|
XR Foreign Body Loc Nose/Rectum Child
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 76010 TC
|
| Hospital Charge Code |
1537084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$503.24 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| 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 |
$289.91
|
| 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 |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| 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 |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$355.55
|
| 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 |
$300.85
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
XR Foreign Body Loc Nose/Rectum Child
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 76010 TC
|
| Hospital Charge Code |
1537084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$70.00 |
| Max. Negotiated Rate |
$519.65 |
| Rate for Payer: Aetna Commercial |
$519.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$519.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$273.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.20
|
| Rate for Payer: Health EOS Commercial |
$497.77
|
| Rate for Payer: HFN Commercial |
$519.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.00
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$519.65
|
| Rate for Payer: Quartz Beloit One Network |
$240.68
|
| Rate for Payer: Quartz Commercial |
$311.79
|
| Rate for Payer: The Alliance Commercial |
$273.50
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
XR Foreign Body Loc Nose/Rectum Child
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 76010 TC
|
| Hospital Charge Code |
1537084
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$268.03 |
| Max. Negotiated Rate |
$503.24 |
| Rate for Payer: Aetna Commercial |
$492.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$470.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$289.91
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$503.24
|
| Rate for Payer: Health EOS Commercial |
$486.83
|
| Rate for Payer: HFN Commercial |
$503.24
|
| Rate for Payer: Multiplan Commercial |
$437.60
|
| Rate for Payer: NAPHCARE Commercial |
$328.20
|
| Rate for Payer: Preferred Network Access Commercial |
$503.24
|
| Rate for Payer: Quartz Beloit One Network |
$268.03
|
| Rate for Payer: Quartz Commercial |
$328.20
|
| Rate for Payer: WEA Trust Commercial |
$300.85
|
| Rate for Payer: WPS Commercial |
$405.16
|
|
|
XR Gastrografin Enema
|
Facility
|
OP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
675797
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,183.12 |
| Rate for Payer: Aetna Commercial |
$1,157.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.96
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$835.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$643.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$617.28
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.58
|
| 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 |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,183.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$719.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,144.54
|
| Rate for Payer: HFN Commercial |
$1,183.12
|
| 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 |
$1,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,183.12
|
| Rate for Payer: Quartz Beloit One Network |
$630.14
|
| Rate for Payer: Quartz Commercial |
$835.90
|
| 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 |
$707.30
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$952.54
|
|
|
XR Gastrografin Enema
|
Professional
|
Both
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
675797
|
| Min. Negotiated Rate |
$543.34 |
| Max. Negotiated Rate |
$1,221.70 |
| Rate for Payer: Aetna Commercial |
$1,221.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.96
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,221.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$643.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.60
|
| Rate for Payer: Health EOS Commercial |
$1,170.26
|
| Rate for Payer: HFN Commercial |
$1,221.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.34
|
| Rate for Payer: Multiplan Commercial |
$1,028.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,221.70
|
| Rate for Payer: Quartz Beloit One Network |
$565.84
|
| Rate for Payer: Quartz Commercial |
$733.02
|
| Rate for Payer: The Alliance Commercial |
$643.00
|
| Rate for Payer: WEA Trust Commercial |
$707.30
|
| Rate for Payer: WPS Commercial |
$952.54
|
|
|
XR Gastrografin Enema
|
Professional
|
Both
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1537086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$543.34 |
| Max. Negotiated Rate |
$1,317.65 |
| Rate for Payer: Aetna Commercial |
$1,317.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.82
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,317.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$693.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$832.20
|
| Rate for Payer: Health EOS Commercial |
$1,262.17
|
| Rate for Payer: HFN Commercial |
$1,317.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.34
|
| Rate for Payer: Multiplan Commercial |
$1,109.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,317.65
|
| Rate for Payer: Quartz Beloit One Network |
$610.28
|
| Rate for Payer: Quartz Commercial |
$790.59
|
| Rate for Payer: The Alliance Commercial |
$693.50
|
