|
CT Spine Lumbar w/ Contrast
|
Facility
|
OP
|
$3,917.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
630052
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$3,747.79 |
| Rate for Payer: Aetna Commercial |
$3,666.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,503.36
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,647.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,036.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,955.37
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,159.05
|
| 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 |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,747.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,279.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$3,625.58
|
| Rate for Payer: HFN Commercial |
$3,747.79
|
| 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 |
$3,258.94
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$3,747.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.10
|
| Rate for Payer: Quartz Commercial |
$2,647.89
|
| 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 |
$2,240.52
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,017.27
|
|
|
CT Spine Lumbar w/ Contrast
|
Professional
|
Both
|
$3,917.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
630052
|
| Min. Negotiated Rate |
$167.76 |
| Max. Negotiated Rate |
$3,870.00 |
| Rate for Payer: Aetna Commercial |
$3,870.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,503.36
|
| Rate for Payer: Aetna Managed Medicare |
$167.76
|
| Rate for Payer: Anthem Medicare Advantage |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$167.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$167.76
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,870.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,036.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.76
|
| Rate for Payer: Health EOS Commercial |
$3,707.05
|
| Rate for Payer: HFN Commercial |
$3,870.00
|
| 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 |
$167.76
|
| Rate for Payer: Multiplan Commercial |
$3,258.94
|
| Rate for Payer: NAPHCARE Commercial |
$251.64
|
| Rate for Payer: Preferred Network Access Commercial |
$3,870.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,792.42
|
| Rate for Payer: Quartz Commercial |
$2,322.00
|
| Rate for Payer: Quartz Medicare Advantage |
$167.76
|
| Rate for Payer: The Alliance Commercial |
$637.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.76
|
| Rate for Payer: WEA Trust Commercial |
$2,240.52
|
| Rate for Payer: WPS Commercial |
$838.81
|
|
|
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 |
$446.78 |
| Max. Negotiated Rate |
$4,290.29 |
| Rate for Payer: Aetna Commercial |
$4,197.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,010.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,305.74
|
| 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 |
$2,471.58
|
| 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: Cash Price |
$1,345.20
|
| Rate for Payer: Cigna Commercial |
$4,290.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,609.69
|
| Rate for Payer: Health EOS Commercial |
$4,150.39
|
| Rate for Payer: HFN Commercial |
$4,290.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,497.52
|
| Rate for Payer: Multiplan Commercial |
$3,730.69
|
| Rate for Payer: NAPHCARE Commercial |
$2,798.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,290.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,285.05
|
| Rate for Payer: Quartz Commercial |
$3,031.18
|
| Rate for Payer: Quartz Medicare Advantage |
$2,798.02
|
| Rate for Payer: The Alliance Commercial |
$446.78
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,564.85
|
| Rate for Payer: WPS Commercial |
$781.87
|
|
|
CT Spine Lumbar w/ Contrast
|
Facility
|
IP
|
$3,917.00
|
|
|
Service Code
|
CPT 72132
|
| Hospital Charge Code |
630052
|
| Min. Negotiated Rate |
$1,996.10 |
| Max. Negotiated Rate |
$3,747.79 |
| Rate for Payer: Aetna Commercial |
$3,666.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,503.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,159.05
|
| Rate for Payer: Cash Price |
$1,175.10
|
| Rate for Payer: Cigna Commercial |
$3,747.79
|
| Rate for Payer: Health EOS Commercial |
$3,625.58
|
| Rate for Payer: HFN Commercial |
$3,747.79
|
| Rate for Payer: Multiplan Commercial |
$3,258.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,747.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,996.10
|
| Rate for Payer: Quartz Commercial |
$2,444.21
|
| Rate for Payer: WEA Trust Commercial |
$2,240.52
|
| Rate for Payer: WPS Commercial |
$3,017.27
|
|
|
CT Spine Lumbar w/ Contrast
|
Professional
|
Both
|
$4,484.00
|
|
|
Service Code
|
CPT 72132 TC
|
| Hospital Charge Code |
1241268
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$111.70 |
| Max. Negotiated Rate |
$4,430.19 |
| Rate for Payer: Aetna Commercial |
