|
CT Soft Tissue Neck w/ + w/o Contrast
|
Facility
|
IP
|
$4,064.00
|
|
|
Service Code
|
CPT 70492 TC
|
| Hospital Charge Code |
1241239
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,071.01 |
| Max. Negotiated Rate |
$3,888.44 |
| Rate for Payer: Aetna Commercial |
$3,803.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,634.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,240.08
|
| Rate for Payer: Cash Price |
$1,219.20
|
| Rate for Payer: Cigna Commercial |
$3,888.44
|
| Rate for Payer: Health EOS Commercial |
$3,761.64
|
| Rate for Payer: HFN Commercial |
$3,888.44
|
| Rate for Payer: Multiplan Commercial |
$3,381.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,888.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,071.01
|
| Rate for Payer: Quartz Commercial |
$2,535.94
|
| Rate for Payer: WEA Trust Commercial |
$2,324.61
|
| Rate for Payer: WPS Commercial |
$3,130.50
|
|
|
CT Spine Cervical w/ Contrast
|
Facility
|
OP
|
$4,283.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
629608
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,097.97 |
| Rate for Payer: Aetna Commercial |
$4,008.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.72
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,895.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,227.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,138.07
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cigna Commercial |
$4,097.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$3,964.34
|
| Rate for Payer: HFN Commercial |
$4,097.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$3,563.46
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.62
|
| Rate for Payer: Quartz Commercial |
$2,895.31
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,449.88
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,299.19
|
|
|
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 |
$445.45 |
| Max. Negotiated Rate |
$4,175.48 |
| Rate for Payer: Aetna Commercial |
$4,084.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,903.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,270.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,405.44
|
| 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 |
$4,175.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,539.85
|
| Rate for Payer: Health EOS Commercial |
$4,039.32
|
| Rate for Payer: HFN Commercial |
$4,175.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,403.92
|
| Rate for Payer: Multiplan Commercial |
$3,630.85
|
| Rate for Payer: NAPHCARE Commercial |
$2,723.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,175.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,223.89
|
| Rate for Payer: Quartz Commercial |
$2,950.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,723.14
|
| Rate for Payer: The Alliance Commercial |
$445.45
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,496.21
|
| Rate for Payer: WPS Commercial |
$779.54
|
|
|
CT Spine Cervical w/ Contrast
|
Professional
|
Both
|
$4,364.00
|
|
|
Service Code
|
CPT 72126 TC
|
| Hospital Charge Code |
1241253
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$111.36 |
| Max. Negotiated Rate |
$4,311.63 |
| Rate for Payer: Aetna Commercial |
$4,311.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,903.16
|
| Rate for Payer: Aetna Managed Medicare |
$111.36
|
| Rate for Payer: Anthem Medicare Advantage |
$111.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.36
|
| 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 |
$4,311.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,269.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.36
|
| Rate for Payer: Health EOS Commercial |
$4,130.09
|
| Rate for Payer: HFN Commercial |
$4,311.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$437.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.36
|
| Rate for Payer: Multiplan Commercial |
$3,630.85
|
| Rate for Payer: NAPHCARE Commercial |
$167.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,311.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.97
|
| Rate for Payer: Quartz Commercial |
$2,586.98
|
| Rate for Payer: Quartz Medicare Advantage |
$111.36
|
| Rate for Payer: The Alliance Commercial |
$423.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.36
|
| Rate for Payer: WEA Trust Commercial |
$2,496.21
|
| Rate for Payer: WPS Commercial |
$556.82
|
|
|
CT Spine Cervical w/ Contrast
|
Facility
|
IP
|
$4,283.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
629608
|
| Min. Negotiated Rate |
$2,182.62 |
| Max. Negotiated Rate |
$4,097.97 |
| Rate for Payer: Aetna Commercial |
$4,008.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.79
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cigna Commercial |
$4,097.97
|
| Rate for Payer: Health EOS Commercial |
$3,964.34
|
| Rate for Payer: HFN Commercial |
$4,097.97
|
| Rate for Payer: Multiplan Commercial |
$3,563.46
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.62
|
| Rate for Payer: Quartz Commercial |
$2,672.59
|
| Rate for Payer: WEA Trust Commercial |
$2,449.88