| Rate for Payer: WEA Trust Commercial |
$762.85
|
| Rate for Payer: WPS Commercial |
$1,027.35
|
|
|
XR Gastrografin Enema
|
Facility
|
IP
|
$1,286.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
675797
|
| Min. Negotiated Rate |
$630.14 |
| Max. Negotiated Rate |
$1,183.12 |
| Rate for Payer: Aetna Commercial |
$1,157.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$681.58
|
| Rate for Payer: Cash Price |
$385.80
|
| Rate for Payer: Cigna Commercial |
$1,183.12
|
| Rate for Payer: Health EOS Commercial |
$1,144.54
|
| Rate for Payer: HFN Commercial |
$1,183.12
|
| Rate for Payer: Multiplan Commercial |
$1,028.80
|
| Rate for Payer: NAPHCARE Commercial |
$771.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,183.12
|
| Rate for Payer: Quartz Beloit One Network |
$630.14
|
| Rate for Payer: Quartz Commercial |
$771.60
|
| Rate for Payer: WEA Trust Commercial |
$707.30
|
| Rate for Payer: WPS Commercial |
$952.54
|
|
|
XR Gastrografin Enema
|
Facility
|
IP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1537086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$679.63 |
| Max. Negotiated Rate |
$1,276.04 |
| Rate for Payer: Aetna Commercial |
$1,248.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$735.11
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,276.04
|
| Rate for Payer: Health EOS Commercial |
$1,234.43
|
| Rate for Payer: HFN Commercial |
$1,276.04
|
| Rate for Payer: Multiplan Commercial |
$1,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$832.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.04
|
| Rate for Payer: Quartz Beloit One Network |
$679.63
|
| Rate for Payer: Quartz Commercial |
$832.20
|
| Rate for Payer: WEA Trust Commercial |
$762.85
|
| Rate for Payer: WPS Commercial |
$1,027.35
|
|
|
XR Gastrografin Enema
|
Facility
|
OP
|
$1,387.00
|
|
|
Service Code
|
CPT 74270
|
| Hospital Charge Code |
1537086
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,276.04 |
| Rate for Payer: Aetna Commercial |
$1,248.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,192.82
|
| 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 |
$735.11
|
| 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 |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,276.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$776.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,234.43
|
| Rate for Payer: HFN Commercial |
$1,276.04
|
| 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 |
$1,109.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.04
|
| Rate for Payer: Quartz Beloit One Network |
$679.63
|
| Rate for Payer: Quartz Commercial |
$901.55
|
| 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 |
$762.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$1,027.35
|
|
|
XR Gastrografin Swallow
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$343.75 |
| Max. Negotiated Rate |
$990.85 |
| Rate for Payer: Aetna Commercial |
$990.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$990.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$521.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.80
|
| Rate for Payer: Health EOS Commercial |
$949.13
|
| Rate for Payer: HFN Commercial |
$990.85
|
| 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 |
$834.40
|
| Rate for Payer: Preferred Network Access Commercial |
$990.85
|
| Rate for Payer: Quartz Beloit One Network |
$458.92
|
| Rate for Payer: Quartz Commercial |
$594.51
|
| Rate for Payer: The Alliance Commercial |
$521.50
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
XR Gastrografin Swallow
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$959.56 |
| Rate for Payer: Aetna Commercial |
$938.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| 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 |
$552.79
|
| 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 |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$959.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$928.27
|
| Rate for Payer: HFN Commercial |
$959.56
|
| 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 |
$834.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$959.56
|
| Rate for Payer: Quartz Beloit One Network |
$511.07
|
| Rate for Payer: Quartz Commercial |
$677.95
|
| 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: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
XR Gastrografin Swallow
|
Facility
|
IP
|
$1,043.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537088
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$511.07 |
| Max. Negotiated Rate |
$959.56 |
| Rate for Payer: Aetna Commercial |
$938.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$896.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.79
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$959.56
|
| Rate for Payer: Health EOS Commercial |
$928.27
|
| Rate for Payer: HFN Commercial |
$959.56
|
| Rate for Payer: Multiplan Commercial |
$834.40
|
| Rate for Payer: NAPHCARE Commercial |
$625.80
|
| Rate for Payer: Preferred Network Access Commercial |
$959.56
|
| Rate for Payer: Quartz Beloit One Network |
$511.07
|
| Rate for Payer: Quartz Commercial |
$625.80
|
| Rate for Payer: WEA Trust Commercial |
$573.65
|
| Rate for Payer: WPS Commercial |
$772.55
|
|
|
XR Gastrografin Swallow
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
675799
|
| 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 Gastrografin Swallow
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
675799
|
