|
XR IVP
|
Professional
|
Both
|
$1,525.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
1537128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$462.92 |
| Max. Negotiated Rate |
$1,448.75 |
| Rate for Payer: Aetna Commercial |
$1,448.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,448.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$762.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$915.00
|
| Rate for Payer: Health EOS Commercial |
$1,387.75
|
| Rate for Payer: HFN Commercial |
$1,448.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$462.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$462.92
|
| Rate for Payer: Multiplan Commercial |
$1,220.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,448.75
|
| Rate for Payer: Quartz Beloit One Network |
$671.00
|
| Rate for Payer: Quartz Commercial |
$869.25
|
| Rate for Payer: The Alliance Commercial |
$762.50
|
| Rate for Payer: WEA Trust Commercial |
$838.75
|
| Rate for Payer: WPS Commercial |
$1,129.57
|
|
|
XR IVP
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
1537128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,403.00 |
| Rate for Payer: Aetna Commercial |
$1,372.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.50
|
| 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 |
$808.25
|
| 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 |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,403.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,357.25
|
| Rate for Payer: HFN Commercial |
$1,403.00
|
| 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 |
$1,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.00
|
| Rate for Payer: Quartz Beloit One Network |
$747.25
|
| Rate for Payer: Quartz Commercial |
$991.25
|
| 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 |
$838.75
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$1,129.57
|
|
|
XR IVP
|
Facility
|
OP
|
$1,412.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
630417
|
| Min. Negotiated Rate |
$181.60 |
| Max. Negotiated Rate |
$1,299.04 |
| Rate for Payer: Aetna Commercial |
$1,270.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.32
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$917.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$706.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$677.76
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.36
|
| 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 |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,299.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$790.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,256.68
|
| Rate for Payer: HFN Commercial |
$1,299.04
|
| 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 |
$1,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.04
|
| Rate for Payer: Quartz Beloit One Network |
$691.88
|
| Rate for Payer: Quartz Commercial |
$917.80
|
| 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 |
$776.60
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$1,045.87
|
|
|
XR IVP
|
Facility
|
IP
|
$1,525.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
1537128
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$747.25 |
| Max. Negotiated Rate |
$1,403.00 |
| Rate for Payer: Aetna Commercial |
$1,372.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.25
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,403.00
|
| Rate for Payer: Health EOS Commercial |
$1,357.25
|
| Rate for Payer: HFN Commercial |
$1,403.00
|
| Rate for Payer: Multiplan Commercial |
$1,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$915.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.00
|
| Rate for Payer: Quartz Beloit One Network |
$747.25
|
| Rate for Payer: Quartz Commercial |
$915.00
|
| Rate for Payer: WEA Trust Commercial |
$838.75
|
| Rate for Payer: WPS Commercial |
$1,129.57
|
|
|
XR IVP
|
Facility
|
IP
|
$1,412.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
630417
|
| Min. Negotiated Rate |
$691.88 |
| Max. Negotiated Rate |
$1,299.04 |
| Rate for Payer: Aetna Commercial |
$1,270.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.36
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,299.04
|
| Rate for Payer: Health EOS Commercial |
$1,256.68
|
| Rate for Payer: HFN Commercial |
$1,299.04
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$847.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.04
|
| Rate for Payer: Quartz Beloit One Network |
$691.88
|
| Rate for Payer: Quartz Commercial |
$847.20
|
| Rate for Payer: WEA Trust Commercial |
$776.60
|
| Rate for Payer: WPS Commercial |
$1,045.87
|
|
|
XR IVP
|
Professional
|
Both
|
$1,412.00
|
|
|
Service Code
|
CPT 74400
|
| Hospital Charge Code |
630417
|
| Min. Negotiated Rate |
$462.92 |
| Max. Negotiated Rate |
$1,341.40 |
| Rate for Payer: Aetna Commercial |
$1,341.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.32
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cash Price |
$423.60
|
| Rate for Payer: Cigna Commercial |
$1,341.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$706.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$847.20
|
| Rate for Payer: Health EOS Commercial |
$1,284.92
|
| Rate for Payer: HFN Commercial |
$1,341.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$462.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$462.92
|
| Rate for Payer: Multiplan Commercial |
$1,129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,341.40
|
| Rate for Payer: Quartz Beloit One Network |
$621.28
|
| Rate for Payer: Quartz Commercial |
$804.84
|
| Rate for Payer: The Alliance Commercial |
$706.00
|
| Rate for Payer: WEA Trust Commercial |
$776.60
|
| Rate for Payer: WPS Commercial |
$1,045.87
|
|
|
XR Joint Survey Single View
|
Professional
|
Both
|
$685.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
1537136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$158.92 |
| Max. Negotiated Rate |
$650.75 |
| Rate for Payer: Aetna Commercial |
$650.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$589.10
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$650.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$342.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$411.00
|
| Rate for Payer: Health EOS Commercial |
$623.35
|
| Rate for Payer: HFN Commercial |
$650.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$158.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$158.92
|
| Rate for Payer: Multiplan Commercial |
$548.00
|
| Rate for Payer: Preferred Network Access Commercial |
