|
XR Spine 1 View Thoracic
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537327
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$441.64 |
| Rate for Payer: Aetna Commercial |
$441.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$15.75
|
| Rate for Payer: Anthem Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.75
|
| 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 |
$441.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.75
|
| Rate for Payer: Health EOS Commercial |
$423.04
|
| Rate for Payer: HFN Commercial |
$441.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$23.62
|
| Rate for Payer: Preferred Network Access Commercial |
$441.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.55
|
| Rate for Payer: Quartz Commercial |
$264.98
|
| Rate for Payer: Quartz Medicare Advantage |
$15.75
|
| Rate for Payer: The Alliance Commercial |
$59.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$78.73
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
|
OP
|
$665.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
1537329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$116.23 |
| Max. Negotiated Rate |
$636.27 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Aetna Managed Medicare |
$193.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.55
|
| 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 |
$636.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.03
|
| Rate for Payer: Health EOS Commercial |
$615.52
|
| Rate for Payer: HFN Commercial |
$636.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$518.70
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: NAPHCARE Commercial |
$414.96
|
| Rate for Payer: Preferred Network Access Commercial |
$636.27
|
| Rate for Payer: Quartz Beloit One Network |
$338.88
|
| Rate for Payer: Quartz Commercial |
$449.54
|
| Rate for Payer: Quartz Medicare Advantage |
$414.96
|
| Rate for Payer: The Alliance Commercial |
$116.23
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$512.25
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
1537329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$636.27 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.55
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$636.27
|
| Rate for Payer: Health EOS Commercial |
$615.52
|
| Rate for Payer: HFN Commercial |
$636.27
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: Preferred Network Access Commercial |
$636.27
|
| Rate for Payer: Quartz Beloit One Network |
$338.88
|
| Rate for Payer: Quartz Commercial |
$414.96
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$512.25
|
|
|
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 |
$116.23 |
| Max. Negotiated Rate |
$636.27 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Aetna Managed Medicare |
$193.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.55
|
| 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 |
$636.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$387.03
|
| Rate for Payer: Health EOS Commercial |
$615.52
|
| Rate for Payer: HFN Commercial |
$636.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$518.70
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: NAPHCARE Commercial |
$414.96
|
| Rate for Payer: Preferred Network Access Commercial |
$636.27
|
| Rate for Payer: Quartz Beloit One Network |
$338.88
|
| Rate for Payer: Quartz Commercial |
$449.54
|
| Rate for Payer: Quartz Medicare Advantage |
$414.96
|
| Rate for Payer: The Alliance Commercial |
$116.23
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$512.25
|
|
|
XR Spine Cervical 2 or 3 Views
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
629600
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$607.62 |
| Rate for Payer: Aetna Commercial |
$607.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$39.46
|
| Rate for Payer: Anthem Medicare Advantage |
$39.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.46
|
| 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 |
$607.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.46
|
| Rate for Payer: Health EOS Commercial |
$582.04
|
| Rate for Payer: HFN Commercial |
$607.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.46
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$59.19
|
| Rate for Payer: Preferred Network Access Commercial |
$607.62
|
| Rate for Payer: Quartz Beloit One Network |
$281.42
|
| Rate for Payer: Quartz Commercial |
$364.57
|
| Rate for Payer: Quartz Medicare Advantage |
$39.46
|
| Rate for Payer: The Alliance Commercial |
$149.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.46
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$197.29
|
|
|
XR Spine Cervical 2 or 3 Views
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
5510672
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$657.02 |
| Rate for Payer: Aetna Commercial |
$657.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Aetna Managed Medicare |
$29.06
|
| Rate for Payer: Anthem Medicare Advantage |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.06