|
| Rate for Payer: WPS Commercial |
$3,299.19
|
|
|
CT Spine Cervical w/ Contrast
|
Facility
|
IP
|
$4,364.00
|
|
|
Service Code
|
CPT 72126 TC
|
| Hospital Charge Code |
1241253
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,223.89 |
| Max. Negotiated Rate |
$4,175.48 |
| Rate for Payer: Aetna Commercial |
$4,084.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,903.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,405.44
|
| Rate for Payer: Cash Price |
$1,309.20
|
| Rate for Payer: Cigna Commercial |
$4,175.48
|
| Rate for Payer: Health EOS Commercial |
$4,039.32
|
| Rate for Payer: HFN Commercial |
$4,175.48
|
| Rate for Payer: Multiplan Commercial |
$3,630.85
|
| Rate for Payer: Preferred Network Access Commercial |
$4,175.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,223.89
|
| Rate for Payer: Quartz Commercial |
$2,723.14
|
| Rate for Payer: WEA Trust Commercial |
$2,496.21
|
| Rate for Payer: WPS Commercial |
$3,361.59
|
|
|
CT Spine Cervical w/ Contrast
|
Professional
|
Both
|
$4,283.00
|
|
|
Service Code
|
CPT 72126
|
| Hospital Charge Code |
629608
|
| Min. Negotiated Rate |
$167.43 |
| Max. Negotiated Rate |
$4,231.60 |
| Rate for Payer: Aetna Commercial |
$4,231.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.72
|
| Rate for Payer: Aetna Managed Medicare |
$167.43
|
| Rate for Payer: Anthem Medicare Advantage |
$167.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$167.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$167.43
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cash Price |
$1,284.90
|
| Rate for Payer: Cigna Commercial |
$4,231.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,227.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.43
|
| Rate for Payer: Health EOS Commercial |
$4,053.43
|
| Rate for Payer: HFN Commercial |
$4,231.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$648.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$648.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$167.43
|
| Rate for Payer: Multiplan Commercial |
$3,563.46
|
| Rate for Payer: NAPHCARE Commercial |
$251.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,231.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.90
|
| Rate for Payer: Quartz Commercial |
$2,538.96
|
| Rate for Payer: Quartz Medicare Advantage |
$167.43
|
| Rate for Payer: The Alliance Commercial |
$636.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.43
|
| Rate for Payer: WEA Trust Commercial |
$2,449.88
|
| Rate for Payer: WPS Commercial |
$837.15
|
|
|
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 |
$334.55 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,130.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| 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: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,259.91
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,028.74
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,422.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,624.91
|
| Rate for Payer: Quartz Medicare Advantage |
$2,422.99
|
| Rate for Payer: The Alliance Commercial |
$334.55
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$585.46
|
|
|
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 |
$83.64 |
| Max. Negotiated Rate |
$830.91 |
| Rate for Payer: Aetna Commercial |
$830.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.19
|
| Rate for Payer: Aetna Managed Medicare |
$83.64
|
| Rate for Payer: Anthem Medicare Advantage |
$83.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.64
|
| 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 |
$830.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$437.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.64
|
| Rate for Payer: Health EOS Commercial |
$795.92
|
| Rate for Payer: HFN Commercial |
$830.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.64
|
| Rate for Payer: Multiplan Commercial |
$699.71
|
| Rate for Payer: NAPHCARE Commercial |
$125.46
|
| Rate for Payer: Preferred Network Access Commercial |
$830.91
|
| Rate for Payer: Quartz Beloit One Network |
$384.84
|
| Rate for Payer: Quartz Commercial |
$498.54
|
| Rate for Payer: Quartz Medicare Advantage |
$83.64
|
| Rate for Payer: The Alliance Commercial |
$317.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.64
|
| Rate for Payer: WEA Trust Commercial |
$481.05
|
| Rate for Payer: WPS Commercial |
$418.18
|
|
|
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 |
$83.64 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,836.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$83.64
|
| Rate for Payer: Anthem Medicare Advantage |
$83.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.64
|
| 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 |
$3,836.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,019.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.64
|
| Rate for Payer: Health EOS Commercial |
$3,674.87
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.64
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$125.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,776.86
