|
XR Bone Age Studies
|
Professional
|
Both
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$25.12 |
| Max. Negotiated Rate |
$634.30 |
| Rate for Payer: Aetna Commercial |
$634.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Aetna Managed Medicare |
$25.12
|
| Rate for Payer: Anthem Medicare Advantage |
$25.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.12
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$634.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$333.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.12
|
| Rate for Payer: Health EOS Commercial |
$607.59
|
| Rate for Payer: HFN Commercial |
$634.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.12
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: NAPHCARE Commercial |
$37.67
|
| Rate for Payer: Preferred Network Access Commercial |
$634.30
|
| Rate for Payer: Quartz Beloit One Network |
$293.78
|
| Rate for Payer: Quartz Commercial |
$380.58
|
| Rate for Payer: Quartz Medicare Advantage |
$25.12
|
| Rate for Payer: The Alliance Commercial |
$95.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.12
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$125.58
|
|
|
XR Bone Age Studies
|
Facility
|
IP
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$327.16 |
| Max. Negotiated Rate |
$614.27 |
| Rate for Payer: Aetna Commercial |
$600.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.87
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$614.27
|
| Rate for Payer: Health EOS Commercial |
$594.24
|
| Rate for Payer: HFN Commercial |
$614.27
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: Preferred Network Access Commercial |
$614.27
|
| Rate for Payer: Quartz Beloit One Network |
$327.16
|
| Rate for Payer: Quartz Commercial |
$400.61
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
XR Bone Age Studies
|
Facility
|
OP
|
$642.00
|
|
|
Service Code
|
CPT 77072
|
| Hospital Charge Code |
627628
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$614.27 |
| Rate for Payer: Aetna Commercial |
$600.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.20
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$433.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$333.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$320.49
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$614.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$594.24
|
| Rate for Payer: HFN Commercial |
$614.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$534.14
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$614.27
|
| Rate for Payer: Quartz Beloit One Network |
$327.16
|
| Rate for Payer: Quartz Commercial |
$433.99
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$367.22
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$494.53
|
|
|
XR Bone Age Studies
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$64.31 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Aetna Managed Medicare |
$202.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.53
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$664.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.91
|
| Rate for Payer: Health EOS Commercial |
$642.37
|
| Rate for Payer: HFN Commercial |
$664.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$541.32
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: NAPHCARE Commercial |
$433.06
|
| Rate for Payer: Preferred Network Access Commercial |
$664.02
|
| Rate for Payer: Quartz Beloit One Network |
$353.66
|
| Rate for Payer: Quartz Commercial |
$469.14
|
| Rate for Payer: Quartz Medicare Advantage |
$433.06
|
| Rate for Payer: The Alliance Commercial |
$64.31
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$534.59
|
|
|
XR Bone Age Studies
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.08 |
| Max. Negotiated Rate |
$685.67 |
| Rate for Payer: Aetna Commercial |
$685.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Aetna Managed Medicare |
$16.08
|
| Rate for Payer: Anthem Medicare Advantage |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.08
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$685.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$360.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.08
|
| Rate for Payer: Health EOS Commercial |
$656.80
|
| Rate for Payer: HFN Commercial |
$685.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.08
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: NAPHCARE Commercial |
$24.12
|
| Rate for Payer: Preferred Network Access Commercial |
$685.67
|
| Rate for Payer: Quartz Beloit One Network |
$317.57
|
| Rate for Payer: Quartz Commercial |
$411.40
|
| Rate for Payer: Quartz Medicare Advantage |
$16.08
|
| Rate for Payer: The Alliance Commercial |
$61.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.08
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$80.39
|
|
|
XR Bone Age Studies
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 77072 TC
|
| Hospital Charge Code |
1536891
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$353.66 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.53
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$664.02
|
| Rate for Payer: Health EOS Commercial |
$642.37
|
| Rate for Payer: HFN Commercial |
$664.02