$4,430.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,010.49
|
| Rate for Payer: Aetna Managed Medicare |
$111.70
|
| Rate for Payer: Anthem Medicare Advantage |
$111.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.70
|
| 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 |
$4,430.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,331.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.70
|
| Rate for Payer: Health EOS Commercial |
$4,243.66
|
| Rate for Payer: HFN Commercial |
$4,430.19
|
| 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 |
$111.70
|
| Rate for Payer: Multiplan Commercial |
$3,730.69
|
| Rate for Payer: NAPHCARE Commercial |
$167.54
|
| Rate for Payer: Preferred Network Access Commercial |
$4,430.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,051.88
|
| Rate for Payer: Quartz Commercial |
$2,658.12
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$424.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$2,564.85
|
| Rate for Payer: WPS Commercial |
$558.48
|
|
|
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 |
$2,285.05 |
| Max. Negotiated Rate |
$4,290.29 |
| Rate for Payer: Aetna Commercial |
$4,197.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,010.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,471.58
|
| Rate for Payer: Cash Price |
$1,345.20
|
| Rate for Payer: Cigna Commercial |
$4,290.29
|
| Rate for Payer: Health EOS Commercial |
$4,150.39
|
| Rate for Payer: HFN Commercial |
$4,290.29
|
| Rate for Payer: Multiplan Commercial |
$3,730.69
|
| Rate for Payer: Preferred Network Access Commercial |
$4,290.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,285.05
|
| Rate for Payer: Quartz Commercial |
$2,798.02
|
| Rate for Payer: WEA Trust Commercial |
$2,564.85
|
| Rate for Payer: WPS Commercial |
$3,454.03
|
|
|
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 |
$1,906.92 |
| 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 w/o Contrast
|
Facility
|
OP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
1241270
|
|
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
|
|
|
CT Spine Lumbar w/o Contrast
|
Professional
|
Both
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
1241270
|
|
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 w/o Contrast
|
Professional
|
Both
|
$3,198.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
630056
|
| Min. Negotiated Rate |
$129.30 |
| Max. Negotiated Rate |
$3,159.62 |
| Rate for Payer: Aetna Commercial |
$3,159.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,860.29
|
| Rate for Payer: Aetna Managed Medicare |
$129.30
|
| Rate for Payer: Anthem Medicare Advantage |
$129.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.30
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cigna Commercial |
$3,159.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,662.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.30
|
| Rate for Payer: Health EOS Commercial |
$3,026.59
|
| Rate for Payer: HFN Commercial |
$3,159.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.30
|
| Rate for Payer: Multiplan Commercial |
$2,660.74
|
| Rate for Payer: NAPHCARE Commercial |
$193.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,159.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,463.40
|
| Rate for Payer: Quartz Commercial |
$1,895.77
|
| Rate for Payer: Quartz Medicare Advantage |
$129.30
|
| Rate for Payer: The Alliance Commercial |
$491.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.30
|
| Rate for Payer: WEA Trust Commercial |
$1,829.26
|
| Rate for Payer: WPS Commercial |
$646.52
|
|
|
CT Spine Lumbar w/o Contrast
|
Facility
|
OP
|
$3,198.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
630056
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$3,059.85 |
| Rate for Payer: Aetna Commercial |
$2,993.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,860.29
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,161.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,662.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,596.44
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.74
|
| 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 |
$959.40
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cigna Commercial |
$3,059.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,861.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$2,960.07
|
| Rate for Payer: HFN Commercial |
$3,059.85
|
| 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 |
$2,660.74
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,059.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.70
|
| Rate for Payer: Quartz Commercial |
$2,161.85
|
| 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 |
$1,829.26
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,463.42
|
|
|
CT Spine Lumbar w/o Contrast
|
Facility
|
IP
|
$3,198.00
|
|
|
Service Code
|
CPT 72131
|
| Hospital Charge Code |
630056
|
| Min. Negotiated Rate |
