial |
$4,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,031.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,647.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,475.48
|
| Rate for Payer: Quartz Commercial |
$3,031.20
|
| Rate for Payer: WEA Trust Commercial |
$2,778.60
|
| Rate for Payer: WPS Commercial |
$3,742.02
|
|
|
CT Spine Lumbar w/ + w/o Contrast
|
Facility
OP
|
$5,148.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
630049
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$4,736.16 |
| Rate for Payer: Aetna Commercial |
$4,633.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,427.28
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,346.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,574.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,471.04
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,728.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,736.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$4,581.72
|
| Rate for Payer: HFN Commercial |
$4,736.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$4,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,736.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,522.52
|
| Rate for Payer: Quartz Commercial |
$3,346.20
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$8.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,831.40
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,813.12
|
|
|
CT Spine Lumbar w/ + w/o Contrast
|
Professional
|
$5,148.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
630049
|
| Min. Negotiated Rate |
$198.52 |
| Max. Negotiated Rate |
$4,890.60 |
| Rate for Payer: Aetna Commercial |
$4,890.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,427.28
|
| Rate for Payer: Aetna Managed Medicare |
$198.52
|
| Rate for Payer: Anthem Medicare Advantage |
$198.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.52
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,890.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,574.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.52
|
| Rate for Payer: Health EOS Commercial |
$4,684.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$731.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$731.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.52
|
| Rate for Payer: Multiplan Commercial |
$4,118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,890.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,265.12
|
| Rate for Payer: Quartz Commercial |
$2,934.36
|
| Rate for Payer: Quartz Medicare Advantage |
$198.52
|
| Rate for Payer: The Alliance Commercial |
$754.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.52
|
| Rate for Payer: WEA Trust Commercial |
$2,831.40
|
| Rate for Payer: WPS Commercial |
$992.60
|
|
|
CT Spine Lumbar w/ + w/o Contrast
|
Facility
OP
|
$5,052.00
|
|
|
Service Code
|
CPT 72133 TC
|
| Hospital Charge Code |
1241266
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$979.51 |
| Max. Negotiated Rate |
$20,208.00 |
| Rate for Payer: Aetna Commercial |
$4,546.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,344.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,414.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,677.56
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,647.84
|
| Rate for Payer: Health EOS Commercial |
$4,496.28
|
| Rate for Payer: HFN Commercial |
$4,647.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,789.00
|
| Rate for Payer: Multiplan Commercial |
$4,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,031.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,647.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,475.48
|
| Rate for Payer: Quartz Commercial |
$3,283.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,031.20
|
| Rate for Payer: The Alliance Commercial |
$20,208.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,778.60
|
| Rate for Payer: WPS Commercial |
$979.51
|
|
|
CT Spine Lumbar w/ + w/o Contrast
|
Professional
|
$5,052.00
|
|
|
Service Code
|
CPT 72133 TC
|
| Hospital Charge Code |
1241266
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$139.93 |
| Max. Negotiated Rate |
$4,799.40 |
| Rate for Payer: Aetna Commercial |
$4,799.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,344.72
|
| Rate for Payer: Aetna Managed Medicare |
$139.93
|
| Rate for Payer: Anthem Medicare Advantage |
$139.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$139.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$139.93
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,799.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,526.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.93
|
| Rate for Payer: Health EOS Commercial |
$4,597.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$521.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$139.93
|
| Rate for Payer: Multiplan Commercial |
$4,041.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,799.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,222.88
|
| Rate for Payer: Quartz Commercial |
$2,879.64
|
| Rate for Payer: Quartz Medicare Advantage |
$139.93
|
| Rate for Payer: The Alliance Commercial |
$531.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$139.93
|
| Rate for Payer: WEA Trust Commercial |
$2,778.60
|
| Rate for Payer: WPS Commercial |
$699.65
|
|
|
CT Spine Thoracic w/ Contrast
|
Facility
OP
|
$4,364.00
|
|
|
Service Code
|
CPT 72129 TC
