|
XR Small Bowel w/ Serial Films
|
Professional
|
$985.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
1537319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$935.75 |
| Rate for Payer: Aetna Commercial |
$935.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.10
|
| Rate for Payer: Aetna Managed Medicare |
$120.05
|
| Rate for Payer: Anthem Medicare Advantage |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.05
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$935.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$492.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.05
|
| Rate for Payer: Health EOS Commercial |
$896.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.05
|
| Rate for Payer: Multiplan Commercial |
$788.00
|
| Rate for Payer: Preferred Network Access Commercial |
$935.75
|
| Rate for Payer: Quartz Beloit One Network |
$433.40
|
| Rate for Payer: Quartz Commercial |
$561.45
|
| Rate for Payer: Quartz Medicare Advantage |
$120.05
|
| Rate for Payer: The Alliance Commercial |
$456.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.05
|
| Rate for Payer: WEA Trust Commercial |
$541.75
|
| Rate for Payer: WPS Commercial |
$600.25
|
|
|
XR Small Bowel w/ Serial Films
|
Professional
|
$912.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
630084
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$866.40 |
| Rate for Payer: Aetna Commercial |
$866.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$784.32
|
| Rate for Payer: Aetna Managed Medicare |
$120.05
|
| Rate for Payer: Anthem Medicare Advantage |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.05
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$866.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$456.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.05
|
| Rate for Payer: Health EOS Commercial |
$829.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$428.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$428.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.05
|
| Rate for Payer: Multiplan Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$866.40
|
| Rate for Payer: Quartz Beloit One Network |
$401.28
|
| Rate for Payer: Quartz Commercial |
$519.84
|
| Rate for Payer: Quartz Medicare Advantage |
$120.05
|
| Rate for Payer: The Alliance Commercial |
$456.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.05
|
| Rate for Payer: WEA Trust Commercial |
$501.60
|
| Rate for Payer: WPS Commercial |
$600.25
|
|
|
XR Small Bowel w/ Serial Films
|
Facility
OP
|
$985.00
|
|
|
Service Code
|
CPT 74250
|
| Hospital Charge Code |
1537319
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$9.88 |
| Max. Negotiated Rate |
$906.20 |
| Rate for Payer: Aetna Commercial |
$886.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.10
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.56
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$522.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cash Price |
$295.50
|
| Rate for Payer: Cigna Commercial |
$906.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$876.65
|
| Rate for Payer: HFN Commercial |
$906.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$788.00
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$906.20
|
| Rate for Payer: Quartz Beloit One Network |
$482.65
|
| Rate for Payer: Quartz Commercial |
$640.25
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$9.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$541.75
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$729.59
|
|
|
XR Sniff Test
|
Professional
|
$1,060.00
|
|
|
Service Code
|
CPT 76000 TC
|
| Hospital Charge Code |
5084629
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.83 |
| Max. Negotiated Rate |
$1,007.00 |
| Rate for Payer: Aetna Commercial |
$1,007.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$911.60
|
| Rate for Payer: Aetna Managed Medicare |
$26.83
|
| Rate for Payer: Anthem Medicare Advantage |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.83
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$1,007.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$530.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.83
|
| Rate for Payer: Health EOS Commercial |
$964.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.83
|
| Rate for Payer: Multiplan Commercial |
$848.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,007.00
|
| Rate for Payer: Quartz Beloit One Network |
$466.40
|
| Rate for Payer: Quartz Commercial |
$604.20
|
| Rate for Payer: Quartz Medicare Advantage |
$26.83
|
| Rate for Payer: The Alliance Commercial |
$101.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.83
|
| Rate for Payer: WEA Trust Commercial |
$583.00
|
| Rate for Payer: WPS Commercial |
$134.15
|
|
|
XR Sniff Test
|
Facility
OP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000 TC
|
| Hospital Charge Code |
5084629
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$296.80 |
| Max. Negotiated Rate |
$4,240.00 |
| Rate for Payer: Aetna Commercial |
$954.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$911.60
|
| Rate for Payer: Aetna Managed Medicare |
$296.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$508.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$561.80
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$975.20
|
| Rate for Payer: Health EOS Commercial |
$943.40
|
| Rate for Payer: HFN Commercial |