$650.75
|
| Rate for Payer: Quartz Beloit One Network |
$301.40
|
| Rate for Payer: Quartz Commercial |
$390.45
|
| Rate for Payer: The Alliance Commercial |
$342.50
|
| Rate for Payer: WEA Trust Commercial |
$376.75
|
| Rate for Payer: WPS Commercial |
$507.38
|
|
|
XR Joint Survey Single View
|
Facility
|
OP
|
$685.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
1537136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$630.20 |
| Rate for Payer: Aetna Commercial |
$616.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$589.10
|
| 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 |
$363.05
|
| 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 |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$630.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$383.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$609.65
|
| Rate for Payer: HFN Commercial |
$630.20
|
| 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 |
$548.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$630.20
|
| Rate for Payer: Quartz Beloit One Network |
$335.65
|
| Rate for Payer: Quartz Commercial |
$445.25
|
| 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 |
$376.75
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$507.38
|
|
|
XR Joint Survey Single View
|
Facility
|
OP
|
$659.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
630410
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$606.28 |
| Rate for Payer: Aetna Commercial |
$593.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.74
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$428.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$316.32
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.27
|
| 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 |
$197.70
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$606.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$586.51
|
| Rate for Payer: HFN Commercial |
$606.28
|
| 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 |
$527.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$606.28
|
| Rate for Payer: Quartz Beloit One Network |
$322.91
|
| Rate for Payer: Quartz Commercial |
$428.35
|
| 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 |
$362.45
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$488.12
|
|
|
XR Joint Survey Single View
|
Facility
|
IP
|
$685.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
1537136
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$335.65 |
| Max. Negotiated Rate |
$630.20 |
| Rate for Payer: Aetna Commercial |
$616.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$589.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$363.05
|
| Rate for Payer: Cash Price |
$205.50
|
| Rate for Payer: Cigna Commercial |
$630.20
|
| Rate for Payer: Health EOS Commercial |
$609.65
|
| Rate for Payer: HFN Commercial |
$630.20
|
| Rate for Payer: Multiplan Commercial |
$548.00
|
| Rate for Payer: NAPHCARE Commercial |
$411.00
|
| Rate for Payer: Preferred Network Access Commercial |
$630.20
|
| Rate for Payer: Quartz Beloit One Network |
$335.65
|
| Rate for Payer: Quartz Commercial |
$411.00
|
| Rate for Payer: WEA Trust Commercial |
$376.75
|
| Rate for Payer: WPS Commercial |
$507.38
|
|
|
XR Joint Survey Single View
|
Professional
|
Both
|
$659.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
630410
|
| Min. Negotiated Rate |
$158.92 |
| Max. Negotiated Rate |
$626.05 |
| Rate for Payer: Aetna Commercial |
$626.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.74
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$626.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$329.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.40
|
| Rate for Payer: Health EOS Commercial |
$599.69
|
| Rate for Payer: HFN Commercial |
$626.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$158.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$158.92
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: Preferred Network Access Commercial |
$626.05
|
| Rate for Payer: Quartz Beloit One Network |
$289.96
|
| Rate for Payer: Quartz Commercial |
$375.63
|
| Rate for Payer: The Alliance Commercial |
$329.50
|
| Rate for Payer: WEA Trust Commercial |
$362.45
|
| Rate for Payer: WPS Commercial |
$488.12
|
|
|
XR Joint Survey Single View
|
Facility
|
IP
|
$659.00
|
|
|
Service Code
|
CPT 77077
|
| Hospital Charge Code |
630410
|
| Min. Negotiated Rate |
$322.91 |
| Max. Negotiated Rate |
$606.28 |
| Rate for Payer: Aetna Commercial |
$593.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.27
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$606.28
|
| Rate for Payer: Health EOS Commercial |
$586.51
|
| Rate for Payer: HFN Commercial |
$606.28
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: NAPHCARE Commercial |
$395.40
|
| Rate for Payer: Preferred Network Access Commercial |
$606.28
|
| Rate for Payer: Quartz Beloit One Network |
$322.91
|
| Rate for Payer: Quartz Commercial |
$395.40
|
| Rate for Payer: WEA Trust Commercial |
$362.45
|
| Rate for Payer: WPS Commercial |
$488.12
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.57 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$513.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.00
|
| Rate for Payer: Health EOS Commercial |
$491.40
|
| Rate for Payer: HFN Commercial |
$513.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.57
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$513.00
|
| Rate for Payer: Quartz Beloit One Network |
$237.60
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| 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 |
$286.20
|
| 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 |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| 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 |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$351.00
|
| 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 |
$297.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Facility
|
IP
|
$1,052.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630365
|
| Min. Negotiated Rate |
$515.48 |
| Max. Negotiated Rate |
$967.84 |
| Rate for Payer: Aetna Commercial |
$946.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$904.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.56
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$967.84
|
| Rate for Payer: Health EOS Commercial |
$936.28
|
| Rate for Payer: HFN Commercial |
$967.84
|
| Rate for Payer: Multiplan Commercial |
$841.60
|
