|
MRI Shoulder w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
1611247
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,567.53 |
| Max. Negotiated Rate |
$6,343.95 |
| Rate for Payer: Aetna Commercial |
$6,343.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,742.94
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$6,343.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,338.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,006.70
|
| Rate for Payer: Health EOS Commercial |
$6,076.83
|
| Rate for Payer: HFN Commercial |
$6,343.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,567.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,567.53
|
| Rate for Payer: Multiplan Commercial |
$5,342.27
|
| Rate for Payer: Preferred Network Access Commercial |
$6,343.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,938.25
|
| Rate for Payer: Quartz Commercial |
$3,806.37
|
| Rate for Payer: The Alliance Commercial |
$3,338.92
|
| Rate for Payer: WEA Trust Commercial |
$3,672.81
|
| Rate for Payer: WPS Commercial |
$4,946.10
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,421.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
1611247
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,869.80 |
| Max. Negotiated Rate |
$6,143.61 |
| Rate for Payer: Aetna Commercial |
$6,010.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,742.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,869.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,539.26
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cash Price |
$1,926.30
|
| Rate for Payer: Cigna Commercial |
$6,143.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,737.02
|
| Rate for Payer: Health EOS Commercial |
$5,943.28
|
| Rate for Payer: HFN Commercial |
$6,143.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,008.38
|
| Rate for Payer: Multiplan Commercial |
$5,342.27
|
| Rate for Payer: NAPHCARE Commercial |
$4,006.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,143.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,272.14
|
| Rate for Payer: Quartz Commercial |
$4,340.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4,006.70
|
| Rate for Payer: The Alliance Commercial |
$3,338.92
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,672.81
|
| Rate for Payer: WPS Commercial |
$4,946.10
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,680.00
|
|
|
Service Code
|
CPT 73223 TC,RT
|
| Hospital Charge Code |
2980048
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,404.13 |
| Max. Negotiated Rate |
$6,391.42 |
| Rate for Payer: Aetna Commercial |
$6,252.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,974.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,682.02
|
| Rate for Payer: Cash Price |
$2,004.00
|
| Rate for Payer: Cigna Commercial |
$6,391.42
|
| Rate for Payer: Health EOS Commercial |
$6,183.01
|
| Rate for Payer: HFN Commercial |
$6,391.42
|
| Rate for Payer: Multiplan Commercial |
$5,557.76
|
| Rate for Payer: Preferred Network Access Commercial |
$6,391.42
|
| Rate for Payer: Quartz Beloit One Network |
$3,404.13
|
| Rate for Payer: Quartz Commercial |
$4,168.32
|
| Rate for Payer: WEA Trust Commercial |
$3,820.96
|
| Rate for Payer: WPS Commercial |
$5,145.60
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631219
|
| Min. Negotiated Rate |
$381.38 |
| Max. Negotiated Rate |
$5,780.79 |
| Rate for Payer: Aetna Commercial |
$5,780.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,233.13
|
| Rate for Payer: Aetna Managed Medicare |
$381.38
|
| Rate for Payer: Anthem Medicare Advantage |
$381.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$381.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$381.38
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,780.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,042.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.38
|
| Rate for Payer: Health EOS Commercial |
$5,537.39
|
| Rate for Payer: HFN Commercial |
$5,780.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,567.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,567.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$381.38
|
| Rate for Payer: Multiplan Commercial |
$4,868.03
|
| Rate for Payer: NAPHCARE Commercial |
$572.07
|
| Rate for Payer: Preferred Network Access Commercial |
$5,780.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,677.42
|
| Rate for Payer: Quartz Commercial |
$3,468.47
|
| Rate for Payer: Quartz Medicare Advantage |
$381.38
|
| Rate for Payer: The Alliance Commercial |
$1,449.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.38
|
| Rate for Payer: WEA Trust Commercial |
$3,346.77
|
| Rate for Payer: WPS Commercial |
$1,906.89
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631219
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,598.24 |
| Rate for Payer: Aetna Commercial |
$5,476.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,233.13