|
| Hospital Charge Code |
1241274
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$796.95 |
| Max. Negotiated Rate |
$17,456.00 |
| Rate for Payer: Aetna Commercial |
$3,927.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,753.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,221.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,312.92
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cigna Commercial |
$4,014.88
|
| Rate for Payer: Health EOS Commercial |
$3,883.96
|
| Rate for Payer: HFN Commercial |
$4,014.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,273.00
|
| Rate for Payer: Multiplan Commercial |
$3,491.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,618.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,014.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,138.36
|
| Rate for Payer: Quartz Commercial |
$2,836.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,618.40
|
| Rate for Payer: The Alliance Commercial |
$17,456.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,400.20
|
| Rate for Payer: WPS Commercial |
$796.95
|
|
|
CT Spine Thoracic w/ Contrast
|
Facility
OP
|
$4,283.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
630168
|
| Min. Negotiated Rate |
$0.08 |
| Max. Negotiated Rate |
$3,940.36 |
| Rate for Payer: Aetna Commercial |
$3,854.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,683.38
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,783.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,141.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,055.84
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cigna Commercial |
$3,940.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$3,811.87
|
| Rate for Payer: HFN Commercial |
$3,940.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$3,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,940.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.67
|
| Rate for Payer: Quartz Commercial |
$2,783.95
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,355.65
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,172.42
|
|
|
CT Spine Thoracic w/ Contrast
|
Professional
|
$4,364.00
|
|
|
Service Code
|
CPT 72129 TC
|
| Hospital Charge Code |
1241274
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$113.85 |
| Max. Negotiated Rate |
$4,145.80 |
| Rate for Payer: Aetna Commercial |
$4,145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,753.04
|
| Rate for Payer: Aetna Managed Medicare |
$113.85
|
| Rate for Payer: Anthem Medicare Advantage |
$113.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.85
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cigna Commercial |
$4,145.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.85
|
| Rate for Payer: Health EOS Commercial |
$3,971.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.85
|
| Rate for Payer: Multiplan Commercial |
$3,491.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,145.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,920.16
|
| Rate for Payer: Quartz Commercial |
$2,487.48
|
| Rate for Payer: Quartz Medicare Advantage |
$113.85
|
| Rate for Payer: The Alliance Commercial |
$432.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.85
|
| Rate for Payer: WEA Trust Commercial |
$2,400.20
|
| Rate for Payer: WPS Commercial |
$569.25
|
|
|
CT Spine Thoracic w/ Contrast
|
Professional
|
$4,283.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
630168
|
| Min. Negotiated Rate |
$170.11 |
| Max. Negotiated Rate |
$4,068.85 |
| Rate for Payer: Aetna Commercial |
$4,068.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,683.38
|
| Rate for Payer: Aetna Managed Medicare |
$170.11
|
| Rate for Payer: Anthem Medicare Advantage |
$170.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.11
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cigna Commercial |
$4,068.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,141.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.11
|
| Rate for Payer: Health EOS Commercial |
$3,897.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$627.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.11
|
| Rate for Payer: Multiplan Commercial |
$3,426.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,068.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.52
|
| Rate for Payer: Quartz Commercial |
$2,441.31
|
| Rate for Payer: Quartz Medicare Advantage |
$170.11
|
| Rate for Payer: The Alliance Commercial |
$646.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.11
|
| Rate for Payer: WEA Trust Commercial |
$2,355.65
|
| Rate for Payer: WPS Commercial |
$850.55
|
|
|
CT Spine Thoracic w/ Contrast
|
Facility
IP
|
$4,364.00
|
|
|
Service Code
|
CPT 72129 TC
|
| Hospital Charge Code |
1241274
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,138.36 |
| Max. Negotiated Rate |
$4,014.88 |
| Rate for Payer: Aetna Commercial |
$3,927.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,312.92
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cigna Commercial |
$4,014.88
|
| Rate for Payer: Health EOS Commercial |
$3,883.96
|
| Rate for Payer: HFN Commercial |
$4,014.88
|
| Rate for Payer: Multiplan Commercial |
$3,491.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,618.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,014.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,138.36
|
| Rate for Payer: Quartz Commercial |
$2,618.40
|