|
| 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 |
$657.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$345.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.06
|
| Rate for Payer: Health EOS Commercial |
$629.36
|
| Rate for Payer: HFN Commercial |
$657.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.06
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: NAPHCARE Commercial |
$43.59
|
| Rate for Payer: Preferred Network Access Commercial |
$657.02
|
| Rate for Payer: Quartz Beloit One Network |
$304.30
|
| Rate for Payer: Quartz Commercial |
$394.21
|
| Rate for Payer: Quartz Medicare Advantage |
$29.06
|
| Rate for Payer: The Alliance Commercial |
$110.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.06
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$145.29
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
629600
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
629600
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
XR Spine Cervical 2 or 3 Views
|
Facility
|
IP
|
$665.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
5510672
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$338.88 |
| Max. Negotiated Rate |
$636.27 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.55
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$636.27
|
| Rate for Payer: Health EOS Commercial |
$615.52
|
| Rate for Payer: HFN Commercial |
$636.27
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: Preferred Network Access Commercial |
$636.27
|
| Rate for Payer: Quartz Beloit One Network |
$338.88
|
| Rate for Payer: Quartz Commercial |
$414.96
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$512.25
|
|
|
XR Spine Cervical 2 or 3 Views
|
Professional
|
Both
|
$665.00
|
|
|
Service Code
|
CPT 72040 TC
|
| Hospital Charge Code |
1537329
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$29.06 |
| Max. Negotiated Rate |
$657.02 |
| Rate for Payer: Aetna Commercial |
$657.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.78
|
| Rate for Payer: Aetna Managed Medicare |
$29.06
|
| Rate for Payer: Anthem Medicare Advantage |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.06
|
| 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 |
$657.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$345.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.06
|
| Rate for Payer: Health EOS Commercial |
$629.36
|
| Rate for Payer: HFN Commercial |
$657.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.06
|
| Rate for Payer: Multiplan Commercial |
$553.28
|
| Rate for Payer: NAPHCARE Commercial |
$43.59
|
| Rate for Payer: Preferred Network Access Commercial |
$657.02
|
| Rate for Payer: Quartz Beloit One Network |
$304.30
|
| Rate for Payer: Quartz Commercial |
$394.21
|
| Rate for Payer: Quartz Medicare Advantage |
$29.06
|
| Rate for Payer: The Alliance Commercial |
$110.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.06
|
| Rate for Payer: WEA Trust Commercial |
$380.38
|
| Rate for Payer: WPS Commercial |
$145.29
|
|
|
XR Spine Cervical Comp w/ Obliques
|
Facility
|
OP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629602
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,088.84 |
| Rate for Payer: Aetna Commercial |
$1,065.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.09
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,088.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,053.33
|
| Rate for Payer: HFN Commercial |
$1,088.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$946.82
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.84
|
| Rate for Payer: Quartz Beloit One Network |
$579.92
|
| Rate for Payer: Quartz Commercial |
$769.29
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$650.94
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$876.60
|
|
|
XR Spine Cervical Comp w/ Obliques
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629602
|
| Min. Negotiated Rate |
$62.31 |
| Max. Negotiated Rate |
$1,124.34 |
| Rate for Payer: Aetna Commercial |
$1,124.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Aetna Managed Medicare |
$62.31
|
| Rate for Payer: Anthem Medicare Advantage |
$62.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.31
|
| 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 |
$1,124.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$591.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.31
|
| Rate for Payer: Health EOS Commercial |
$1,077.00
|
| Rate for Payer: HFN Commercial |
$1,124.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$218.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.31
|
| Rate for Payer: Multiplan Commercial |
$946.82
|
| Rate for Payer: NAPHCARE Commercial |
$93.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,124.34
|
| Rate for Payer: Quartz Beloit One Network |
$520.75
|
| Rate for Payer: Quartz Commercial |
$674.61
|
| Rate for Payer: Quartz Medicare Advantage |
$62.31
|
| Rate for Payer: The Alliance Commercial |
$236.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.31