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,955.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,042.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,920.82
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,225.07
|
| 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 |
$1,755.30
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,598.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,405.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,415.69
|
| Rate for Payer: HFN Commercial |
$5,598.24
|
| 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 |
$4,868.03
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,598.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,981.67
|
| Rate for Payer: Quartz Commercial |
$3,955.28
|
| 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 |
$3,346.77
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,507.03
|
|
|
MRI Shoulder w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,851.00
|
|
|
Service Code
|
CPT 73223
|
| Hospital Charge Code |
631219
|
| Min. Negotiated Rate |
$2,981.67 |
| Max. Negotiated Rate |
$5,598.24 |
| Rate for Payer: Aetna Commercial |
$5,476.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,233.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,225.07
|
| Rate for Payer: Cash Price |
$1,755.30
|
| Rate for Payer: Cigna Commercial |
$5,598.24
|
| Rate for Payer: Health EOS Commercial |
$5,415.69
|
| Rate for Payer: HFN Commercial |
$5,598.24
|
| Rate for Payer: Multiplan Commercial |
$4,868.03
|
| Rate for Payer: Preferred Network Access Commercial |
$5,598.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,981.67
|
| Rate for Payer: Quartz Commercial |
$3,651.02
|
| Rate for Payer: WEA Trust Commercial |
$3,346.77
|
| Rate for Payer: WPS Commercial |
$4,507.03
|
|
|
MRI Spine Cervical, Brac Plex w/o Left
|
Facility
|
IP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,LT
|
| Hospital Charge Code |
1611275
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,359.96 |
| Max. Negotiated Rate |
$4,430.94 |
| Rate for Payer: Aetna Commercial |
$4,334.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,141.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,552.61
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,430.94
|
| Rate for Payer: Health EOS Commercial |
$4,286.45
|
| Rate for Payer: HFN Commercial |
$4,430.94
|
| Rate for Payer: Multiplan Commercial |
$3,852.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,430.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,359.96
|
| Rate for Payer: Quartz Commercial |
$2,889.74
|
| Rate for Payer: WEA Trust Commercial |
$2,648.93
|
| Rate for Payer: WPS Commercial |
$3,567.26
|
|
|
MRI Spine Cervical, Brac Plex w/o Left
|
Professional
|
Both
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,LT
|
| Hospital Charge Code |
1611275
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,227.83 |
| Max. Negotiated Rate |
$4,575.43 |
| Rate for Payer: Aetna Commercial |
$4,575.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,141.97
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,575.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,408.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,889.74
|
| Rate for Payer: Health EOS Commercial |
$4,382.78
|
| Rate for Payer: HFN Commercial |
$4,575.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,227.83
|
| Rate for Payer: Multiplan Commercial |
$3,852.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,575.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,119.15
|
| Rate for Payer: Quartz Commercial |
$2,745.26
|
| Rate for Payer: The Alliance Commercial |
$2,408.12
|
| Rate for Payer: WEA Trust Commercial |
$2,648.93
|
| Rate for Payer: WPS Commercial |
$3,567.26
|
|
|
MRI Spine Cervical, Brac Plex w/o Left
|
Facility
|
OP
|
$4,631.00
|
|
|
Service Code
|
CPT 73218 TC,LT
|
| Hospital Charge Code |
1611275
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,348.55 |
| Max. Negotiated Rate |
$4,430.94 |
| Rate for Payer: Aetna Commercial |
$4,334.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,141.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,348.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,552.61
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cash Price |
$1,389.30
|
| Rate for Payer: Cigna Commercial |
$4,430.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,695.24
|
| Rate for Payer: Health EOS Commercial |
$4,286.45
|
| Rate for Payer: HFN Commercial |
$4,430.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,612.18
|
| Rate for Payer: Multiplan Commercial |
$3,852.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,889.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,430.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,359.96
|
| Rate for Payer: Quartz Commercial |
$3,130.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,889.74
|
| Rate for Payer: The Alliance Commercial |
$2,408.12
