|
XR ERCP Pancreatic Duct
|
Facility
|
OP
|
$2,417.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2587220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$9,668.00 |
| Rate for Payer: Aetna Commercial |
$2,175.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Managed Medicare |
$676.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,571.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,208.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,160.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,281.01
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,223.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,352.55
|
| Rate for Payer: Health EOS Commercial |
$2,151.13
|
| Rate for Payer: HFN Commercial |
$2,223.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,812.75
|
| Rate for Payer: Multiplan Commercial |
$1,933.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.33
|
| Rate for Payer: Quartz Commercial |
$1,571.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,450.20
|
| Rate for Payer: The Alliance Commercial |
$9,668.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,329.35
|
| Rate for Payer: WPS Commercial |
$1,790.27
|
|
|
XR ERCP Pancreatic Duct
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2448811
|
| Min. Negotiated Rate |
$650.72 |
| Max. Negotiated Rate |
$9,296.00 |
| Rate for Payer: Aetna Commercial |
$2,091.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.64
|
| Rate for Payer: Aetna Managed Medicare |
$650.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,510.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,115.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.72
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,138.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,300.51
|
| Rate for Payer: Health EOS Commercial |
$2,068.36
|
| Rate for Payer: HFN Commercial |
$2,138.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,743.00
|
| Rate for Payer: Multiplan Commercial |
$1,859.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,138.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.76
|
| Rate for Payer: Quartz Commercial |
$1,510.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,394.40
|
| Rate for Payer: The Alliance Commercial |
$9,296.00
|
| Rate for Payer: WEA Trust Commercial |
$1,278.20
|
| Rate for Payer: WPS Commercial |
$1,721.39
|
|
|
XR ERCP Pancreatic Duct
|
Professional
|
Both
|
$2,417.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2587220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$546.55 |
| Max. Negotiated Rate |
$2,296.15 |
| Rate for Payer: Aetna Commercial |
$2,296.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.62
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,296.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,208.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,450.20
|
| Rate for Payer: Health EOS Commercial |
$2,199.47
|
| Rate for Payer: HFN Commercial |
$2,296.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$546.55
|
| Rate for Payer: Multiplan Commercial |
$1,933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.48
|
| Rate for Payer: Quartz Commercial |
$1,377.69
|
| Rate for Payer: The Alliance Commercial |
$1,208.50
|
| Rate for Payer: WEA Trust Commercial |
$1,329.35
|
| Rate for Payer: WPS Commercial |
$1,790.27
|
|
|
XR ERCP Pancreatic Duct
|
Facility
|
IP
|
$2,417.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2587220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,184.33 |
| Max. Negotiated Rate |
$2,223.64 |
| Rate for Payer: Aetna Commercial |
$2,175.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,281.01
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,223.64
|
| Rate for Payer: Health EOS Commercial |
$2,151.13
|
| Rate for Payer: HFN Commercial |
$2,223.64
|
| Rate for Payer: Multiplan Commercial |
$1,933.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.33
|
| Rate for Payer: Quartz Commercial |
$1,450.20
|
| Rate for Payer: WEA Trust Commercial |
$1,329.35
|
| Rate for Payer: WPS Commercial |
$1,790.27
|
|
|
XR Esophagus
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
XR Esophagus
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$343.75 |
| Max. Negotiated Rate |
$1,165.65 |
| Rate for Payer: Aetna Commercial |
$1,165.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,165.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.20
|
| Rate for Payer: Health EOS Commercial |
$1,116.57
|
| Rate for Payer: HFN Commercial |
$1,165.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$343.75
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.65
|
| Rate for Payer: Quartz Beloit One Network |
$539.88
|
| Rate for Payer: Quartz Commercial |
$699.39
|
| Rate for Payer: The Alliance Commercial |
$613.50
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
XR Esophagus
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
630671
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$922.76 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.44
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$651.95
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
XR Esophagus
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.56
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$726.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
