|
XR Spine Cervical Comp w/ Obliques
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629602
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,046.96 |
| Rate for Payer: Aetna Commercial |
$1,024.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.68
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$739.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$569.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$546.24
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.14
|
| 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 |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,046.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,012.82
|
| Rate for Payer: HFN Commercial |
$1,046.96
|
| 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 |
$910.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.96
|
| Rate for Payer: Quartz Beloit One Network |
$557.62
|
| Rate for Payer: Quartz Commercial |
$739.70
|
| 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 |
$625.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$842.92
|
|
|
XR Spine Cervical Comp w/ Obliques
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629602
|
| Min. Negotiated Rate |
$210.56 |
| Max. Negotiated Rate |
$1,081.10 |
| Rate for Payer: Aetna Commercial |
$1,081.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.68
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,081.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$569.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$682.80
|
| Rate for Payer: Health EOS Commercial |
$1,035.58
|
| Rate for Payer: HFN Commercial |
$1,081.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.56
|
| Rate for Payer: Multiplan Commercial |
$910.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,081.10
|
| Rate for Payer: Quartz Beloit One Network |
$500.72
|
| Rate for Payer: Quartz Commercial |
$648.66
|
| Rate for Payer: The Alliance Commercial |
$569.00
|
| Rate for Payer: WEA Trust Commercial |
$625.90
|
| Rate for Payer: WPS Commercial |
$842.92
|
|
|
XR Spine Cervical Comp w/ Obliques
|
Facility
|
IP
|
$932.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
1537331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$456.68 |
| Max. Negotiated Rate |
$857.44 |
| Rate for Payer: Aetna Commercial |
$838.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.96
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$857.44
|
| Rate for Payer: Health EOS Commercial |
$829.48
|
| Rate for Payer: HFN Commercial |
$857.44
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: NAPHCARE Commercial |
$559.20
|
| Rate for Payer: Preferred Network Access Commercial |
$857.44
|
| Rate for Payer: Quartz Beloit One Network |
$456.68
|
| Rate for Payer: Quartz Commercial |
$559.20
|
| Rate for Payer: WEA Trust Commercial |
$512.60
|
| Rate for Payer: WPS Commercial |
$690.33
|
|
|
XR Spine Cervical Comp w/ Obliques
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629602
|
| Min. Negotiated Rate |
$557.62 |
| Max. Negotiated Rate |
$1,046.96 |
| Rate for Payer: Aetna Commercial |
$1,024.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$603.14
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,046.96
|
| Rate for Payer: Health EOS Commercial |
$1,012.82
|
| Rate for Payer: HFN Commercial |
$1,046.96
|
| Rate for Payer: Multiplan Commercial |
$910.40
|
| Rate for Payer: NAPHCARE Commercial |
$682.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,046.96
|
| Rate for Payer: Quartz Beloit One Network |
$557.62
|
| Rate for Payer: Quartz Commercial |
$682.80
|
| Rate for Payer: WEA Trust Commercial |
$625.90
|
| Rate for Payer: WPS Commercial |
$842.92
|
|
|
XR Spine Cervical Comp w/ Obliques
|
Professional
|
Both
|
$932.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
1537331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.62 |
| Max. Negotiated Rate |
$885.40 |
| Rate for Payer: Aetna Commercial |
$885.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.52
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$885.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$466.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.20
|
| Rate for Payer: Health EOS Commercial |
$848.12
|
| Rate for Payer: HFN Commercial |
$885.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.62
|
| Rate for Payer: Multiplan Commercial |
$745.60
|
| Rate for Payer: Preferred Network Access Commercial |
$885.40
|
| Rate for Payer: Quartz Beloit One Network |
$410.08
|
| Rate for Payer: Quartz Commercial |
$531.24
|
| Rate for Payer: The Alliance Commercial |
$466.00
|
| Rate for Payer: WEA Trust Commercial |
$512.60
|
| Rate for Payer: WPS Commercial |
$690.33
|
|
|
XR Spine Cervical Comp w/ Obliques
|
Facility
|
OP
|
$932.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
1537331
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$857.44 |
| Rate for Payer: Aetna Commercial |
$838.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.52
|
| 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 |
$493.96
|
| 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 |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$857.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$521.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$829.48
|
| Rate for Payer: HFN Commercial |
$857.44
|
| 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 |
$745.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$857.44
|
| Rate for Payer: Quartz Beloit One Network |
$456.68
|
| Rate for Payer: Quartz Commercial |
$605.80
|
| 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 |
$512.60
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$690.33
|
|
|
XR Spine Cervical Cross-Table Lateral
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$424.65 |
| Rate for Payer: Aetna Commercial |
$424.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$424.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.20
|
| Rate for Payer: Health EOS Commercial |
$406.77
|
| Rate for Payer: HFN Commercial |
$424.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.06
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$424.65
|
| Rate for Payer: Quartz Beloit One Network |
$196.68
|
| Rate for Payer: Quartz Commercial |
$254.79
|
| Rate for Payer: The Alliance Commercial |
$223.50
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