| Rate for Payer: WEA Trust Commercial |
$2,400.20
|
| Rate for Payer: WPS Commercial |
$3,232.41
|
|
|
CT Spine Thoracic w/ Contrast
|
Facility
IP
|
$4,283.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
630168
|
| Min. Negotiated Rate |
$2,098.67 |
| Max. Negotiated Rate |
$3,940.36 |
| Rate for Payer: Aetna Commercial |
$3,854.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,269.99
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cigna Commercial |
$3,940.36
|
| Rate for Payer: Health EOS Commercial |
$3,811.87
|
| Rate for Payer: HFN Commercial |
$3,940.36
|
| Rate for Payer: Multiplan Commercial |
$3,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,569.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,940.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,098.67
|
| Rate for Payer: Quartz Commercial |
$2,569.80
|
| Rate for Payer: WEA Trust Commercial |
$2,355.65
|
| Rate for Payer: WPS Commercial |
$3,172.42
|
|
|
CT Spine Thoracic w/o Contrast
|
Facility
IP
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
1241276
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,859.06 |
| Max. Negotiated Rate |
$3,490.48 |
| Rate for Payer: Aetna Commercial |
$3,414.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,010.82
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,490.48
|
| Rate for Payer: Health EOS Commercial |
$3,376.66
|
| Rate for Payer: HFN Commercial |
$3,490.48
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,276.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,490.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,859.06
|
| Rate for Payer: Quartz Commercial |
$2,276.40
|
| Rate for Payer: WEA Trust Commercial |
$2,086.70
|
| Rate for Payer: WPS Commercial |
$2,810.22
|
|
|
CT Spine Thoracic w/o Contrast
|
Facility
OP
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
1241276
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$588.91 |
| Max. Negotiated Rate |
$15,176.00 |
| Rate for Payer: Aetna Commercial |
$3,414.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,262.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,062.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,010.82
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,490.48
|
| Rate for Payer: Health EOS Commercial |
$3,376.66
|
| Rate for Payer: HFN Commercial |
$3,490.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,845.50
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,276.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,490.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,859.06
|
| Rate for Payer: Quartz Commercial |
$2,466.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,276.40
|
| Rate for Payer: The Alliance Commercial |
$15,176.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,086.70
|
| Rate for Payer: WPS Commercial |
$588.91
|
|
|
CT Spine Thoracic w/o Contrast
|
Facility
OP
|
$3,344.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
630172
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$3,076.48 |
| Rate for Payer: Aetna Commercial |
$3,009.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,875.84
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,173.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,672.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,605.12
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,772.32
|
| 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 |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,076.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,976.16
|
| Rate for Payer: HFN Commercial |
$3,076.48
|
| 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 |
$2,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,076.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,638.56
|
| Rate for Payer: Quartz Commercial |
$2,173.60
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$15.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,839.20
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$2,476.90
|
|
|
CT Spine Thoracic w/o Contrast
|
Professional
|
$3,344.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
630172
|
| Min. Negotiated Rate |
$130.03 |
| Max. Negotiated Rate |
$3,176.80 |
| Rate for Payer: Aetna Commercial |
$3,176.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,875.84
|
| Rate for Payer: Aetna Managed Medicare |
$130.03
|
| Rate for Payer: Anthem Medicare Advantage |
$130.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.03
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,176.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,672.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.03
|
| Rate for Payer: Health EOS Commercial |
$3,043.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$476.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$476.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.03
|
| Rate for Payer: Multiplan Commercial |
$2,675.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,176.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,471.36
|
| Rate for Payer: Quartz Commercial |
$1,906.08
|
| Rate for Payer: Quartz Medicare Advantage |
$130.03
|
| Rate for Payer: The Alliance Commercial |
$494.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.03
|
| Rate for Payer: WEA Trust Commercial |
$1,839.20
|
| Rate for Payer: WPS Commercial |
$650.15
|
|
|
CT Spine Thoracic w/o Contrast
|
Facility
IP
|
$3,344.00