$1,629.70 |
| Max. Negotiated Rate |
$3,059.85 |
| Rate for Payer: Aetna Commercial |
$2,993.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,860.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,762.74
|
| Rate for Payer: Cash Price |
$959.40
|
| Rate for Payer: Cigna Commercial |
$3,059.85
|
| Rate for Payer: Health EOS Commercial |
$2,960.07
|
| Rate for Payer: HFN Commercial |
$3,059.85
|
| Rate for Payer: Multiplan Commercial |
$2,660.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,059.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,629.70
|
| Rate for Payer: Quartz Commercial |
$1,995.55
|
| Rate for Payer: WEA Trust Commercial |
$1,829.26
|
| Rate for Payer: WPS Commercial |
$2,463.42
|
|
|
CT Spine Lumbar w/ + w/o Contrast
|
Facility
|
OP
|
$5,148.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
630049
|
| 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 Lumbar w/ + w/o Contrast
|
Professional
|
Both
|
$5,052.00
|
|
|
Service Code
|
CPT 72133 TC
|
| Hospital Charge Code |
1241266
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$137.32 |
| Max. Negotiated Rate |
$4,991.38 |
| Rate for Payer: Aetna Commercial |
$4,991.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,518.51
|
| Rate for Payer: Aetna Managed Medicare |
$137.32
|
| Rate for Payer: Anthem Medicare Advantage |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.32
|
| 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 |
$4,991.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,627.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.32
|
| Rate for Payer: Health EOS Commercial |
$4,781.21
|
| Rate for Payer: HFN Commercial |
$4,991.38
|
| 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 |
$137.32
|
| Rate for Payer: Multiplan Commercial |
$4,203.26
|
| Rate for Payer: NAPHCARE Commercial |
$205.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,991.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,311.80
|
| Rate for Payer: Quartz Commercial |
$2,994.83
|
| Rate for Payer: Quartz Medicare Advantage |
$137.32
|
| Rate for Payer: The Alliance Commercial |
$521.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.32
|
| Rate for Payer: WEA Trust Commercial |
$2,889.74
|
| Rate for Payer: WPS Commercial |
$686.61
|
|
|
CT Spine Lumbar w/ + w/o Contrast
|
Professional
|
Both
|
$5,148.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
630049
|
| Min. Negotiated Rate |
$195.78 |
| 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 |
$195.78
|
| Rate for Payer: Anthem Medicare Advantage |
$195.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$195.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$195.78
|
| 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 |
$195.78
|
| 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 |
$195.78
|
| Rate for Payer: Multiplan Commercial |
$4,283.14
|
| Rate for Payer: NAPHCARE Commercial |
$293.67
|
| 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 |
$195.78
|
| Rate for Payer: The Alliance Commercial |
$743.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$195.78
|
| Rate for Payer: WEA Trust Commercial |
$2,944.66
|
| Rate for Payer: WPS Commercial |
$978.90
|
|
|
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 |
$549.29 |
| Max. Negotiated Rate |
$4,833.75 |
| Rate for Payer: Aetna Commercial |
$4,728.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,518.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,471.14
|
| 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 |
$2,784.66
|
| 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 |
$4,833.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,940.26
|
| Rate for Payer: Health EOS Commercial |
$4,676.13
|
| Rate for Payer: HFN Commercial |
$4,833.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,940.56
|
| Rate for Payer: Multiplan Commercial |
$4,203.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,152.45
|
| Rate for Payer: Preferred Network Access Commercial |
$4,833.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.50
|
| Rate for Payer: Quartz Commercial |
$3,415.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,152.45
|
| Rate for Payer: The Alliance Commercial |
$549.29
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,889.74
|
| Rate for Payer: WPS Commercial |
$961.25
|
|
|
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 |
$2,574.50 |
| Max. Negotiated Rate |
$4,833.75 |
| Rate for Payer: Aetna Commercial |
$4,728.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,518.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,784.66
|
| Rate for Payer: Cash Price |
$1,515.60
|
| Rate for Payer: Cigna Commercial |
$4,833.75
|
| Rate for Payer: Health EOS Commercial |
$4,676.13
|
| Rate for Payer: HFN Commercial |
$4,833.75
|
| Rate for Payer: Multiplan Commercial |
$4,203.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,833.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,574.50