XR Spine Cervical Cross-Table Lateral
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629604
|
| Min. Negotiated Rate |
$83.10 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$408.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.00
|
| Rate for Payer: Health EOS Commercial |
$391.30
|
| Rate for Payer: HFN Commercial |
$408.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.10
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Preferred Network Access Commercial |
$408.50
|
| Rate for Payer: Quartz Beloit One Network |
$189.20
|
| Rate for Payer: Quartz Commercial |
$245.10
|
| Rate for Payer: The Alliance Commercial |
$215.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
XR Spine Cervical Cross-Table Lateral
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629604
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
XR Spine Cervical Cross-Table Lateral
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
XR Spine Cervical Cross-Table Lateral
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629604
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.40
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| 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 |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| 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 |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$279.50
|
| 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 |
$236.50
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
XR Spine Cervical Cross-Table Lateral
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537333
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$268.20
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
XR Spine Cervical Flexion + Extension
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
1537335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.49 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna Commercial |
$608.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$608.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$320.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.00
|
| Rate for Payer: Health EOS Commercial |
$582.40
|
| Rate for Payer: HFN Commercial |
$608.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.49
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Preferred Network Access Commercial |
$608.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.60
|
| Rate for Payer: Quartz Commercial |
$364.80
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
XR Spine Cervical Flexion + Extension
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
711795
|
| Min. Negotiated Rate |
$133.40 |
| Max. Negotiated Rate |
$584.25 |
| Rate for Payer: Aetna Commercial |
$584.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$584.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$307.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$369.00
|
| Rate for Payer: Health EOS Commercial |
$559.65
|
| Rate for Payer: HFN Commercial |
$584.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.40
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: Preferred Network Access Commercial |
$584.25
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$350.55
|
| Rate for Payer: The Alliance Commercial |
$307.50
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
XR Spine Cervical Flexion + Extension
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
1537335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.60 |
| Max. Negotiated Rate |
$588.80 |
| Rate for Payer: Aetna Commercial |
$576.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$588.80
|
| Rate for Payer: Health EOS Commercial |
$569.60
|
| Rate for Payer: HFN Commercial |
$588.80
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: NAPHCARE Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$588.80
|
| Rate for Payer: Quartz Beloit One Network |
$313.60
|
| Rate for Payer: Quartz Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
XR Spine Cervical Flexion + Extension
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
711795
|
| Min. Negotiated Rate |
$301.35 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| Rate for Payer: Multiplan Commercial |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$369.00
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$369.00
|
| Rate for Payer: WEA Trust Commercial |
$338.25
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
XR Spine Cervical Flexion + Extension
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
1537335
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$588.80 |
| Rate for Payer: Aetna Commercial |
$576.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| 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 |
$339.20
|
| 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 |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$588.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$569.60
|
| Rate for Payer: HFN Commercial |
$588.80
|
| 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 |
$512.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$588.80
|
| Rate for Payer: Quartz Beloit One Network |
$313.60
|
| Rate for Payer: Quartz Commercial |
$416.00
|
| 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 |
$352.00
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
XR Spine Cervical Flexion + Extension
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
711795
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$565.80 |
| Rate for Payer: Aetna Commercial |
$553.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.90
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.20
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.95
|
| 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 |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$565.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$547.35
|
| Rate for Payer: HFN Commercial |
$565.80
|
| 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 |
$492.00
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$565.80
|
| Rate for Payer: Quartz Beloit One Network |
$301.35
|
| Rate for Payer: Quartz Commercial |
$399.75
|
| 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 |
$338.25
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$455.53
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
