|
CT Spine Cervical w/ Contrast
|
Professional
|
Both
|
$4,283.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
629608
|
| Min. Negotiated Rate |
$623.54 |
| 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: 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 |
$2,569.80
|
| Rate for Payer: Health EOS Commercial |
$3,897.53
|
| Rate for Payer: HFN Commercial |
$4,068.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$623.54
|
| 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: The Alliance Commercial |
$2,141.50
|
| Rate for Payer: WEA Trust Commercial |
$2,355.65
|
| Rate for Payer: WPS Commercial |
$3,172.42
|
|
|
CT Spine Cervical w/ Contrast
|
Facility
|
OP
|
$4,283.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
629608
|
| Min. Negotiated Rate |
$380.12 |
| 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 |
$380.12
|
| 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 |
$380.12
|
| 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 |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| 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 |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,396.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| 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 |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$3,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| 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 |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$2,355.65
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,172.42
|
|
|
CT Spine Cervical w/ Contrast
|
Facility
|
IP
|
$4,283.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
629608
|
| Min. Negotiated Rate |
$2,098.67 |
| 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: 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 Cervical w/ Contrast
|
Facility
|
OP
|
$4,364.00
|
|
|
Service Code
|
CPT 72126 TC
|
| Hospital Charge Code |
1241253
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,221.92 |
| 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: Cigna Commercial |
$4,014.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,442.09
|
| 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 |
$3,232.41
|
|
|
CT Spine Cervical w/o Contrast
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
629610
|
| Min. Negotiated Rate |
$478.10 |
| Max. Negotiated Rate |
$3,171.10 |
| Rate for Payer: Aetna Commercial |
$3,171.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,870.68
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,171.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,669.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,002.80
|
| Rate for Payer: Health EOS Commercial |
$3,037.58
|
| Rate for Payer: HFN Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$478.10
|
| Rate for Payer: Multiplan Commercial |
$2,670.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,171.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,468.72
|
| Rate for Payer: Quartz Commercial |
$1,902.66
|
| Rate for Payer: The Alliance Commercial |
$1,669.00
|
| Rate for Payer: WEA Trust Commercial |
$1,835.90
|
| Rate for Payer: WPS Commercial |
$2,472.46
|
|
|
CT Spine Cervical w/o Contrast
|
Facility
|
IP
|
$3,338.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
629610
|
| Min. Negotiated Rate |
$1,635.62 |
| Max. Negotiated Rate |
$3,070.96 |
| Rate for Payer: Aetna Commercial |
$3,004.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,870.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,769.14
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,070.96
|
| Rate for Payer: Health EOS Commercial |
$2,970.82
|
| Rate for Payer: HFN Commercial |
$3,070.96
|
| Rate for Payer: Multiplan Commercial |
$2,670.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,002.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,070.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,635.62
|
| Rate for Payer: Quartz Commercial |
$2,002.80
|
| Rate for Payer: WEA Trust Commercial |
$1,835.90
|
| Rate for Payer: WPS Commercial |
$2,472.46
|
|
|
CT Spine Cervical w/o Contrast
|
Facility
|
OP
|
$841.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
2950238
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$235.48 |
| Max. Negotiated Rate |
$3,364.00 |
| Rate for Payer: Aetna Commercial |
$756.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.26
|
| Rate for Payer: Aetna Managed Medicare |
$235.48
|
| 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 |
$445.73
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$773.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$470.62
|
| Rate for Payer: Health EOS Commercial |
$748.49
|
| Rate for Payer: HFN Commercial |
$773.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$630.75
|
| Rate for Payer: Multiplan Commercial |
$672.80
|
| Rate for Payer: NAPHCARE Commercial |
$504.60
|
| Rate for Payer: Preferred Network Access Commercial |
$773.72
|