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: Preferred Network Access Commercial |
$664.02
|
| Rate for Payer: Quartz Beloit One Network |
$353.66
|
| Rate for Payer: Quartz Commercial |
$433.06
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$534.59
|
|
|
XR Bone Length Adult
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$159.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| 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 |
$523.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.35
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.66
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$341.33
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$369.77
|
| Rate for Payer: Quartz Medicare Advantage |
$341.33
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Adult
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$540.44 |
| Rate for Payer: Aetna Commercial |
$540.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$33.05
|
| Rate for Payer: Anthem Medicare Advantage |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.05
|
| 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 |
$540.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.05
|
| Rate for Payer: Health EOS Commercial |
$517.68
|
| Rate for Payer: HFN Commercial |
$540.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.05
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$49.58
|
| Rate for Payer: Preferred Network Access Commercial |
$540.44
|
| Rate for Payer: Quartz Beloit One Network |
$250.31
|
| Rate for Payer: Quartz Commercial |
$324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$33.05
|
| Rate for Payer: The Alliance Commercial |
$125.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.05
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$165.26
|
|
|
XR Bone Length Adult
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$341.33
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Child
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$540.44 |
| Rate for Payer: Aetna Commercial |
$540.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$33.05
|
| Rate for Payer: Anthem Medicare Advantage |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.05
|
| 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 |
$540.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.05
|
| Rate for Payer: Health EOS Commercial |
$517.68
|
| Rate for Payer: HFN Commercial |
$540.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.05
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$49.58
|
| Rate for Payer: Preferred Network Access Commercial |
$540.44
|
| Rate for Payer: Quartz Beloit One Network |
$250.31
|
| Rate for Payer: Quartz Commercial |
$324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$33.05
|
| Rate for Payer: The Alliance Commercial |
$125.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.05
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$165.26
|
|
|
XR Bone Length Child
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$159.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| 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 |
$523.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.35
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.66
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$341.33
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$369.77
|
| Rate for Payer: Quartz Medicare Advantage |
$341.33
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Child
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
5963658
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$341.33
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Studies Scanograms
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
1536893
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.20 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$159.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| 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 |
$523.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.35
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.66
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$341.33
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$369.77
|
| Rate for Payer: Quartz Medicare Advantage |
$341.33
|
| Rate for Payer: The Alliance Commercial |
$132.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Studies Scanograms
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
627646
|
| Min. Negotiated Rate |
$45.95 |
| Max. Negotiated Rate |
$531.54 |
| Rate for Payer: Aetna Commercial |
$531.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.19
|
| Rate for Payer: Aetna Managed Medicare |
$45.95
|
| Rate for Payer: Anthem Medicare Advantage |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.95
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$531.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$279.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.95
|
| Rate for Payer: Health EOS Commercial |
$509.16
|
| Rate for Payer: HFN Commercial |
$531.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$158.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$158.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.95
|
| Rate for Payer: Multiplan Commercial |
$447.62
|
| Rate for Payer: NAPHCARE Commercial |
$68.92
|