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,648.93
|
| Rate for Payer: WPS Commercial |
$3,567.26
|
|
|
MRI Spine Cervical, Brac Plex w/o Right
|
Facility
|
IP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
1611278
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,451.18 |
| Max. Negotiated Rate |
$4,602.21 |
| Rate for Payer: Aetna Commercial |
$4,502.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,302.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,651.27
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,602.21
|
| Rate for Payer: Health EOS Commercial |
$4,452.14
|
| Rate for Payer: HFN Commercial |
$4,602.21
|
| Rate for Payer: Multiplan Commercial |
$4,001.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,602.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,451.18
|
| Rate for Payer: Quartz Commercial |
$3,001.44
|
| Rate for Payer: WEA Trust Commercial |
$2,751.32
|
| Rate for Payer: WPS Commercial |
$3,705.14
|
|
|
MRI Spine Cervical, Brac Plex w/o Right
|
Professional
|
Both
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
1611278
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,227.83 |
| Max. Negotiated Rate |
$4,752.28 |
| Rate for Payer: Aetna Commercial |
$4,752.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,302.06
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,752.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,501.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,001.44
|
| Rate for Payer: Health EOS Commercial |
$4,552.18
|
| Rate for Payer: HFN Commercial |
$4,752.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,227.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,227.83
|
| Rate for Payer: Multiplan Commercial |
$4,001.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,752.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.06
|
| Rate for Payer: Quartz Commercial |
$2,851.37
|
| Rate for Payer: The Alliance Commercial |
$2,501.20
|
| Rate for Payer: WEA Trust Commercial |
$2,751.32
|
| Rate for Payer: WPS Commercial |
$3,705.14
|
|
|
MRI Spine Cervical, Brac Plex w/o Right
|
Facility
|
OP
|
$4,810.00
|
|
|
Service Code
|
CPT 73218 TC,RT
|
| Hospital Charge Code |
1611278
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,400.67 |
| Max. Negotiated Rate |
$4,602.21 |
| Rate for Payer: Aetna Commercial |
$4,502.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,302.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,400.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,651.27
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cash Price |
$1,443.00
|
| Rate for Payer: Cigna Commercial |
$4,602.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,799.42
|
| Rate for Payer: Health EOS Commercial |
$4,452.14
|
| Rate for Payer: HFN Commercial |
$4,602.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,751.80
|
| Rate for Payer: Multiplan Commercial |
$4,001.92
|
| Rate for Payer: NAPHCARE Commercial |
$3,001.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,602.21
|
| Rate for Payer: Quartz Beloit One Network |
$2,451.18
|
| Rate for Payer: Quartz Commercial |
$3,251.56
|
| Rate for Payer: Quartz Medicare Advantage |
$3,001.44
|
| Rate for Payer: The Alliance Commercial |
$2,501.20
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,751.32
|
| Rate for Payer: WPS Commercial |
$3,705.14
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Lt
|
Facility
|
OP
|
$5,880.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611269
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,712.26 |
| Max. Negotiated Rate |
$5,625.98 |
| Rate for Payer: Aetna Commercial |
$5,503.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,259.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,712.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,241.06
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,625.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,422.16
|
| Rate for Payer: Health EOS Commercial |
$5,442.53
|
| Rate for Payer: HFN Commercial |
$5,625.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,586.40
|
| Rate for Payer: Multiplan Commercial |
$4,892.16
|
| Rate for Payer: NAPHCARE Commercial |
$3,669.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,625.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,996.45
|
| Rate for Payer: Quartz Commercial |
$3,974.88
|
| Rate for Payer: Quartz Medicare Advantage |
$3,669.12
|
| Rate for Payer: The Alliance Commercial |
$3,057.60
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,363.36
|
| Rate for Payer: WPS Commercial |
$4,529.36
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Lt
|
Facility
|
IP
|
$5,880.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611269
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,996.45 |
| Max. Negotiated Rate |
$5,625.98 |
| Rate for Payer: Aetna Commercial |
$5,503.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,259.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,241.06