$975.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.00
|
| Rate for Payer: Multiplan Commercial |
$848.00
|
| Rate for Payer: NAPHCARE Commercial |
$636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$975.20
|
| Rate for Payer: Quartz Beloit One Network |
$519.40
|
| Rate for Payer: Quartz Commercial |
$689.00
|
| Rate for Payer: Quartz Medicare Advantage |
$636.00
|
| Rate for Payer: The Alliance Commercial |
$4,240.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$583.00
|
| Rate for Payer: WPS Commercial |
$785.14
|
|
|
XR Sniff Test
|
Facility
IP
|
$1,060.00
|
|
|
Service Code
|
CPT 76000 TC
|
| Hospital Charge Code |
5084629
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$519.40 |
| Max. Negotiated Rate |
$975.20 |
| Rate for Payer: Aetna Commercial |
$954.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$561.80
|
| Rate for Payer: Cash Price |
$318.00
|
| Rate for Payer: Cigna Commercial |
$975.20
|
| Rate for Payer: Health EOS Commercial |
$943.40
|
| Rate for Payer: HFN Commercial |
$975.20
|
| Rate for Payer: Multiplan Commercial |
$848.00
|
| Rate for Payer: NAPHCARE Commercial |
$636.00
|
| Rate for Payer: Preferred Network Access Commercial |
$975.20
|
| Rate for Payer: Quartz Beloit One Network |
$519.40
|
| Rate for Payer: Quartz Commercial |
$636.00
|
| Rate for Payer: WEA Trust Commercial |
$583.00
|
| Rate for Payer: WPS Commercial |
$785.14
|
|
|
XR Spine 1 View Cervical
|
Facility
IP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629692
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| 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 1 View Cervical
|
Professional
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629692
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$23.66
|
| Rate for Payer: Anthem Medicare Advantage |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.66
|
| 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 |
$23.66
|
| Rate for Payer: Health EOS Commercial |
$391.30
|
| 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: Independent Care Health Plan Medicare |
$23.66
|
| 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: Quartz Medicare Advantage |
$23.66
|
| Rate for Payer: The Alliance Commercial |
$89.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.66
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$118.30
|
|
|
XR Spine 1 View Cervical
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Aetna Managed Medicare |
$156.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$268.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$364.00
|
| Rate for Payer: Quartz Medicare Advantage |
$336.00
|
| Rate for Payer: The Alliance Commercial |
$2,240.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Spine 1 View Cervical
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Spine 1 View Cervical
|
Facility
OP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629692
|
| Min. Negotiated Rate |
$69.48 |
| 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 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 |
$69.48
|
| 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 1 View Cervical
|
Professional
|
$560.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537323
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.20
|
| Rate for Payer: Anthem Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.20
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.20
|
| Rate for Payer: Health EOS Commercial |
$509.60
|
| 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: Independent Care Health Plan Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$532.00
|
| Rate for Payer: Quartz Beloit One Network |
$246.40
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$61.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$81.00
|
|
|
XR Spine 1 View Lumbar
|
Facility
OP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630080
|
| Min. Negotiated Rate |
$69.48 |
| 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 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 |
$69.48
|
| 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 1 View Lumbar
|
Facility
IP
|
$560.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$274.40 |
| Max. Negotiated Rate |
$515.20 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Spine 1 View Lumbar
|
Professional
|
$560.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$532.00 |
| Rate for Payer: Aetna Commercial |
$532.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.20
|
| Rate for Payer: Anthem Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.20
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$532.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.20
|
| Rate for Payer: Health EOS Commercial |
$509.60
|
| 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: Independent Care Health Plan Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: Preferred Network Access Commercial |
$532.00
|
| Rate for Payer: Quartz Beloit One Network |
$246.40
|
| Rate for Payer: Quartz Commercial |
$319.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$61.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$81.00
|
|
|
XR Spine 1 View Lumbar
|
Professional
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630080
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$23.66
|
| Rate for Payer: Anthem Medicare Advantage |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.66
|