XR Esophagus
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
630671
|
| Min. Negotiated Rate |
$491.47 |
| Max. Negotiated Rate |
$922.76 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$601.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$601.80
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
XR Esophagus
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
630671
|
| Min. Negotiated Rate |
$343.75 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Aetna Commercial |
$952.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$952.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$501.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$601.80
|
| Rate for Payer: Health EOS Commercial |
$912.73
|
| Rate for Payer: HFN Commercial |
$952.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$343.75
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Preferred Network Access Commercial |
$952.85
|
| Rate for Payer: Quartz Beloit One Network |
$441.32
|
| Rate for Payer: Quartz Commercial |
$571.71
|
| Rate for Payer: The Alliance Commercial |
$501.50
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
XR Facial Bones < 3 Views
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 70140 TC
|
| Hospital Charge Code |
1537016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.13 |
| Max. Negotiated Rate |
$494.04 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$322.20
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$322.20
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
XR Facial Bones < 3 Views
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
630666
|
| Min. Negotiated Rate |
$108.83 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Aetna Commercial |
$472.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$472.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$248.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.20
|
| Rate for Payer: Health EOS Commercial |
$452.27
|
| Rate for Payer: HFN Commercial |
$472.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.83
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: Preferred Network Access Commercial |
$472.15
|
| Rate for Payer: Quartz Beloit One Network |
$218.68
|
| Rate for Payer: Quartz Commercial |
$283.29
|
| Rate for Payer: The Alliance Commercial |
$248.50
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
XR Facial Bones < 3 Views
|
Professional
|
Both
|
$537.00
|
|
|
Service Code
|
CPT 70140 TC
|
| Hospital Charge Code |
1537016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$74.62 |
| Max. Negotiated Rate |
$510.15 |
| Rate for Payer: Aetna Commercial |
$510.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$510.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$322.20
|
| Rate for Payer: Health EOS Commercial |
$488.67
|
| Rate for Payer: HFN Commercial |
$510.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.62
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$510.15
|
| Rate for Payer: Quartz Beloit One Network |
$236.28
|
| Rate for Payer: Quartz Commercial |
$306.09
|
| Rate for Payer: The Alliance Commercial |
$268.50
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
XR Facial Bones < 3 Views
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 70140 TC
|
| Hospital Charge Code |
1537016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$494.04 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$349.05
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
XR Facial Bones < 3 Views
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
630666
|
| Min. Negotiated Rate |
$243.53 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$298.20
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
XR Facial Bones < 3 Views
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
630666
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.56
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
XR Facial Bones Minimum 3 Views
|
Professional
|
Both
|
$697.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
630663
|
| Min. Negotiated Rate |
$160.40 |
| Max. Negotiated Rate |
$662.15 |
| Rate for Payer: Aetna Commercial |
$662.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.42
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$662.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$348.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.20
|
| Rate for Payer: Health EOS Commercial |
$634.27
|
| Rate for Payer: HFN Commercial |
$662.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$160.40
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$662.15
|
| Rate for Payer: Quartz Beloit One Network |
$306.68
|
| Rate for Payer: Quartz Commercial |
$397.29
|
| Rate for Payer: The Alliance Commercial |
$348.50
|
| Rate for Payer: WEA Trust Commercial |
$383.35
|
| Rate for Payer: WPS Commercial |
$516.27
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
630663
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$641.24 |
| Rate for Payer: Aetna Commercial |
$627.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.42
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$453.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.56
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$641.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$620.33
|
| Rate for Payer: HFN Commercial |