|
| Rate for Payer: Quartz Commercial |
$2,301.84
|
| Rate for Payer: Quartz Medicare Advantage |
$83.64
|
| Rate for Payer: The Alliance Commercial |
$317.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.64
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$418.18
|
|
|
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 |
$1,978.78 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,422.99
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
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 |
$428.57 |
| Max. Negotiated Rate |
$804.67 |
| Rate for Payer: Aetna Commercial |
$787.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.56
|
| Rate for Payer: Cash Price |
$252.30
|
| Rate for Payer: Cigna Commercial |
$804.67
|
| Rate for Payer: Health EOS Commercial |
$778.43
|
| Rate for Payer: HFN Commercial |
$804.67
|
| Rate for Payer: Multiplan Commercial |
$699.71
|
| Rate for Payer: Preferred Network Access Commercial |
$804.67
|
| Rate for Payer: Quartz Beloit One Network |
$428.57
|
| Rate for Payer: Quartz Commercial |
$524.78
|
| Rate for Payer: WEA Trust Commercial |
$481.05
|
| Rate for Payer: WPS Commercial |
$647.82
|
|
|
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 |
$244.90 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$787.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$752.19
|
| Rate for Payer: Aetna Managed Medicare |
$244.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.56
|
| Rate for Payer: Cash Price |
$252.30
|
| 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 |
$804.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.46
|
| Rate for Payer: Health EOS Commercial |
$778.43
|
| Rate for Payer: HFN Commercial |
$804.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$655.98
|
| Rate for Payer: Multiplan Commercial |
$699.71
|
| Rate for Payer: NAPHCARE Commercial |
$524.78
|
| Rate for Payer: Preferred Network Access Commercial |
$804.67
|
| Rate for Payer: Quartz Beloit One Network |
$428.57
|
| Rate for Payer: Quartz Commercial |
$568.52
|
| Rate for Payer: Quartz Medicare Advantage |
$524.78
|
| Rate for Payer: The Alliance Commercial |
$334.55
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$481.05
|
| Rate for Payer: WPS Commercial |
$585.46
|
|
|
CT Spine Cervical w/o Contrast
|
Facility
|
IP
|
$3,338.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
629610
|
| Min. Negotiated Rate |
$1,701.04 |
| Max. Negotiated Rate |
$3,193.80 |
| Rate for Payer: Aetna Commercial |
$3,124.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,839.91
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,193.80
|
| Rate for Payer: Health EOS Commercial |
$3,089.65
|
| Rate for Payer: HFN Commercial |
$3,193.80
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,193.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.04
|
| Rate for Payer: Quartz Commercial |
$2,082.91
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: WPS Commercial |
$2,571.26
|
|
|
CT Spine Cervical w/o Contrast
|
Facility
|
OP
|
$3,338.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
629610
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$3,193.80 |
| Rate for Payer: Aetna Commercial |
$3,124.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,256.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,735.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,666.33
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,839.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,193.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,942.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$3,089.65
|
| Rate for Payer: HFN Commercial |
$3,193.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,193.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.04
|
| Rate for Payer: Quartz Commercial |
$2,256.49
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,571.26
|
|
|
CT Spine Cervical w/o Contrast
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
CPT 72125
|
| Hospital Charge Code |
629610
|
| Min. Negotiated Rate |
$129.97 |
| Max. Negotiated Rate |
$3,297.94 |
| Rate for Payer: Aetna Commercial |
$3,297.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Aetna Managed Medicare |
$129.97
|
| Rate for Payer: Anthem Medicare Advantage |
$129.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.97
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,297.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,735.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.97
|
| Rate for Payer: Health EOS Commercial |
$3,159.08
|
| Rate for Payer: HFN Commercial |
$3,297.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$497.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$497.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.97
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: NAPHCARE Commercial |
$194.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,297.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,527.47
|
| Rate for Payer: Quartz Commercial |
$1,978.77
|
