|
XR Hip Operative Right
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 73501 RT
|
| Hospital Charge Code |
1537118
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$412.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.40
|
| Rate for Payer: Health EOS Commercial |
$394.94
|
| Rate for Payer: HFN Commercial |
$412.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$412.30
|
| Rate for Payer: Quartz Beloit One Network |
$190.96
|
| Rate for Payer: Quartz Commercial |
$247.38
|
| Rate for Payer: The Alliance Commercial |
$217.00
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
XR Hip Operative Right
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 73501
|
| Hospital Charge Code |
630439
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna Commercial |
$589.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$589.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.00
|
| Rate for Payer: Health EOS Commercial |
$564.20
|
| Rate for Payer: HFN Commercial |
$589.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$589.00
|
| Rate for Payer: Quartz Beloit One Network |
$272.80
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$310.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
XR Hip Right w/Pelvis
|
Facility
|
IP
|
$739.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$362.11 |
| Max. Negotiated Rate |
$679.88 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$443.40
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$443.40
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
XR Hip Right w/Pelvis
|
Facility
|
OP
|
$739.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$480.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.72
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$679.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$657.71
|
| Rate for Payer: HFN Commercial |
$679.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$679.88
|
| Rate for Payer: Quartz Beloit One Network |
$362.11
|
| Rate for Payer: Quartz Commercial |
$480.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
XR Hip Right w/Pelvis
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
CPT 36252 TC,RT
|
| Hospital Charge Code |
2980132
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$325.16 |
| Max. Negotiated Rate |
$1,227.91 |
| Rate for Payer: Aetna Commercial |
$702.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.54
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$702.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,227.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$443.40
|
| Rate for Payer: Health EOS Commercial |
$672.49
|
| Rate for Payer: HFN Commercial |
$702.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,145.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,145.27
|
| Rate for Payer: Multiplan Commercial |
$591.20
|
| Rate for Payer: Preferred Network Access Commercial |
$702.05
|
| Rate for Payer: Quartz Beloit One Network |
$325.16
|
| Rate for Payer: Quartz Commercial |
$421.23
|
| Rate for Payer: The Alliance Commercial |
$369.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,227.91
|
| Rate for Payer: WEA Trust Commercial |
$406.45
|
| Rate for Payer: WPS Commercial |
$547.38
|
|
|
XR Hip Therapeutic Injection Lt
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570655
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$441.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.84
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$573.95
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$1,171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$662.25
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Lt
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570655
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$432.67 |
| Max. Negotiated Rate |
$812.36 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$529.80
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Lt
|
Professional
|
Both
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,LT
|
| Hospital Charge Code |
4570655
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Aetna Commercial |
$838.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$838.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.80
|
| Rate for Payer: Health EOS Commercial |
$803.53
|
| Rate for Payer: HFN Commercial |
$838.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.77
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$838.85
|
| Rate for Payer: Quartz Beloit One Network |
$388.52
|
| Rate for Payer: Quartz Commercial |
$503.31
|
| Rate for Payer: The Alliance Commercial |
$441.50
|
| Rate for Payer: United Healthcare Medicaid |
$64.65
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Rt
|
Facility
|
IP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570661
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$432.67 |
| Max. Negotiated Rate |
$812.36 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$529.80
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Rt
|
Facility
|
OP
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570661
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$292.75 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$794.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Aetna Managed Medicare |
$292.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$441.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.84
|
| Rate for Payer: Anthem Medicare Advantage |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.75
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$812.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$292.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$292.75
|
| Rate for Payer: Health EOS Commercial |
$785.87
|
| Rate for Payer: HFN Commercial |
$812.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,089.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$292.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$292.75
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: NAPHCARE Commercial |
$439.12
|
| Rate for Payer: Preferred Network Access Commercial |
$812.36
|
| Rate for Payer: Quartz Beloit One Network |
$432.67
|
| Rate for Payer: Quartz Commercial |
$573.95
|
| Rate for Payer: Quartz Medicare Advantage |
$292.75
|
| Rate for Payer: The Alliance Commercial |
$1,171.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.75
|
| Rate for Payer: United Healthcare PPO |
$662.25
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: Wellcare Medicare |
$292.75
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip Therapeutic Injection Rt
|
Professional
|
Both
|
$883.00
|
|
|
Service Code
|
CPT 20610 TC,RT
|
| Hospital Charge Code |
4570661
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$64.65 |
| Max. Negotiated Rate |
$838.85 |
| Rate for Payer: Aetna Commercial |
$838.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.38
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cash Price |
$264.90
|
| Rate for Payer: Cigna Commercial |
$838.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.80
|
| Rate for Payer: Health EOS Commercial |
$803.53
|
| Rate for Payer: HFN Commercial |
$838.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.77
|
| Rate for Payer: Multiplan Commercial |
$706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$838.85
|
| Rate for Payer: Quartz Beloit One Network |
$388.52
|
| Rate for Payer: Quartz Commercial |
$503.31
|
| Rate for Payer: The Alliance Commercial |
$441.50
|
| Rate for Payer: United Healthcare Medicaid |
$64.65
|
| Rate for Payer: WEA Trust Commercial |
$485.65
|
| Rate for Payer: WPS Commercial |
$654.04
|
|
|
XR Hip w or w/o Pel 2 or 3 Views Right