$641.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$641.24
|
| Rate for Payer: Quartz Beloit One Network |
$341.53
|
| Rate for Payer: Quartz Commercial |
$453.05
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$383.35
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$516.27
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
|
OP
|
$753.00
|
|
|
Service Code
|
CPT 70150 TC
|
| Hospital Charge Code |
1537018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$692.76 |
| Rate for Payer: Aetna Commercial |
$677.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.58
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$692.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$670.17
|
| Rate for Payer: HFN Commercial |
$692.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$602.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$692.76
|
| Rate for Payer: Quartz Beloit One Network |
$368.97
|
| Rate for Payer: Quartz Commercial |
$489.45
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$414.15
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$557.75
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 70150
|
| Hospital Charge Code |
630663
|
| Min. Negotiated Rate |
$341.53 |
| Max. Negotiated Rate |
$641.24 |
| Rate for Payer: Aetna Commercial |
$627.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.41
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$641.24
|
| Rate for Payer: Health EOS Commercial |
$620.33
|
| Rate for Payer: HFN Commercial |
$641.24
|
| Rate for Payer: Multiplan Commercial |
$557.60
|
| Rate for Payer: NAPHCARE Commercial |
$418.20
|
| Rate for Payer: Preferred Network Access Commercial |
$641.24
|
| Rate for Payer: Quartz Beloit One Network |
$341.53
|
| Rate for Payer: Quartz Commercial |
$418.20
|
| Rate for Payer: WEA Trust Commercial |
$383.35
|
| Rate for Payer: WPS Commercial |
$516.27
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
|
IP
|
$753.00
|
|
|
Service Code
|
CPT 70150 TC
|
| Hospital Charge Code |
1537018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.97 |
| Max. Negotiated Rate |
$692.76 |
| Rate for Payer: Aetna Commercial |
$677.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.09
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$692.76
|
| Rate for Payer: Health EOS Commercial |
$670.17
|
| Rate for Payer: HFN Commercial |
$692.76
|
| Rate for Payer: Multiplan Commercial |
$602.40
|
| Rate for Payer: NAPHCARE Commercial |
$451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$692.76
|
| Rate for Payer: Quartz Beloit One Network |
$368.97
|
| Rate for Payer: Quartz Commercial |
$451.80
|
| Rate for Payer: WEA Trust Commercial |
$414.15
|
| Rate for Payer: WPS Commercial |
$557.75
|
|
|
XR Facial Bones Minimum 3 Views
|
Professional
|
Both
|
$753.00
|
|
|
Service Code
|
CPT 70150 TC
|
| Hospital Charge Code |
1537018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.42 |
| Max. Negotiated Rate |
$715.35 |
| Rate for Payer: Aetna Commercial |
$715.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.58
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$715.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$451.80
|
| Rate for Payer: Health EOS Commercial |
$685.23
|
| Rate for Payer: HFN Commercial |
$715.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.42
|
| Rate for Payer: Multiplan Commercial |
$602.40
|
| Rate for Payer: Preferred Network Access Commercial |
$715.35
|
| Rate for Payer: Quartz Beloit One Network |
$331.32
|
| Rate for Payer: Quartz Commercial |
$429.21
|
| Rate for Payer: The Alliance Commercial |
$376.50
|
| Rate for Payer: WEA Trust Commercial |
$414.15
|
| Rate for Payer: WPS Commercial |
$557.75
|
|
|
XR Femur 1 View 73551
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 73551
|
| Hospital Charge Code |
4605843
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$99.33 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.80
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| Rate for Payer: HFN Commercial |
$50.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.33
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Preferred Network Access Commercial |
$50.35
|
| Rate for Payer: Quartz Beloit One Network |
$23.32
|
| Rate for Payer: Quartz Commercial |
$30.21
|
| Rate for Payer: The Alliance Commercial |
$26.50
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
XR Femur 1 View 7355126
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 73551 26
|
| Hospital Charge Code |
4605844
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.80
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| Rate for Payer: HFN Commercial |
$50.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.20
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Preferred Network Access Commercial |
$50.35
|
| Rate for Payer: Quartz Beloit One Network |
$23.32
|
| Rate for Payer: Quartz Commercial |
$30.21
|
| Rate for Payer: The Alliance Commercial |
$26.50
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
XR Femur 1 View Left
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 73551 TC,LT
|
| Hospital Charge Code |
4590783
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$415.84 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$293.80
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