| Rate for Payer: Quartz Medicare Advantage |
$129.97
|
| Rate for Payer: The Alliance Commercial |
$493.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.97
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: WPS Commercial |
$649.84
|
|
|
CT Spine Cervical w/ + w/o Contrast
|
Professional
|
Both
|
$5,148.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
629606
|
| Min. Negotiated Rate |
$195.11 |
| Max. Negotiated Rate |
$5,086.22 |
| Rate for Payer: Aetna Commercial |
$5,086.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,604.37
|
| Rate for Payer: Aetna Managed Medicare |
$195.11
|
| Rate for Payer: Anthem Medicare Advantage |
$195.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.11
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$5,086.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,676.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.11
|
| Rate for Payer: Health EOS Commercial |
$4,872.07
|
| Rate for Payer: HFN Commercial |
$5,086.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$761.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$761.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$195.11
|
| Rate for Payer: Multiplan Commercial |
$4,283.14
|
| Rate for Payer: NAPHCARE Commercial |
$292.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,086.22
|
| Rate for Payer: Quartz Beloit One Network |
$2,355.72
|
| Rate for Payer: Quartz Commercial |
$3,051.73
|
| Rate for Payer: Quartz Medicare Advantage |
$195.11
|
| Rate for Payer: The Alliance Commercial |
$741.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.11
|
| Rate for Payer: WEA Trust Commercial |
$2,944.66
|
| Rate for Payer: WPS Commercial |
$975.57
|
|
|
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 |
$136.99 |
| Max. Negotiated Rate |
$5,183.05 |
| Rate for Payer: Aetna Commercial |
$5,183.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,692.02
|
| Rate for Payer: Aetna Managed Medicare |
$136.99
|
| Rate for Payer: Anthem Medicare Advantage |
$136.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.99
|
| 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 |
$5,183.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,727.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.99
|
| Rate for Payer: Health EOS Commercial |
$4,964.81
|
| Rate for Payer: HFN Commercial |
$5,183.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$542.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.99
|
| Rate for Payer: Multiplan Commercial |
$4,364.67
|
| Rate for Payer: NAPHCARE Commercial |
$205.48
|
| Rate for Payer: Preferred Network Access Commercial |
$5,183.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,400.57
|
| Rate for Payer: Quartz Commercial |
$3,109.83
|
| Rate for Payer: Quartz Medicare Advantage |
$136.99
|
| Rate for Payer: The Alliance Commercial |
$520.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.99
|
| Rate for Payer: WEA Trust Commercial |
$3,000.71
|
| Rate for Payer: WPS Commercial |
$684.94
|
|
|
CT Spine Cervical w/ + w/o Contrast
|
Facility
|
OP
|
$5,148.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
629606
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$4,925.61 |
| Rate for Payer: Aetna Commercial |
$4,818.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,604.37
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,480.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,676.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,569.88
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,837.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,925.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,996.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$4,764.99
|
| Rate for Payer: HFN Commercial |
$4,925.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$4,283.14
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$4,925.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,623.42
|
| Rate for Payer: Quartz Commercial |
$3,480.05
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$2,944.66
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,965.50
|
|
|
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 |
$547.96 |
| Max. Negotiated Rate |
$5,019.37 |
| Rate for Payer: Aetna Commercial |
$4,910.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,692.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,527.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,891.60
|
| 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: Cash Price |
$1,573.80
|
| Rate for Payer: Cigna Commercial |
$5,019.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,053.17
|
| Rate for Payer: Health EOS Commercial |
$4,855.70
|
| Rate for Payer: HFN Commercial |
$5,019.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,091.88
|
| Rate for Payer: Multiplan Commercial |
$4,364.67
|
| Rate for Payer: NAPHCARE Commercial |
$3,273.50
|
| Rate for Payer: Preferred Network Access Commercial |
$5,019.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.36
|
| Rate for Payer: Quartz Commercial |