| Rate for Payer: Preferred Network Access Commercial |
$531.54
|
| Rate for Payer: Quartz Beloit One Network |
$246.19
|
| Rate for Payer: Quartz Commercial |
$318.93
|
| Rate for Payer: Quartz Medicare Advantage |
$45.95
|
| Rate for Payer: The Alliance Commercial |
$174.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.95
|
| Rate for Payer: WEA Trust Commercial |
$307.74
|
| Rate for Payer: WPS Commercial |
$229.74
|
|
|
XR Bone Length Studies Scanograms
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
1536893
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$341.33
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
XR Bone Length Studies Scanograms
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 77073 TC
|
| Hospital Charge Code |
1536893
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$33.05 |
| Max. Negotiated Rate |
$540.44 |
| Rate for Payer: Aetna Commercial |
$540.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$33.05
|
| Rate for Payer: Anthem Medicare Advantage |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.05
|
| 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 |
$540.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.05
|
| Rate for Payer: Health EOS Commercial |
$517.68
|
| Rate for Payer: HFN Commercial |
$540.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.05
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$49.58
|
| Rate for Payer: Preferred Network Access Commercial |
$540.44
|
| Rate for Payer: Quartz Beloit One Network |
$250.31
|
| Rate for Payer: Quartz Commercial |
$324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$33.05
|
| Rate for Payer: The Alliance Commercial |
$125.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.05
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$165.26
|
|
|
XR Bone Length Studies Scanograms
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
627646
|
| Min. Negotiated Rate |
$274.16 |
| Max. Negotiated Rate |
$514.76 |
| Rate for Payer: Aetna Commercial |
$503.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.55
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$514.76
|
| Rate for Payer: Health EOS Commercial |
$497.97
|
| Rate for Payer: HFN Commercial |
$514.76
|
| Rate for Payer: Multiplan Commercial |
$447.62
|
| Rate for Payer: Preferred Network Access Commercial |
$514.76
|
| Rate for Payer: Quartz Beloit One Network |
$274.16
|
| Rate for Payer: Quartz Commercial |
$335.71
|
| Rate for Payer: WEA Trust Commercial |
$307.74
|
| Rate for Payer: WPS Commercial |
$414.42
|
|
|
XR Bone Length Studies Scanograms
|
Facility
|
OP
|
$538.00
|
|
|
Service Code
|
CPT 77073
|
| Hospital Charge Code |
627646
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$514.76 |
| Rate for Payer: Aetna Commercial |
$503.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.19
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$363.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$279.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$268.57
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$514.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$497.97
|
| Rate for Payer: HFN Commercial |
$514.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$447.62
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$514.76
|
| Rate for Payer: Quartz Beloit One Network |
$274.16
|
| Rate for Payer: Quartz Commercial |
$363.69
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$307.74
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$414.42
|
|
|
XR Bone Survey Complete (Mets)
|
Facility
|
IP
|
$1,426.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
627658
|
| Min. Negotiated Rate |
$726.69 |
| Max. Negotiated Rate |
$1,364.40 |
| Rate for Payer: Aetna Commercial |
$1,334.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,275.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.01
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,364.40
|
| Rate for Payer: Health EOS Commercial |
$1,319.91
|
| Rate for Payer: HFN Commercial |
$1,364.40
|
| Rate for Payer: Multiplan Commercial |
$1,186.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,364.40
|
| Rate for Payer: Quartz Beloit One Network |
$726.69
|
| Rate for Payer: Quartz Commercial |
$889.82
|
| Rate for Payer: WEA Trust Commercial |
$815.67
|
| Rate for Payer: WPS Commercial |
$1,098.45
|
|
|
XR Bone Survey Complete (Mets)
|
Professional
|
Both
|
$1,426.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
627658
|
| Min. Negotiated Rate |
$97.17 |
| Max. Negotiated Rate |
$1,408.89 |
| Rate for Payer: Aetna Commercial |
$1,408.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,275.41
|
| Rate for Payer: Aetna Managed Medicare |
$97.17
|
| Rate for Payer: Anthem Medicare Advantage |
$97.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.17
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,408.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$741.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.17
|
| Rate for Payer: Health EOS Commercial |
$1,349.57
|
| Rate for Payer: HFN Commercial |
$1,408.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$348.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.17
|
| Rate for Payer: Multiplan Commercial |
$1,186.43
|
| Rate for Payer: NAPHCARE Commercial |