|
| Rate for Payer: WEA Trust Commercial |
$650.94
|
| Rate for Payer: WPS Commercial |
$311.53
|
|
|
XR Spine Cervical Comp w/ Obliques
|
Facility
|
IP
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629602
|
| Min. Negotiated Rate |
$579.92 |
| Max. Negotiated Rate |
$1,088.84 |
| Rate for Payer: Aetna Commercial |
$1,065.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.27
|
| Rate for Payer: Cash Price |
$341.40
|
| Rate for Payer: Cigna Commercial |
$1,088.84
|
| Rate for Payer: Health EOS Commercial |
$1,053.33
|
| Rate for Payer: HFN Commercial |
$1,088.84
|
| Rate for Payer: Multiplan Commercial |
$946.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.84
|
| Rate for Payer: Quartz Beloit One Network |
$579.92
|
| Rate for Payer: Quartz Commercial |
$710.11
|
| Rate for Payer: WEA Trust Commercial |
$650.94
|
| Rate for Payer: WPS Commercial |
$876.60
|
|
|
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 |
$41.70 |
| Max. Negotiated Rate |
$920.82 |
| Rate for Payer: Aetna Commercial |
$920.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$833.58
|
| Rate for Payer: Aetna Managed Medicare |
$41.70
|
| Rate for Payer: Anthem Medicare Advantage |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.70
|
| 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 |
$920.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$484.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.70
|
| Rate for Payer: Health EOS Commercial |
$882.04
|
| Rate for Payer: HFN Commercial |
$920.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.70
|
| Rate for Payer: Multiplan Commercial |
$775.42
|
| Rate for Payer: NAPHCARE Commercial |
$62.56
|
| Rate for Payer: Preferred Network Access Commercial |
$920.82
|
| Rate for Payer: Quartz Beloit One Network |
$426.48
|
| Rate for Payer: Quartz Commercial |
$552.49
|
| Rate for Payer: Quartz Medicare Advantage |
$41.70
|
| Rate for Payer: The Alliance Commercial |
$158.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.70
|
| Rate for Payer: WEA Trust Commercial |
$533.10
|
| Rate for Payer: WPS Commercial |
$208.52
|
|
|
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 |
$166.82 |
| Max. Negotiated Rate |
$891.74 |
| Rate for Payer: Aetna Commercial |
$872.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$833.58
|
| Rate for Payer: Aetna Managed Medicare |
$271.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.72
|
| 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 |
$891.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$542.42
|
| Rate for Payer: Health EOS Commercial |
$862.66
|
| Rate for Payer: HFN Commercial |
$891.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$726.96
|
| Rate for Payer: Multiplan Commercial |
$775.42
|
| Rate for Payer: NAPHCARE Commercial |
$581.57
|
| Rate for Payer: Preferred Network Access Commercial |
$891.74
|
| Rate for Payer: Quartz Beloit One Network |
$474.95
|
| Rate for Payer: Quartz Commercial |
$630.03
|
| Rate for Payer: Quartz Medicare Advantage |
$581.57
|
| Rate for Payer: The Alliance Commercial |
$166.82
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$533.10
|
| Rate for Payer: WPS Commercial |
$717.92
|
|
|
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 |
$474.95 |
| Max. Negotiated Rate |
$891.74 |
| Rate for Payer: Aetna Commercial |
$872.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$833.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$513.72
|
| Rate for Payer: Cash Price |
$279.60
|
| Rate for Payer: Cigna Commercial |
$891.74
|
| Rate for Payer: Health EOS Commercial |
$862.66
|
| Rate for Payer: HFN Commercial |
$891.74
|
| Rate for Payer: Multiplan Commercial |
$775.42
|
| Rate for Payer: Preferred Network Access Commercial |
$891.74
|
| Rate for Payer: Quartz Beloit One Network |
$474.95
|
| Rate for Payer: Quartz Commercial |
$581.57
|
| Rate for Payer: WEA Trust Commercial |
$533.10
|
| Rate for Payer: WPS Commercial |
$717.92
|
|
|
XR Spine Cervical Cross-Table Lateral
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629604
|
| Min. Negotiated Rate |
$219.13 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$268.32
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
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 |
$62.98 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$130.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| 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 |
$427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.15
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.66
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$278.93
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| Rate for Payer: Quartz Medicare Advantage |
$278.93
|
| Rate for Payer: The Alliance Commercial |
$62.98
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
XR Spine Cervical Cross-Table Lateral
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629604
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.66
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$290.68