| Rate for Payer: Quartz Beloit One Network |
$412.09
|
| Rate for Payer: Quartz Commercial |
$546.65
|
| Rate for Payer: Quartz Medicare Advantage |
$504.60
|
| Rate for Payer: The Alliance Commercial |
$3,364.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$462.55
|
| Rate for Payer: WPS Commercial |
$622.93
|
|
|
CT Spine Cervical w/o Contrast
|
Facility
|
OP
|
$3,338.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
629610
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$3,070.96 |
| Rate for Payer: Aetna Commercial |
$3,004.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,870.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,169.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,669.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,602.24
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,769.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,070.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,867.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,970.82
|
| Rate for Payer: HFN Commercial |
$3,070.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$2,670.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,070.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,635.62
|
| Rate for Payer: Quartz Commercial |
$2,169.70
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,835.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$2,472.46
|
|
|
CT Spine Cervical w/o Contrast
|
Facility
|
IP
|
$841.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
2950238
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$412.09 |
| Max. Negotiated Rate |
$773.72 |
| Rate for Payer: Aetna Commercial |
$756.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.73
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$773.72
|
| Rate for Payer: Health EOS Commercial |
$748.49
|
| Rate for Payer: HFN Commercial |
$773.72
|
| Rate for Payer: Multiplan Commercial |
$672.80
|
| Rate for Payer: NAPHCARE Commercial |
$504.60
|
| Rate for Payer: Preferred Network Access Commercial |
$773.72
|
| Rate for Payer: Quartz Beloit One Network |
$412.09
|
| Rate for Payer: Quartz Commercial |
$504.60
|
| Rate for Payer: WEA Trust Commercial |
$462.55
|
| Rate for Payer: WPS Commercial |
$622.93
|
|
|
CT Spine Cervical w/o Contrast
|
Professional
|
Both
|
$3,883.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
1241255
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$311.35 |
| Max. Negotiated Rate |
$3,688.85 |
| Rate for Payer: Aetna Commercial |
$3,688.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,688.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,941.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,329.80
|
| Rate for Payer: Health EOS Commercial |
$3,533.53
|
| Rate for Payer: HFN Commercial |
$3,688.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$311.35
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,688.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,708.52
|
| Rate for Payer: Quartz Commercial |
$2,213.31
|
| Rate for Payer: The Alliance Commercial |
$1,941.50
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
CT Spine Cervical w/o Contrast
|
Professional
|
Both
|
$841.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
2950238
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$311.35 |
| Max. Negotiated Rate |
$798.95 |
| Rate for Payer: Aetna Commercial |
$798.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.26
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$798.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$420.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.60
|
| Rate for Payer: Health EOS Commercial |
$765.31
|
| Rate for Payer: HFN Commercial |
$798.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$311.35
|
| Rate for Payer: Multiplan Commercial |
$672.80
|
| Rate for Payer: Preferred Network Access Commercial |
$798.95
|
| Rate for Payer: Quartz Beloit One Network |
$370.04
|
| Rate for Payer: Quartz Commercial |
$479.37
|
| Rate for Payer: The Alliance Commercial |
$420.50
|
| Rate for Payer: WEA Trust Commercial |
$462.55
|
| Rate for Payer: WPS Commercial |
$622.93
|
|
|
CT Spine Cervical w/o Contrast
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
1241255
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,902.67 |
| Max. Negotiated Rate |
$3,572.36 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,057.99
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| Rate for Payer: Health EOS Commercial |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,329.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,329.80
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
CT Spine Cervical w/o Contrast
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 72125 TC
|
| Hospital Charge Code |
1241255
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,087.24 |
| Max. Negotiated Rate |
$15,532.00 |
| Rate for Payer: Aetna Commercial |