|
| Rate for Payer: Quartz Commercial |
$3,152.45
|
| Rate for Payer: WEA Trust Commercial |
$2,889.74
|
| Rate for Payer: WPS Commercial |
$3,891.56
|
|
|
CT Spine Lumbar w/ + w/o Contrast
|
Facility
|
IP
|
$5,148.00
|
|
|
Service Code
|
CPT 72133
|
| Hospital Charge Code |
630049
|
| 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 Thoracic w/ Contrast
|
Facility
|
OP
|
$4,364.00
|
|
|
Service Code
|
CPT 72129 TC
|
| Hospital Charge Code |
1241274
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$449.45 |
| 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 |
$449.45
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,496.21
|
| Rate for Payer: WPS Commercial |
$786.53
|
|
|
CT Spine Thoracic w/ Contrast
|
Professional
|
Both
|
$4,364.00
|
|
|
Service Code
|
CPT 72129 TC
|
| Hospital Charge Code |
1241274
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$112.36 |
| 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 |
$112.36
|
| Rate for Payer: Anthem Medicare Advantage |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.36
|
| 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 |
$112.36
|
| 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 |
$440.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.36
|
| Rate for Payer: Multiplan Commercial |
$3,630.85
|
| Rate for Payer: NAPHCARE Commercial |
$168.54
|
| 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 |
$112.36
|
| Rate for Payer: The Alliance Commercial |
$426.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.36
|
| Rate for Payer: WEA Trust Commercial |
$2,496.21
|
| Rate for Payer: WPS Commercial |
$561.81
|
|
|
CT Spine Thoracic w/ Contrast
|
Facility
|
IP
|
$4,283.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
630168
|
| 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 Thoracic w/ Contrast
|
Professional
|
Both
|
$4,283.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
630168
|
| Min. Negotiated Rate |
$168.43 |
| 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 |
$168.43
|
| Rate for Payer: Anthem Medicare Advantage |
$168.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.43
|
| 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 |
$168.43
|
| 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 |
$652.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$652.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.43
|
| Rate for Payer: Multiplan Commercial |
$3,563.46
|
| Rate for Payer: NAPHCARE Commercial |
$252.64
|
| 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 |
$168.43
|
| Rate for Payer: The Alliance Commercial |
$640.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.43
|
| Rate for Payer: WEA Trust Commercial |
$2,449.88
|
| Rate for Payer: WPS Commercial |
$842.14
|
|
|
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 |
$2,223.89 |
| 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 Thoracic w/ Contrast
|
Facility
|
OP
|
$4,283.00
|
|
|
Service Code
|
CPT 72129
|
| Hospital Charge Code |
630168
|
| Min. Negotiated Rate |
$184.59 |
| 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 |
$184.59
|
| 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 |
$184.59
|
| 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 |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| 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 |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| 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 |
$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 |
$3,563.46
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| 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 |
$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 |
$2,449.88
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$3,299.19
|
|
|
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 |
$333.22 |
| Max. Negotiated Rate |
$3,630.10 |
| Rate for Payer: Aetna Commercial |
$3,551.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,393.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,104.81
|
| 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 |
$2,091.25
|
| 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 |
$3,630.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,208.11
|
| Rate for Payer: Health EOS Commercial |
$3,511.73
|
| Rate for Payer: HFN Commercial |
$3,630.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,959.32
|
| Rate for Payer: Multiplan Commercial |
$3,156.61
|
| Rate for Payer: NAPHCARE Commercial |
$2,367.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,630.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,933.42
|
| Rate for Payer: Quartz Commercial |
$2,564.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,367.46
|
| Rate for Payer: The Alliance Commercial |
$333.22
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,170.17
|
| Rate for Payer: WPS Commercial |
$583.13
|
|