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4590789
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| 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 |
$398.03
|
| 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 |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| 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 |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$488.15
|
| 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 |
$413.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip w or w/o Pel 2 or 3 Views Right
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4590789
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$450.60
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip w or w/o Pel 2 or 3 Views Right
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 73502 TC,RT
|
| Hospital Charge Code |
4590789
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.79 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Aetna Commercial |
$713.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$713.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.60
|
| Rate for Payer: Health EOS Commercial |
$683.41
|
| Rate for Payer: HFN Commercial |
$713.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.79
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$713.45
|
| Rate for Payer: Quartz Beloit One Network |
$330.44
|
| Rate for Payer: Quartz Commercial |
$428.07
|
| Rate for Payer: The Alliance Commercial |
$375.50
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip w or w/o Pelvis 1 view Left
|
Facility
|
IP
|
$364.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4592958
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
XR Hip w or w/o Pelvis 1 view Left
|
Facility
|
OP
|
$364.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4592958
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$359.28 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| 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 |
$192.92
|
| 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 |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| 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 |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| 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 |
$200.20
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
XR Hip w or w/o Pelvis 1 view Left
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
CPT 73501 TC,LT
|
| Hospital Charge Code |
4592958
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.76 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.40
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: The Alliance Commercial |
$182.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
XR Hip w or w/o Pelvis 1 view Right
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 73501 RT,TC
|
| Hospital Charge Code |
4592961
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip w or w/o Pelvis 1 view Right
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 73501 RT,TC
|
| Hospital Charge Code |
4592961
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$359.28 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| 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 |
$129.85
|
| 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 |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| 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 |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| 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 |
$134.75
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip w or w/o Pelvis 1 view Right
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 73501 RT,TC
|
| Hospital Charge Code |
4592961
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: HFN Commercial |
$232.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.76
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Facility
|
IP
|
$751.00
|
|
|
Service Code
|
CPT 73502 LT,TC
|
| Hospital Charge Code |
4590792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$367.99 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$398.03
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$450.60
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$450.60
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Facility
|
OP
|
$751.00
|
|
|
Service Code
|
CPT 73502 LT,TC
|
| Hospital Charge Code |
4590792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$690.92 |
| Rate for Payer: Aetna Commercial |
$675.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| 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 |
$398.03
|
| 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 |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$690.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$668.39
|
| Rate for Payer: HFN Commercial |
$690.92
|
| 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 |
$600.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$690.92
|
| Rate for Payer: Quartz Beloit One Network |
$367.99
|
| Rate for Payer: Quartz Commercial |
$488.15
|
| 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 |
$413.05
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Hip w or w/o Pelvis 2 or 3 Views Left
|
Professional
|
Both
|
$751.00
|
|
|
Service Code
|
CPT 73502 LT,TC
|
| Hospital Charge Code |
4590792
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$157.79 |
| Max. Negotiated Rate |
$713.45 |
| Rate for Payer: Aetna Commercial |
$713.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.86
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cash Price |
$225.30
|
| Rate for Payer: Cigna Commercial |
$713.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$450.60
|
| Rate for Payer: Health EOS Commercial |
$683.41
|
| Rate for Payer: HFN Commercial |
$713.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.79
|
| Rate for Payer: Multiplan Commercial |
$600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$713.45
|
| Rate for Payer: Quartz Beloit One Network |
$330.44
|
| Rate for Payer: Quartz Commercial |
$428.07
|
| Rate for Payer: The Alliance Commercial |
$375.50
|
| Rate for Payer: WEA Trust Commercial |
$413.05
|
| Rate for Payer: WPS Commercial |
$556.27
|
|
|
XR Humerus Bilateral
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 73060 LT,TC
|
| Hospital Charge Code |
1537120
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna Commercial |
$529.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$529.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.20
|
| Rate for Payer: Health EOS Commercial |
$506.87
|
| Rate for Payer: HFN Commercial |
$529.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.62
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$529.15
|
| Rate for Payer: Quartz Beloit One Network |
$245.08
|
| Rate for Payer: Quartz Commercial |
$317.49
|
| Rate for Payer: The Alliance Commercial |
$278.50
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
XR Humerus Bilateral
|
Facility
|
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 73060
|
| Hospital Charge Code |
630433
|
| Min. Negotiated Rate |
$504.70 |
| Max. Negotiated Rate |
$947.60 |
| Rate for Payer: Aetna Commercial |
$927.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.90
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$947.60
|
| Rate for Payer: Health EOS Commercial |
$916.70
|
| Rate for Payer: HFN Commercial |
$947.60
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: NAPHCARE Commercial |
$618.00
|
| Rate for Payer: Preferred Network Access Commercial |
$947.60
|
| Rate for Payer: Quartz Beloit One Network |
$504.70
|
| Rate for Payer: Quartz Commercial |
$618.00
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