|
|
|
Service Code
|
CPT 72128
|
| Hospital Charge Code |
630172
|
| Min. Negotiated Rate |
$1,638.56 |
| Max. Negotiated Rate |
$3,076.48 |
| Rate for Payer: Aetna Commercial |
$3,009.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,772.32
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,076.48
|
| Rate for Payer: Health EOS Commercial |
$2,976.16
|
| Rate for Payer: HFN Commercial |
$3,076.48
|
| Rate for Payer: Multiplan Commercial |
$2,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,006.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,076.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,638.56
|
| Rate for Payer: Quartz Commercial |
$2,006.40
|
| Rate for Payer: WEA Trust Commercial |
$1,839.20
|
| Rate for Payer: WPS Commercial |
$2,476.90
|
|
|
CT Spine Thoracic w/o Contrast
|
Professional
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
1241276
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$84.13 |
| Max. Negotiated Rate |
$3,604.30 |
| Rate for Payer: Aetna Commercial |
$3,604.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,262.84
|
| Rate for Payer: Aetna Managed Medicare |
$84.13
|
| Rate for Payer: Anthem Medicare Advantage |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.13
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,604.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,897.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.13
|
| Rate for Payer: Health EOS Commercial |
$3,452.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.13
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,604.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,669.36
|
| Rate for Payer: Quartz Commercial |
$2,162.58
|
| Rate for Payer: Quartz Medicare Advantage |
$84.13
|
| Rate for Payer: The Alliance Commercial |
$319.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.13
|
| Rate for Payer: WEA Trust Commercial |
$2,086.70
|
| Rate for Payer: WPS Commercial |
$420.65
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Facility
OP
|
$5,052.00
|
|
|
Service Code
|
CPT 72130 TC
|
| Hospital Charge Code |
1241272
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$988.54 |
| Max. Negotiated Rate |
$20,208.00 |
| Rate for Payer: Aetna Commercial |
$4,546.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,344.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,414.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,677.56
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,647.84
|
| Rate for Payer: Health EOS Commercial |
$4,496.28
|
| Rate for Payer: HFN Commercial |
$4,647.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,789.00
|
| Rate for Payer: Multiplan Commercial |
$4,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,031.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,647.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,475.48
|
| Rate for Payer: Quartz Commercial |
$3,283.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,031.20
|
| Rate for Payer: The Alliance Commercial |
$20,208.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,778.60
|
| Rate for Payer: WPS Commercial |
$988.54
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Professional
|
$5,052.00
|
|
|
Service Code
|
CPT 72130 TC
|
| Hospital Charge Code |
1241272
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$141.22 |
| Max. Negotiated Rate |
$4,799.40 |
| Rate for Payer: Aetna Commercial |
$4,799.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,344.72
|
| Rate for Payer: Aetna Managed Medicare |
$141.22
|
| Rate for Payer: Anthem Medicare Advantage |
$141.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.22
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,799.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,526.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.22
|
| Rate for Payer: Health EOS Commercial |
$4,597.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$524.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$524.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.22
|
| Rate for Payer: Multiplan Commercial |
$4,041.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,799.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,222.88
|
| Rate for Payer: Quartz Commercial |
$2,879.64
|
| Rate for Payer: Quartz Medicare Advantage |
$141.22
|
| Rate for Payer: The Alliance Commercial |
$536.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.22
|
| Rate for Payer: WEA Trust Commercial |
$2,778.60
|
| Rate for Payer: WPS Commercial |
$706.10
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Facility
IP
|
$5,052.00
|
|
|
Service Code
|
CPT 72130 TC
|
| Hospital Charge Code |
1241272
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,475.48 |
| Max. Negotiated Rate |
$4,647.84 |
| Rate for Payer: Aetna Commercial |
$4,546.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,677.56
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,647.84
|
| Rate for Payer: Health EOS Commercial |
$4,496.28
|
| Rate for Payer: HFN Commercial |
$4,647.84
|
| Rate for Payer: Multiplan Commercial |
$4,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,031.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,647.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,475.48
|
| Rate for Payer: Quartz Commercial |
$3,031.20
|
| Rate for Payer: WEA Trust Commercial |
$2,778.60
|
| Rate for Payer: WPS Commercial |
$3,742.02
|
|