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,625.98
|
| Rate for Payer: Health EOS Commercial |
$5,442.53
|
| Rate for Payer: HFN Commercial |
$5,625.98
|
| Rate for Payer: Multiplan Commercial |
$4,892.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,625.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,996.45
|
| Rate for Payer: Quartz Commercial |
$3,669.12
|
| Rate for Payer: WEA Trust Commercial |
$3,363.36
|
| Rate for Payer: WPS Commercial |
$4,529.36
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Lt
|
Professional
|
Both
|
$5,880.00
|
|
|
Service Code
|
CPT 73220 TC,LT
|
| Hospital Charge Code |
1611269
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,659.96 |
| Max. Negotiated Rate |
$5,809.44 |
| Rate for Payer: Aetna Commercial |
$5,809.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,259.07
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,809.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,057.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,669.12
|
| Rate for Payer: Health EOS Commercial |
$5,564.83
|
| Rate for Payer: HFN Commercial |
$5,809.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,659.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,659.96
|
| Rate for Payer: Multiplan Commercial |
$4,892.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,809.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,690.69
|
| Rate for Payer: Quartz Commercial |
$3,485.66
|
| Rate for Payer: The Alliance Commercial |
$3,057.60
|
| Rate for Payer: WEA Trust Commercial |
$3,363.36
|
| Rate for Payer: WPS Commercial |
$4,529.36
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Rt
|
Facility
|
IP
|
$5,880.00
|
|
|
Service Code
|
CPT 72156 TC,RT
|
| Hospital Charge Code |
1611272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,996.45 |
| Max. Negotiated Rate |
$5,625.98 |
| Rate for Payer: Aetna Commercial |
$5,503.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,259.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,241.06
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,625.98
|
| Rate for Payer: Health EOS Commercial |
$5,442.53
|
| Rate for Payer: HFN Commercial |
$5,625.98
|
| Rate for Payer: Multiplan Commercial |
$4,892.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,625.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,996.45
|
| Rate for Payer: Quartz Commercial |
$3,669.12
|
| Rate for Payer: WEA Trust Commercial |
$3,363.36
|
| Rate for Payer: WPS Commercial |
$4,529.36
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Rt
|
Professional
|
Both
|
$5,880.00
|
|
|
Service Code
|
CPT 72156 TC,RT
|
| Hospital Charge Code |
1611272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,272.08 |
| Max. Negotiated Rate |
$5,809.44 |
| Rate for Payer: Aetna Commercial |
$5,809.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,259.07
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,809.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,057.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,669.12
|
| Rate for Payer: Health EOS Commercial |
$5,564.83
|
| Rate for Payer: HFN Commercial |
$5,809.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,272.08
|
| Rate for Payer: Multiplan Commercial |
$4,892.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,809.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,690.69
|
| Rate for Payer: Quartz Commercial |
$3,485.66
|
| Rate for Payer: The Alliance Commercial |
$3,057.60
|
| Rate for Payer: WEA Trust Commercial |
$3,363.36
|
| Rate for Payer: WPS Commercial |
$4,529.36
|
|
|
MRI Spine Cervical, Brac Plex w + w/o Rt
|
Facility
|
OP
|
$5,880.00
|
|
|
Service Code
|
CPT 72156 TC,RT
|
| Hospital Charge Code |
1611272
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,712.26 |
| Max. Negotiated Rate |
$5,625.98 |
| Rate for Payer: Aetna Commercial |
$5,503.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,259.07
|
| Rate for Payer: Aetna Managed Medicare |
$1,712.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,241.06
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cash Price |
$1,764.00
|
| Rate for Payer: Cigna Commercial |
$5,625.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,422.16
|
| Rate for Payer: Health EOS Commercial |
$5,442.53
|
| Rate for Payer: HFN Commercial |
$5,625.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,586.40
|
| Rate for Payer: Multiplan Commercial |
$4,892.16
|
| Rate for Payer: NAPHCARE Commercial |
$3,669.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,625.98
|
| Rate for Payer: Quartz Beloit One Network |
$2,996.45
|
| Rate for Payer: Quartz Commercial |
$3,974.88
|
| Rate for Payer: Quartz Medicare Advantage |
$3,669.12
|
| Rate for Payer: The Alliance Commercial |
$3,057.60
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,363.36
|
| Rate for Payer: WPS Commercial |
$4,529.36
|
|
|
MRI Spine Cervical w/ Contrast