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
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 |
$15.75 |
| Max. Negotiated Rate |
$441.64 |
| Rate for Payer: Aetna Commercial |
$441.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$15.75
|
| Rate for Payer: Anthem Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.75
|
| 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 |
$441.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.75
|
| Rate for Payer: Health EOS Commercial |
$423.04
|
| Rate for Payer: HFN Commercial |
$441.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$23.62
|
| Rate for Payer: Preferred Network Access Commercial |
$441.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.55
|
| Rate for Payer: Quartz Commercial |
$264.98
|
| Rate for Payer: Quartz Medicare Advantage |
$15.75
|
| Rate for Payer: The Alliance Commercial |
$59.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$78.73
|
|
|
XR Spine Cervical Cross-Table Lateral
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
629604
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna Commercial |
$424.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$23.41
|
| Rate for Payer: Anthem Medicare Advantage |
$23.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.41
|
| 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 |
$424.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.41
|
| Rate for Payer: Health EOS Commercial |
$406.95
|
| Rate for Payer: HFN Commercial |
$424.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.41
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$35.12
|
| Rate for Payer: Preferred Network Access Commercial |
$424.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.77
|
| Rate for Payer: Quartz Commercial |
$254.90
|
| Rate for Payer: Quartz Medicare Advantage |
$23.41
|
| Rate for Payer: The Alliance Commercial |
$88.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.41
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$117.05
|
|
|
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 |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
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 |
$326.14 |
| Max. Negotiated Rate |
$612.35 |
| Rate for Payer: Aetna Commercial |
$599.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.77
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$612.35
|
| Rate for Payer: Health EOS Commercial |
$592.38
|
| Rate for Payer: HFN Commercial |
$612.35
|
| Rate for Payer: Multiplan Commercial |
$532.48
|
| Rate for Payer: Preferred Network Access Commercial |
$612.35
|
| Rate for Payer: Quartz Beloit One Network |
$326.14
|
| Rate for Payer: Quartz Commercial |
$399.36
|
| Rate for Payer: WEA Trust Commercial |
$366.08
|
| Rate for Payer: WPS Commercial |
$492.99
|
|
|
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 |
$116.23 |
| Max. Negotiated Rate |
$612.35 |
| Rate for Payer: Aetna Commercial |
$599.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.42
|
| Rate for Payer: Aetna Managed Medicare |
$186.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.77
|
| 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 |
$612.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.48
|
| Rate for Payer: Health EOS Commercial |
$592.38
|
| Rate for Payer: HFN Commercial |
$612.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$499.20
|
| Rate for Payer: Multiplan Commercial |
$532.48
|
| Rate for Payer: NAPHCARE Commercial |
$399.36
|
| Rate for Payer: Preferred Network Access Commercial |
$612.35
|
| Rate for Payer: Quartz Beloit One Network |
$326.14
|
| Rate for Payer: Quartz Commercial |
$432.64
|
| Rate for Payer: Quartz Medicare Advantage |
$399.36
|
| Rate for Payer: The Alliance Commercial |
$116.23
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$366.08
|
| Rate for Payer: WPS Commercial |
$492.99
|
|
|
XR Spine Cervical Flexion + Extension
|
Professional
|
Both
|
$615.00
|
|
|
Service Code
|
CPT 72040
|
| Hospital Charge Code |
711795
|
| Min. Negotiated Rate |
$39.46 |
| Max. Negotiated Rate |
$607.62 |
| Rate for Payer: Aetna Commercial |
$607.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$39.46
|
| Rate for Payer: Anthem Medicare Advantage |
$39.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.46
|
| 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 |
$607.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.46
|
| Rate for Payer: Health EOS Commercial |
$582.04
|
| Rate for Payer: HFN Commercial |
$607.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.46
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$59.19
|
| Rate for Payer: Preferred Network Access Commercial |
$607.62
|
| Rate for Payer: Quartz Beloit One Network |
$281.42
|
| Rate for Payer: Quartz Commercial |
$364.57
|
| Rate for Payer: Quartz Medicare Advantage |
$39.46
|
| Rate for Payer: The Alliance Commercial |
$149.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.46
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$197.29
|
|