| Rate for Payer: NAPHCARE Commercial |
$631.20
|
| Rate for Payer: Preferred Network Access Commercial |
$967.84
|
| Rate for Payer: Quartz Beloit One Network |
$515.48
|
| Rate for Payer: Quartz Commercial |
$631.20
|
| Rate for Payer: WEA Trust Commercial |
$578.60
|
| Rate for Payer: WPS Commercial |
$779.22
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Professional
|
Both
|
$1,052.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630365
|
| Min. Negotiated Rate |
$115.57 |
| Max. Negotiated Rate |
$999.40 |
| Rate for Payer: Aetna Commercial |
$999.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$904.72
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$999.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$526.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$631.20
|
| Rate for Payer: Health EOS Commercial |
$957.32
|
| Rate for Payer: HFN Commercial |
$999.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.57
|
| Rate for Payer: Multiplan Commercial |
$841.60
|
| Rate for Payer: Preferred Network Access Commercial |
$999.40
|
| Rate for Payer: Quartz Beloit One Network |
$462.88
|
| Rate for Payer: Quartz Commercial |
$599.64
|
| Rate for Payer: The Alliance Commercial |
$526.00
|
| Rate for Payer: WEA Trust Commercial |
$578.60
|
| Rate for Payer: WPS Commercial |
$779.22
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537138
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Bilateral
|
Facility
|
OP
|
$1,052.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630365
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$967.84 |
| Rate for Payer: Aetna Commercial |
$946.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$904.72
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$683.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$526.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$504.96
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$557.56
|
| 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 |
$315.60
|
| Rate for Payer: Cash Price |
$315.60
|
| Rate for Payer: Cigna Commercial |
$967.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$588.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$936.28
|
| Rate for Payer: HFN Commercial |
$967.84
|
| 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 |
$841.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$967.84
|
| Rate for Payer: Quartz Beloit One Network |
$515.48
|
| Rate for Payer: Quartz Commercial |
$683.80
|
| 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: WEA Trust Commercial |
$578.60
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$779.22
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630361
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$341.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.48
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| 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 |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| 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 |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$341.90
|
| 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 |
$289.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| 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 |
$286.20
|
| 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 |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| 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 |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$351.00
|
| 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 |
$297.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Left
|
Facility
|
IP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630361
|
| Min. Negotiated Rate |
$257.74 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$315.60
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$315.60
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Knee 1 or 2 Views Left
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 73560 LT,TC
|
| Hospital Charge Code |
1537140
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$115.57 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$513.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.00
|
| Rate for Payer: Health EOS Commercial |
$491.40
|
| Rate for Payer: HFN Commercial |
$513.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.57
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$513.00
|
| Rate for Payer: Quartz Beloit One Network |
$237.60
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
XR Knee 1 or 2 Views Left
|
Professional
|
Both
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630361
|
| Min. Negotiated Rate |
$115.57 |
| Max. Negotiated Rate |
$499.70 |
| Rate for Payer: Aetna Commercial |
$499.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$499.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$263.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.60
|
| Rate for Payer: Health EOS Commercial |
$478.66
|
| Rate for Payer: HFN Commercial |
$499.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.57
|
| Rate for Payer: Multiplan Commercial |
$420.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.70
|
| Rate for Payer: Quartz Beloit One Network |
$231.44
|
| Rate for Payer: Quartz Commercial |
$299.82
|
| Rate for Payer: The Alliance Commercial |
$263.00
|
| Rate for Payer: WEA Trust Commercial |
$289.30
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
|
XR Knee 1 or 2 Views Right
|
Facility
|
OP
|
$526.00
|
|
|
Service Code
|
CPT 73560
|
| Hospital Charge Code |
630355
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$483.92 |
| Rate for Payer: Aetna Commercial |
$473.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.36
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$341.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.48
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.78
|
| 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 |
$157.80
|
| Rate for Payer: Cash Price |
$157.80
|
| Rate for Payer: Cigna Commercial |
$483.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$468.14
|
| Rate for Payer: HFN Commercial |
$483.92
|
| 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 |
$420.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$483.92
|
| Rate for Payer: Quartz Beloit One Network |
$257.74
|
| Rate for Payer: Quartz Commercial |
$341.90
|
| 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 |
$289.30
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$389.61
|
|