| 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 |
$23.66
|
| Rate for Payer: Health EOS Commercial |
$391.30
|
| 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: Independent Care Health Plan Medicare |
$23.66
|
| 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: Quartz Medicare Advantage |
$23.66
|
| Rate for Payer: The Alliance Commercial |
$89.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.66
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$118.30
|
|
|
XR Spine 1 View Lumbar
|
Facility
OP
|
$560.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$2,240.00 |
| Rate for Payer: Aetna Commercial |
$504.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.60
|
| Rate for Payer: Aetna Managed Medicare |
$156.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$268.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.80
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$515.20
|
| Rate for Payer: Health EOS Commercial |
$498.40
|
| Rate for Payer: HFN Commercial |
$515.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$420.00
|
| Rate for Payer: Multiplan Commercial |
$448.00
|
| Rate for Payer: NAPHCARE Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$515.20
|
| Rate for Payer: Quartz Beloit One Network |
$274.40
|
| Rate for Payer: Quartz Commercial |
$364.00
|
| Rate for Payer: Quartz Medicare Advantage |
$336.00
|
| Rate for Payer: The Alliance Commercial |
$2,240.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$308.00
|
| Rate for Payer: WPS Commercial |
$414.79
|
|
|
XR Spine 1 View Lumbar
|
Facility
IP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630080
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| 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 1 View Thoracic
|
Facility
IP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630076
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| 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 1 View Thoracic
|
Professional
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630076
|
| Min. Negotiated Rate |
$23.66 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$23.66
|
| Rate for Payer: Anthem Medicare Advantage |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.66
|
| 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 |
$23.66
|
| Rate for Payer: Health EOS Commercial |
$391.30
|
| 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: Independent Care Health Plan Medicare |
$23.66
|
| 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: Quartz Medicare Advantage |
$23.66
|
| Rate for Payer: The Alliance Commercial |
$89.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.66
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$118.30
|
|
|
XR Spine 1 View Thoracic
|
Professional
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$424.65 |
| Rate for Payer: Aetna Commercial |
$424.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$16.20
|
| Rate for Payer: Anthem Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.20
|
| 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 |
$16.20
|
| Rate for Payer: Health EOS Commercial |
$406.77
|
| 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: Independent Care Health Plan Medicare |
$16.20
|
| 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: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$61.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$81.00
|
|
|
XR Spine 1 View Thoracic
|
Facility
OP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630076
|
| Min. Negotiated Rate |
$69.48 |
| 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 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 |
$69.48
|
| 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 1 View Thoracic
|
Facility
IP
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| 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 1 View Thoracic
|
Facility
OP
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$1,788.00 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| 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: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.25
|
| 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 |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$268.20
|
| Rate for Payer: The Alliance Commercial |
$1,788.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
OP
|
$665.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
5510672
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$186.20 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.90
|
| Rate for Payer: Aetna Managed Medicare |
$186.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$432.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$319.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.45
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$611.80
|
| Rate for Payer: Health EOS Commercial |
$591.85
|
| Rate for Payer: HFN Commercial |
$611.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.75
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: NAPHCARE Commercial |
$399.00
|
| Rate for Payer: Preferred Network Access Commercial |
$611.80
|
| Rate for Payer: Quartz Beloit One Network |
$325.85
|
| Rate for Payer: Quartz Commercial |
$432.25
|
| Rate for Payer: Quartz Medicare Advantage |
$399.00
|
| Rate for Payer: The Alliance Commercial |
$2,660.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$365.75
|
| Rate for Payer: WPS Commercial |
$492.57
|
|