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
629596
|
| Min. Negotiated Rate |
$3,098.37 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$3,793.92
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Spine Cervical w/ Contrast
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 72142 TC
|
| Hospital Charge Code |
1611265
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$189.68 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$189.68
|
| Rate for Payer: Anthem Medicare Advantage |
$189.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$189.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$189.68
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.68
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$781.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$781.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$189.68
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$284.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: Quartz Medicare Advantage |
$189.68
|
| Rate for Payer: The Alliance Commercial |
$720.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.68
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$948.38
|
|
|
MRI Spine Cervical w/ Contrast
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 72142 TC
|
| Hospital Charge Code |
1611265
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$758.70 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$758.70
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$1,327.73
|
|
|
MRI Spine Cervical w/ Contrast
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
629596
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,161.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.14
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| 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 |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| 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 |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$4,110.08
|
| 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 |
$3,477.76
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Spine Cervical w/ Contrast
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 72142
|
| Hospital Charge Code |
629596
|
| Min. Negotiated Rate |
$272.26 |
| Max. Negotiated Rate |
$6,007.04 |
| Rate for Payer: Aetna Commercial |
$6,007.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$272.26
|
| Rate for Payer: Anthem Medicare Advantage |
$272.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$272.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$272.26
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$6,007.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,161.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.26
|
| Rate for Payer: Health EOS Commercial |
$5,754.11
|
| Rate for Payer: HFN Commercial |
$6,007.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,091.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,091.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$272.26
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$408.39
|
| Rate for Payer: Preferred Network Access Commercial |
$6,007.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,782.21
|
| Rate for Payer: Quartz Commercial |
$3,604.22
|
| Rate for Payer: Quartz Medicare Advantage |
$272.26
|
| Rate for Payer: The Alliance Commercial |
$1,034.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.26
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,361.31
|
|
|
MRI Spine Cervical w/ Contrast
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 72142 TC
|
| Hospital Charge Code |
1611265
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Spine Cervical w/o Contrast
|
Facility
|
OP
|
$5,058.00
|
|
|
Service Code
|
CPT 72141 TC
|
| Hospital Charge Code |
3072640
|
|
Hospital Revenue Code
|
612
|
| Min. Negotiated Rate |
$486.72 |
| Max. Negotiated Rate |
$4,839.49 |
| Rate for Payer: Aetna Commercial |
$4,734.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,523.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,472.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,787.97
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cash Price |
$1,517.40
|
| Rate for Payer: Cigna Commercial |
$4,839.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,943.76
|
| Rate for Payer: Health EOS Commercial |
$4,681.68
|
| Rate for Payer: HFN Commercial |
$4,839.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,945.24
|
| Rate for Payer: Multiplan Commercial |
$4,208.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,156.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,839.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,577.56
|
| Rate for Payer: Quartz Commercial |
$3,419.21
|
| Rate for Payer: Quartz Medicare Advantage |
$3,156.19
|
| Rate for Payer: The Alliance Commercial |
$486.72
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,893.18
|
| Rate for Payer: WPS Commercial |
$851.76
|
|
