|
XR Spine Cervical w/ Flext and/or Ext
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
1537340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$725.69 |
| Max. Negotiated Rate |
$1,362.52 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$784.93
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| Rate for Payer: Multiplan Commercial |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$888.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$888.60
|
| Rate for Payer: WEA Trust Commercial |
$814.55
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| 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 w/ Flext and/or Ext
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| 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 w/ Flext and/or Ext
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| 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 w/ Flext and/or Ext
|
Facility
|
OP
|
$1,481.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
1537340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,362.52 |
| Rate for Payer: Aetna Commercial |
$1,332.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,273.66
|
| 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 |
$784.93
|
| 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 |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,362.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,318.09
|
| Rate for Payer: HFN Commercial |
$1,362.52
|
| 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 |
$1,184.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,362.52
|
| Rate for Payer: Quartz Beloit One Network |
$725.69
|
| Rate for Payer: Quartz Commercial |
$962.65
|
| 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 |
$814.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,096.98
|
|
|
XR Spine Entire Survey AP/Lat
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 72084 TC
|
| Hospital Charge Code |
1537342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,120.56 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| 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 |
$645.54
|
| 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 |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| 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 |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$791.70
|
| 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: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
XR Spine Entire Survey AP/Lat
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 72084 TC
|
| Hospital Charge Code |
1537342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$596.82 |
| Max. Negotiated Rate |
$1,120.56 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.54
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$730.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$730.80
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
XR Spine Entire Survey AP/Lat
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
CPT 72084 TC
|
| Hospital Charge Code |
1537342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$261.43 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Aetna Commercial |
$1,157.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,157.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$609.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.80
|
| Rate for Payer: Health EOS Commercial |
$1,108.38
|
| Rate for Payer: HFN Commercial |
$1,157.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$261.43
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.10
|
| Rate for Payer: Quartz Beloit One Network |
$535.92
|
| Rate for Payer: Quartz Commercial |
$694.26
|
| Rate for Payer: The Alliance Commercial |
$609.00
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$623.76 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.44
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| 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 |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| 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 |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$440.70
|
| 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 |
$372.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
XR Spine Lumbar Flexion + Extension
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
1537344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$100.15 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$551.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.00
|
| Rate for Payer: Health EOS Commercial |
$527.80
|
| Rate for Payer: HFN Commercial |
$551.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.15
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$551.00
|
| Rate for Payer: Quartz Beloit One Network |
$255.20
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$290.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$332.22 |
| Max. Negotiated Rate |
$623.76 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$406.80
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$406.80
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
1537344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| 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 |
$307.40
|
| 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 |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| 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 |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
1537344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
XR Spine Lumbar Flexion + Extension
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$134.56 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna Commercial |
$644.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$644.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$339.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.80
|
| Rate for Payer: Health EOS Commercial |
$616.98
|
| Rate for Payer: HFN Commercial |
$644.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.56
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: Preferred Network Access Commercial |
$644.10
|
| Rate for Payer: Quartz Beloit One Network |
$298.32
|
| Rate for Payer: Quartz Commercial |
$386.46
|
| Rate for Payer: The Alliance Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
1537347
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$673.44 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| 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 |
$387.96
|