$3,494.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,339.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,087.24
|
| 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 |
$2,057.99
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,572.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,172.93
|
| Rate for Payer: Health EOS Commercial |
$3,455.87
|
| Rate for Payer: HFN Commercial |
$3,572.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,912.25
|
| Rate for Payer: Multiplan Commercial |
$3,106.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,329.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,572.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,902.67
|
| Rate for Payer: Quartz Commercial |
$2,523.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,329.80
|
| Rate for Payer: The Alliance Commercial |
$15,532.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,135.65
|
| Rate for Payer: WPS Commercial |
$2,876.14
|
|
|
CT Spine Cervical w/ + w/o Contrast
|
Facility
|
OP
|
$5,246.00
|
|
|
Service Code
|
CPT 72127 TC
|
| Hospital Charge Code |
1241251
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,468.88 |
| Max. Negotiated Rate |
$20,984.00 |
| Rate for Payer: Aetna Commercial |
$4,721.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,511.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,468.88
|
| 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 |
$2,780.38
|
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Cigna Commercial |
$4,826.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,935.66
|
| Rate for Payer: Health EOS Commercial |
$4,668.94
|
| Rate for Payer: HFN Commercial |
$4,826.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,934.50
|
| Rate for Payer: Multiplan Commercial |
$4,196.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,826.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,570.54
|
| Rate for Payer: Quartz Commercial |
$3,409.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,147.60
|
| Rate for Payer: The Alliance Commercial |
$20,984.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,885.30
|
| Rate for Payer: WPS Commercial |
$3,885.71
|
|
|
CT Spine Cervical w/ + w/o Contrast
|
Professional
|
Both
|
$5,148.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
629606
|
| Min. Negotiated Rate |
$731.80 |
| 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: 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 |
$3,088.80
|
| Rate for Payer: Health EOS Commercial |
$4,684.68
|
| Rate for Payer: HFN Commercial |
$4,890.60
|
| 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: 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: The Alliance Commercial |
$2,574.00
|
| Rate for Payer: WEA Trust Commercial |
$2,831.40
|
| Rate for Payer: WPS Commercial |
$3,813.12
|
|
|
CT Spine Cervical w/ + w/o Contrast
|
Professional
|
Both
|
$5,246.00
|
|
|
Service Code
|
CPT 72127 TC
|
| Hospital Charge Code |
1241251
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$521.35 |
| Max. Negotiated Rate |
$4,983.70 |
| Rate for Payer: Aetna Commercial |
$4,983.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,511.56
|
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Cigna Commercial |
$4,983.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,623.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,147.60
|
| Rate for Payer: Health EOS Commercial |
$4,773.86
|
| Rate for Payer: HFN Commercial |
$4,983.70
|
| 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: Multiplan Commercial |
$4,196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,983.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,308.24
|
| Rate for Payer: Quartz Commercial |
$2,990.22
|
| Rate for Payer: The Alliance Commercial |
$2,623.00
|
| Rate for Payer: WEA Trust Commercial |
$2,885.30
|
| Rate for Payer: WPS Commercial |
$3,885.71
|
|
|
CT Spine Cervical w/ + w/o Contrast
|
Facility
|
IP
|
$5,246.00
|
|
|
Service Code
|
CPT 72127 TC
|
| Hospital Charge Code |
1241251
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,570.54 |
| Max. Negotiated Rate |
$4,826.32 |
| Rate for Payer: Aetna Commercial |
$4,721.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,511.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,780.38
|
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Cigna Commercial |
$4,826.32
|
| Rate for Payer: Health EOS Commercial |
$4,668.94
|
| Rate for Payer: HFN Commercial |
$4,826.32
|
| Rate for Payer: Multiplan Commercial |
$4,196.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,826.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,570.54
|
| Rate for Payer: Quartz Commercial |
$3,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,885.30
|
| Rate for Payer: WPS Commercial |
$3,885.71
|
|
|
CT Spine Cervical w/ + w/o Contrast
|
Facility
|
OP
|
$5,148.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
629606
|
| Min. Negotiated Rate |
$181.60 |
| 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 DHI/DHP/ASO |