$3,546.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,273.50
|
| Rate for Payer: The Alliance Commercial |
$547.96
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$3,000.71
|
| Rate for Payer: WPS Commercial |
$958.92
|
|
|
CT Spine Cervical w/ + w/o Contrast
|
Facility
|
IP
|
$5,148.00
|
|
|
Service Code
|
CPT 72127
|
| Hospital Charge Code |
629606
|
| Min. Negotiated Rate |
$2,623.42 |
| Max. Negotiated Rate |
$4,925.61 |
| Rate for Payer: Aetna Commercial |
$4,818.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,604.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,837.58
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,925.61
|
| Rate for Payer: Health EOS Commercial |
$4,764.99
|
| Rate for Payer: HFN Commercial |
$4,925.61
|
| Rate for Payer: Multiplan Commercial |
$4,283.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,925.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,623.42
|
| Rate for Payer: Quartz Commercial |
$3,212.35
|
| Rate for Payer: WEA Trust Commercial |
$2,944.66
|
| Rate for Payer: WPS Commercial |
$3,965.50
|
|
|
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 |
$2,673.36 |
| Max. Negotiated Rate |
$5,019.37 |
| Rate for Payer: Aetna Commercial |
$4,910.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,692.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,891.60
|
| Rate for Payer: Cash Price |
$1,573.80
|
| Rate for Payer: Cigna Commercial |
$5,019.37
|
| Rate for Payer: Health EOS Commercial |
$4,855.70
|
| Rate for Payer: HFN Commercial |
$5,019.37
|
| Rate for Payer: Multiplan Commercial |
$4,364.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,019.37
|
| Rate for Payer: Quartz Beloit One Network |
$2,673.36
|
| Rate for Payer: Quartz Commercial |
$3,273.50
|
| Rate for Payer: WEA Trust Commercial |
$3,000.71
|
| Rate for Payer: WPS Commercial |
$4,040.99
|
|
|
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 |
$1,906.92 |
| Max. Negotiated Rate |
$3,580.35 |
| Rate for Payer: Aetna Commercial |
$3,502.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,346.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,062.59
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,580.35
|
| Rate for Payer: Health EOS Commercial |
$3,463.60
|
| Rate for Payer: HFN Commercial |
$3,580.35
|
| Rate for Payer: Multiplan Commercial |
$3,113.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,580.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,906.92
|
| Rate for Payer: Quartz Commercial |
$2,335.01
|
| Rate for Payer: WEA Trust Commercial |
$2,140.42
|
| Rate for Payer: WPS Commercial |
$2,882.46
|
|
|
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 |
$82.97 |
| Max. Negotiated Rate |
$3,697.10 |
| Rate for Payer: Aetna Commercial |
$3,697.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,346.84
|
| Rate for Payer: Aetna Managed Medicare |
$82.97
|
| Rate for Payer: Anthem Medicare Advantage |
$82.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.97
|
| 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 |
$3,697.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,945.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.97
|
| Rate for Payer: Health EOS Commercial |
$3,541.43
|
| Rate for Payer: HFN Commercial |
$3,697.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$321.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$321.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.97
|
| Rate for Payer: Multiplan Commercial |
$3,113.34
|
| Rate for Payer: NAPHCARE Commercial |
$124.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,697.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,712.34
|
| Rate for Payer: Quartz Commercial |
$2,218.26
|
| Rate for Payer: Quartz Medicare Advantage |
$82.97
|
| Rate for Payer: The Alliance Commercial |
$315.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.97
|
| Rate for Payer: WEA Trust Commercial |
$2,140.42
|
| Rate for Payer: WPS Commercial |
$414.86
|
|
|
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 |
$331.88 |
| Max. Negotiated Rate |
$3,580.35 |
| Rate for Payer: Aetna Commercial |
$3,502.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,346.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,089.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,062.59
|
| 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 |
$3,580.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,177.84
|
| Rate for Payer: Health EOS Commercial |
$3,463.60
|
| Rate for Payer: HFN Commercial |
$3,580.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,918.76
|
| Rate for Payer: Multiplan Commercial |
$3,113.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,335.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,580.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,906.92
|
| Rate for Payer: Quartz Commercial |
$2,529.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,335.01
|
| Rate for Payer: The Alliance Commercial |
$331.88
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,140.42
|
| Rate for Payer: WPS Commercial |
$580.80
|
|