$145.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.89
|
| Rate for Payer: Quartz Beloit One Network |
$652.54
|
| Rate for Payer: Quartz Commercial |
$845.33
|
| Rate for Payer: Quartz Medicare Advantage |
$97.17
|
| Rate for Payer: The Alliance Commercial |
$369.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.17
|
| Rate for Payer: WEA Trust Commercial |
$815.67
|
| Rate for Payer: WPS Commercial |
$485.84
|
|
|
XR Bone Survey Complete (Mets)
|
Facility
|
OP
|
$1,426.00
|
|
|
Service Code
|
CPT 77075
|
| Hospital Charge Code |
627658
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,364.40 |
| Rate for Payer: Aetna Commercial |
$1,334.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,275.41
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.86
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,364.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,319.91
|
| Rate for Payer: HFN Commercial |
$1,364.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,186.43
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,364.40
|
| Rate for Payer: Quartz Beloit One Network |
$726.69
|
| Rate for Payer: Quartz Commercial |
$963.98
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$815.67
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,098.45
|
|
|
XR Bone Survey Complete (Mets)
|
Facility
|
OP
|
$1,539.00
|
|
|
Service Code
|
CPT 77075 TC
|
| Hospital Charge Code |
1536895
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.71 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$448.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.70
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,200.42
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$960.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$1,040.36
|
| Rate for Payer: Quartz Medicare Advantage |
$960.34
|
| Rate for Payer: The Alliance Commercial |
$285.71
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
XR Bone Survey Complete (Mets)
|
Facility
|
IP
|
$1,539.00
|
|
|
Service Code
|
CPT 77075 TC
|
| Hospital Charge Code |
1536895
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$784.27 |
| Max. Negotiated Rate |
$1,472.52 |
| Rate for Payer: Aetna Commercial |
$1,440.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$848.30
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,472.52
|
| Rate for Payer: Health EOS Commercial |
$1,424.50
|
| Rate for Payer: HFN Commercial |
$1,472.52
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.52
|
| Rate for Payer: Quartz Beloit One Network |
$784.27
|
| Rate for Payer: Quartz Commercial |
$960.34
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$1,185.49
|
|
|
XR Bone Survey Complete (Mets)
|
Professional
|
Both
|
$1,539.00
|
|
|
Service Code
|
CPT 77075 TC
|
| Hospital Charge Code |
1536895
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.43 |
| Max. Negotiated Rate |
$1,520.53 |
| Rate for Payer: Aetna Commercial |
$1,520.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,376.48
|
| Rate for Payer: Aetna Managed Medicare |
$71.43
|
| Rate for Payer: Anthem Medicare Advantage |
$71.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.43
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cash Price |
$461.70
|
| Rate for Payer: Cigna Commercial |
$1,520.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$800.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.43
|
| Rate for Payer: Health EOS Commercial |
$1,456.51
|
| Rate for Payer: HFN Commercial |
$1,520.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$252.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.43
|
| Rate for Payer: Multiplan Commercial |
$1,280.45
|
| Rate for Payer: NAPHCARE Commercial |
$107.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,520.53
|
| Rate for Payer: Quartz Beloit One Network |
$704.25
|
| Rate for Payer: Quartz Commercial |
$912.32
|
| Rate for Payer: Quartz Medicare Advantage |
$71.43
|
| Rate for Payer: The Alliance Commercial |
$271.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.43
|
| Rate for Payer: WEA Trust Commercial |
$880.31
|
| Rate for Payer: WPS Commercial |
$357.14
|
|
|
XR Bone Survey Infant
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 77076 TC
|
| Hospital Charge Code |
1536897
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$71.76 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Aetna Commercial |
$687.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Aetna Managed Medicare |
$71.76
|
| Rate for Payer: Anthem Medicare Advantage |
$71.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.76
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$687.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$361.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$658.69
|
| Rate for Payer: HFN Commercial |
$687.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$254.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: NAPHCARE Commercial |
$107.64
|
| Rate for Payer: Preferred Network Access Commercial |
$687.65
|
| Rate for Payer: Quartz Beloit One Network |
$318.49
|
| Rate for Payer: Quartz Commercial |
$412.59
|
| Rate for Payer: Quartz Medicare Advantage |
$71.76
|
| Rate for Payer: The Alliance Commercial |
$272.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: WPS Commercial |
$358.80
|
|