$2,880.82
|
| 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 |
$726.40
|
| 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 Cervical w/ + w/o Contrast
|
Facility
|
IP
|
$5,148.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
629606
|
| Min. Negotiated Rate |
$2,522.52 |
| 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: 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 Stereo w/o Contrast
|
Facility
|
IP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
5724169
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$3,218.12
|
| 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 Stereo w/o Contrast
|
Facility
|
OP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
5724169
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,047.76 |
| 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: Cigna Commercial |
$3,442.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,094.02
|
| 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 |
$2,771.70
|
|
|
CT Spine Lumbar Stereo w/o Contrast
|
Professional
|
Both
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
5724169
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$309.02 |
| 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: 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 |
$2,245.20
|
| Rate for Payer: Health EOS Commercial |
$3,405.22
|
| Rate for Payer: HFN Commercial |
$3,554.90
|
| 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: 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: The Alliance Commercial |
$1,871.00
|
| Rate for Payer: WEA Trust Commercial |
$2,058.10
|
| Rate for Payer: WPS Commercial |
$2,771.70
|
|
|
CT Spine Lumbar w/ Contrast
|
Professional
|
Both
|
$3,917.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
630052
|
| Min. Negotiated Rate |
$623.54 |
| Max. Negotiated Rate |
$3,721.15 |
| Rate for Payer: Aetna Commercial |
$3,721.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,368.62
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,721.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,958.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,350.20
|
| Rate for Payer: Health EOS Commercial |
$3,564.47
|
| Rate for Payer: HFN Commercial |
$3,721.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$623.54
|
| Rate for Payer: Multiplan Commercial |
$3,133.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,721.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,723.48
|
| Rate for Payer: Quartz Commercial |
$2,232.69
|
| Rate for Payer: The Alliance Commercial |
$1,958.50
|
| Rate for Payer: WEA Trust Commercial |
$2,154.35
|
| Rate for Payer: WPS Commercial |
$2,901.32
|
|
|
CT Spine Lumbar w/ Contrast
|
Facility
|
IP
|
$4,484.00
|
|
|
Service Code
|
CPT 72132 TC
|
| Hospital Charge Code |
1241268
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,197.16 |
| Max. Negotiated Rate |
$4,125.28 |
| Rate for Payer: Aetna Commercial |
$4,035.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,856.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,376.52
|
| Rate for Payer: Cash Price |
$1,345.20
|
| Rate for Payer: Cigna Commercial |
$4,125.28
|
| Rate for Payer: Health EOS Commercial |
$3,990.76
|
| Rate for Payer: HFN Commercial |
$4,125.28
|
| Rate for Payer: Multiplan Commercial |
$3,587.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,690.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,125.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,197.16
|
| Rate for Payer: Quartz Commercial |
$2,690.40
|
| Rate for Payer: WEA Trust Commercial |
$2,466.20
|
| Rate for Payer: WPS Commercial |
$3,321.30
|
|
|
CT Spine Lumbar w/ Contrast
|
Facility
|
OP
|
$4,484.00
|
|
|
Service Code
|
CPT 72132 TC
|
| Hospital Charge Code |
1241268
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,255.52 |
| Max. Negotiated Rate |
$17,936.00 |
| Rate for Payer: Aetna Commercial |
$4,035.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,856.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,255.52
|
| 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 |
$2,376.52
|
| Rate for Payer: Cash Price |
$1,345.20
|
| Rate for Payer: Cash Price |
$1,345.20
|
| Rate for Payer: Cash Price |
$1,345.20
|
| Rate for Payer: Cigna Commercial |
$4,125.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,509.25
|
| Rate for Payer: Health EOS Commercial |
$3,990.76
|
| Rate for Payer: HFN Commercial |
$4,125.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,363.00
|
| Rate for Payer: Multiplan Commercial |
$3,587.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,690.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,125.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,197.16
|
| Rate for Payer: Quartz Commercial |
$2,914.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,690.40
|
| Rate for Payer: The Alliance Commercial |
$17,936.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,466.20
|
| Rate for Payer: WPS Commercial |
$3,321.30
|
|