| 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 |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| 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 |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$475.80
|
| 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 |
$402.60
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$623.76 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$440.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325.44
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| 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 |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| 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 |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$440.70
|
| 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 |
$372.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
OP
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
5510674
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$673.44 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| 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 |
$387.96
|
| 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 |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| 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 |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$475.80
|
| 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 |
$402.60
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| Min. Negotiated Rate |
$134.56 |
| Max. Negotiated Rate |
$644.10 |
| Rate for Payer: Aetna Commercial |
$644.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$644.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$339.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.80
|
| Rate for Payer: Health EOS Commercial |
$616.98
|
| Rate for Payer: HFN Commercial |
$644.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.56
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: Preferred Network Access Commercial |
$644.10
|
| Rate for Payer: Quartz Beloit One Network |
$298.32
|
| Rate for Payer: Quartz Commercial |
$386.46
|
| Rate for Payer: The Alliance Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
1537347
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$673.44 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$439.20
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
1537347
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna Commercial |
$695.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$695.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$366.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.20
|
| Rate for Payer: Health EOS Commercial |
$666.12
|
| Rate for Payer: HFN Commercial |
$695.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$96.65
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Preferred Network Access Commercial |
$695.40
|
| Rate for Payer: Quartz Beloit One Network |
$322.08
|
| Rate for Payer: Quartz Commercial |
$417.24
|
| Rate for Payer: The Alliance Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Professional
|
Both
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
5510674
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.65 |
| Max. Negotiated Rate |
$695.40 |
| Rate for Payer: Aetna Commercial |
$695.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$695.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$366.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.20
|
| Rate for Payer: Health EOS Commercial |
$666.12
|
| Rate for Payer: HFN Commercial |
$695.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$96.65
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: Preferred Network Access Commercial |
$695.40
|
| Rate for Payer: Quartz Beloit One Network |
$322.08
|
| Rate for Payer: Quartz Commercial |
$417.24
|
| Rate for Payer: The Alliance Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| Min. Negotiated Rate |
$332.22 |
| Max. Negotiated Rate |
$623.76 |
| Rate for Payer: Aetna Commercial |
$610.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$359.34
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$623.76
|
| Rate for Payer: Health EOS Commercial |
$603.42
|
| Rate for Payer: HFN Commercial |
$623.76
|
| Rate for Payer: Multiplan Commercial |
$542.40
|
| Rate for Payer: NAPHCARE Commercial |
$406.80
|
| Rate for Payer: Preferred Network Access Commercial |
$623.76
|
| Rate for Payer: Quartz Beloit One Network |
$332.22
|
| Rate for Payer: Quartz Commercial |
$406.80
|
| Rate for Payer: WEA Trust Commercial |
$372.90
|
| Rate for Payer: WPS Commercial |
$502.19
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
IP
|
$732.00
|
|
|
Service Code
|
CPT 72100 TC
|
| Hospital Charge Code |
5510674
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$673.44 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$439.20
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Professional
|
Both
|
$1,367.00
|
|
|
Service Code
|
CPT 72114 TC
|
| Hospital Charge Code |
1537351
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$159.31 |
| Max. Negotiated Rate |
$1,298.65 |
| Rate for Payer: Aetna Commercial |
$1,298.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.62
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cigna Commercial |
$1,298.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$683.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.20
|
| Rate for Payer: Health EOS Commercial |
$1,243.97
|
| Rate for Payer: HFN Commercial |
$1,298.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$159.31
|
| Rate for Payer: Multiplan Commercial |
$1,093.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,298.65
|
| Rate for Payer: Quartz Beloit One Network |
$601.48
|
| Rate for Payer: Quartz Commercial |
$779.19
|
| Rate for Payer: The Alliance Commercial |
$683.50
|
| Rate for Payer: WEA Trust Commercial |
$751.85
|
| Rate for Payer: WPS Commercial |
$1,012.54
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
630028
|
| Min. Negotiated Rate |
$619.85 |
| Max. Negotiated Rate |
$1,163.80 |
| Rate for Payer: Aetna Commercial |
$1,138.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.45
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,163.80
|
| Rate for Payer: Health EOS Commercial |
$1,125.85
|
| Rate for Payer: HFN Commercial |
$1,163.80
|
| Rate for Payer: Multiplan Commercial |
$1,012.00
|
| Rate for Payer: NAPHCARE Commercial |
$759.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.80
|
| Rate for Payer: Quartz Beloit One Network |
$619.85
|
| Rate for Payer: Quartz Commercial |
$759.00
|
| Rate for Payer: WEA Trust Commercial |
$695.75
|
| Rate for Payer: WPS Commercial |
$936.99
|
|