1537338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$722.20 |
| Rate for Payer: Aetna Commercial |
$706.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.10
|
| 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 |
$416.05
|
| 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 |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$722.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$698.65
|
| Rate for Payer: HFN Commercial |
$722.20
|
| 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 |
$628.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.20
|
| Rate for Payer: Quartz Beloit One Network |
$384.65
|
| Rate for Payer: Quartz Commercial |
$510.25
|
| 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 |
$431.75
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$581.45
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
OP
|
$782.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
629612
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$719.44 |
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.52
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$508.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$391.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$375.36
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.46
|
| 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 |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$719.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$695.98
|
| Rate for Payer: HFN Commercial |
$719.44
|
| 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 |
$625.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$719.44
|
| Rate for Payer: Quartz Beloit One Network |
$383.18
|
| Rate for Payer: Quartz Commercial |
$508.30
|
| 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 |
$430.10
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$579.23
|
|
|
XR Spine Cervical Minimum 4 Views
|
Professional
|
Both
|
$782.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
629612
|
| Min. Negotiated Rate |
$179.01 |
| Max. Negotiated Rate |
$742.90 |
| Rate for Payer: Aetna Commercial |
$742.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.52
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$742.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.20
|
| Rate for Payer: Health EOS Commercial |
$711.62
|
| Rate for Payer: HFN Commercial |
$742.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.01
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: Preferred Network Access Commercial |
$742.90
|
| Rate for Payer: Quartz Beloit One Network |
$344.08
|
| Rate for Payer: Quartz Commercial |
$445.74
|
| Rate for Payer: The Alliance Commercial |
$391.00
|
| Rate for Payer: WEA Trust Commercial |
$430.10
|
| Rate for Payer: WPS Commercial |
$579.23
|
|
|
XR Spine Cervical Minimum 4 Views
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
1537338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.62 |
| Max. Negotiated Rate |
$745.75 |
| Rate for Payer: Aetna Commercial |
$745.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.10
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$745.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$392.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$471.00
|
| Rate for Payer: Health EOS Commercial |
$714.35
|
| Rate for Payer: HFN Commercial |
$745.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.62
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: Preferred Network Access Commercial |
$745.75
|
| Rate for Payer: Quartz Beloit One Network |
$345.40
|
| Rate for Payer: Quartz Commercial |
$447.45
|
| Rate for Payer: The Alliance Commercial |
$392.50
|
| Rate for Payer: WEA Trust Commercial |
$431.75
|
| Rate for Payer: WPS Commercial |
$581.45
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
IP
|
$782.00
|
|
|
Service Code
|
CPT 72050
|
| Hospital Charge Code |
629612
|
| Min. Negotiated Rate |
$383.18 |
| Max. Negotiated Rate |
$719.44 |
| Rate for Payer: Aetna Commercial |
$703.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$672.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$414.46
|
| Rate for Payer: Cash Price |
$234.60
|
| Rate for Payer: Cigna Commercial |
$719.44
|
| Rate for Payer: Health EOS Commercial |
$695.98
|
| Rate for Payer: HFN Commercial |
$719.44
|
| Rate for Payer: Multiplan Commercial |
$625.60
|
| Rate for Payer: NAPHCARE Commercial |
$469.20
|
| Rate for Payer: Preferred Network Access Commercial |
$719.44
|
| Rate for Payer: Quartz Beloit One Network |
$383.18
|
| Rate for Payer: Quartz Commercial |
$469.20
|
| Rate for Payer: WEA Trust Commercial |
$430.10
|
| Rate for Payer: WPS Commercial |
$579.23
|
|
|
XR Spine Cervical Minimum 4 Views
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 72050 TC
|
| Hospital Charge Code |
1537338
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$384.65 |
| Max. Negotiated Rate |
$722.20 |
| Rate for Payer: Aetna Commercial |
$706.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.05
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$722.20
|
| Rate for Payer: Health EOS Commercial |
$698.65
|
| Rate for Payer: HFN Commercial |
$722.20
|
| Rate for Payer: Multiplan Commercial |
$628.00
|
| Rate for Payer: NAPHCARE Commercial |
$471.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.20
|
| Rate for Payer: Quartz Beloit One Network |
$384.65
|
| Rate for Payer: Quartz Commercial |
$471.00
|
| Rate for Payer: WEA Trust Commercial |
$431.75
|
| Rate for Payer: WPS Commercial |
$581.45
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
1537340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$160.47 |
| Max. Negotiated Rate |
$1,406.95 |
| Rate for Payer: Aetna Commercial |
$1,406.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,406.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$740.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$888.60
|
| Rate for Payer: Health EOS Commercial |
$1,347.71
|
| Rate for Payer: HFN Commercial |
$1,406.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$160.47
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.95
|
| Rate for Payer: Quartz Beloit One Network |
$651.64
|
| Rate for Payer: Quartz Commercial |
$844.17
|
| Rate for Payer: The Alliance Commercial |
$740.50
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