| 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 Gastrografin Swallow
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
675799
|
| 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 Hand 2 Views Bilateral
|
Facility
|
IP
|
$700.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630498
|
| Min. Negotiated Rate |
$343.00 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna Commercial |
$630.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$644.00
|
| Rate for Payer: Health EOS Commercial |
$623.00
|
| Rate for Payer: HFN Commercial |
$644.00
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: NAPHCARE Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$644.00
|
| Rate for Payer: Quartz Beloit One Network |
$343.00
|
| Rate for Payer: Quartz Commercial |
$420.00
|
| Rate for Payer: WEA Trust Commercial |
$385.00
|
| Rate for Payer: WPS Commercial |
$518.49
|
|
|
XR Hand 2 Views Bilateral
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630498
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$665.00 |
| Rate for Payer: Aetna Commercial |
$665.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$665.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$350.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.00
|
| Rate for Payer: Health EOS Commercial |
$637.00
|
| Rate for Payer: HFN Commercial |
$665.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$560.00
|
| Rate for Payer: Preferred Network Access Commercial |
$665.00
|
| Rate for Payer: Quartz Beloit One Network |
$308.00
|
| Rate for Payer: Quartz Commercial |
$399.00
|
| Rate for Payer: The Alliance Commercial |
$350.00
|
| Rate for Payer: WEA Trust Commercial |
$385.00
|
| Rate for Payer: WPS Commercial |
$518.49
|
|
|
XR Hand 2 Views Bilateral
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$434.68 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| 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 |
$207.23
|
| 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 |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| 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 |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| 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 |
$215.05
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Bilateral
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Bilateral
|
Facility
|
OP
|
$700.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630498
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$644.00 |
| Rate for Payer: Aetna Commercial |
$630.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.00
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$455.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$350.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.00
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.00
|
| 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 |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$644.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$391.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$623.00
|
| Rate for Payer: HFN Commercial |
$644.00
|
| 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 |
$560.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$644.00
|
| Rate for Payer: Quartz Beloit One Network |
$343.00
|
| Rate for Payer: Quartz Commercial |
$455.00
|
| 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 |
$385.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$518.49
|
|
|
XR Hand 2 Views Bilateral
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537090
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: HFN Commercial |
$371.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: The Alliance Commercial |
$195.50
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Left
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630493
|
| Min. Negotiated Rate |
$171.01 |
| Max. Negotiated Rate |
$321.08 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$209.40
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
XR Hand 2 Views Left
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$434.68 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| 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 |
$207.23
|
| 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 |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| 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 |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| 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 |
$215.05
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Left
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 73120 LT,TC
|
| Hospital Charge Code |
1537092
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
XR Hand 2 Views Left
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
CPT 73120
|
| Hospital Charge Code |
630493
|
| Min. Negotiated Rate |
$105.12 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Aetna Commercial |
$331.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$331.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.40
|
| Rate for Payer: Health EOS Commercial |
$317.59
|
| Rate for Payer: HFN Commercial |
$331.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$105.12
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Preferred Network Access Commercial |
$331.55
|
| Rate for Payer: Quartz Beloit One Network |
$153.56
|
| Rate for Payer: Quartz Commercial |
$198.93
|
| Rate for Payer: The Alliance Commercial |
$174.50
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
