|
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 |
$373.03 |
| Max. Negotiated Rate |
$700.38 |
| Rate for Payer: Aetna Commercial |
$685.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$654.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.48
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$700.38
|
| Rate for Payer: Health EOS Commercial |
$677.54
|
| Rate for Payer: HFN Commercial |
$700.38
|
| Rate for Payer: Multiplan Commercial |
$609.02
|
| Rate for Payer: Preferred Network Access Commercial |
$700.38
|
| Rate for Payer: Quartz Beloit One Network |
$373.03
|
| Rate for Payer: Quartz Commercial |
$456.77
|
| Rate for Payer: WEA Trust Commercial |
$418.70
|
| Rate for Payer: WPS Commercial |
$563.86
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| Min. Negotiated Rate |
$345.51 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$423.07
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
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 |
$117.56 |
| Max. Negotiated Rate |
$700.38 |
| Rate for Payer: Aetna Commercial |
$685.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$654.70
|
| Rate for Payer: Aetna Managed Medicare |
$213.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.48
|
| 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 |
$700.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.02
|
| Rate for Payer: Health EOS Commercial |
$677.54
|
| Rate for Payer: HFN Commercial |
$700.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$570.96
|
| Rate for Payer: Multiplan Commercial |
$609.02
|
| Rate for Payer: NAPHCARE Commercial |
$456.77
|
| Rate for Payer: Preferred Network Access Commercial |
$700.38
|
| Rate for Payer: Quartz Beloit One Network |
$373.03
|
| Rate for Payer: Quartz Commercial |
$494.83
|
| Rate for Payer: Quartz Medicare Advantage |
$456.77
|
| Rate for Payer: The Alliance Commercial |
$117.56
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$418.70
|
| Rate for Payer: WPS Commercial |
$563.86
|
|
|
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 |
$373.03 |
| Max. Negotiated Rate |
$700.38 |
| Rate for Payer: Aetna Commercial |
$685.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$654.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.48
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$700.38
|
| Rate for Payer: Health EOS Commercial |
$677.54
|
| Rate for Payer: HFN Commercial |
$700.38
|
| Rate for Payer: Multiplan Commercial |
$609.02
|
| Rate for Payer: Preferred Network Access Commercial |
$700.38
|
| Rate for Payer: Quartz Beloit One Network |
$373.03
|
| Rate for Payer: Quartz Commercial |
$456.77
|
| Rate for Payer: WEA Trust Commercial |
$418.70
|
| Rate for Payer: WPS Commercial |
$563.86
|
|
|
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 |
$29.39 |
| Max. Negotiated Rate |
$723.22 |
| Rate for Payer: Aetna Commercial |
$723.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$654.70
|
| Rate for Payer: Aetna Managed Medicare |
$29.39
|
| Rate for Payer: Anthem Medicare Advantage |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.39
|
| 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 |
$723.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.39
|
| Rate for Payer: Health EOS Commercial |
$692.76
|
| Rate for Payer: HFN Commercial |
$723.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.39
|
| Rate for Payer: Multiplan Commercial |
$609.02
|
| Rate for Payer: NAPHCARE Commercial |
$44.09
|
| Rate for Payer: Preferred Network Access Commercial |
$723.22
|
| Rate for Payer: Quartz Beloit One Network |
$334.96
|
| Rate for Payer: Quartz Commercial |
$433.93
|
| Rate for Payer: Quartz Medicare Advantage |
$29.39
|
| Rate for Payer: The Alliance Commercial |
$111.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.39
|
| Rate for Payer: WEA Trust Commercial |
$418.70
|
| Rate for Payer: WPS Commercial |
$146.95
|
|
|
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 |
$117.56 |
| Max. Negotiated Rate |
$700.38 |
| Rate for Payer: Aetna Commercial |
$685.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$654.70
|
| Rate for Payer: Aetna Managed Medicare |
$213.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$403.48
|
| 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 |
$700.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.02
|
| Rate for Payer: Health EOS Commercial |
$677.54
|
| Rate for Payer: HFN Commercial |
$700.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$570.96
|
| Rate for Payer: Multiplan Commercial |
$609.02
|
| Rate for Payer: NAPHCARE Commercial |
$456.77
|
| Rate for Payer: Preferred Network Access Commercial |
$700.38
|
| Rate for Payer: Quartz Beloit One Network |
$373.03
|
| Rate for Payer: Quartz Commercial |
$494.83
|
| Rate for Payer: Quartz Medicare Advantage |
$456.77
|
| Rate for Payer: The Alliance Commercial |
$117.56
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$418.70
|
| Rate for Payer: WPS Commercial |
$563.86
|
|
|
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 |
$29.39 |
| Max. Negotiated Rate |
$723.22 |
| Rate for Payer: Aetna Commercial |
$723.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$654.70
|
| Rate for Payer: Aetna Managed Medicare |
$29.39
|
| Rate for Payer: Anthem Medicare Advantage |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.39
|
| 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 |
$723.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.39
|
| Rate for Payer: Health EOS Commercial |
$692.76
|
| Rate for Payer: HFN Commercial |
$723.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.39
|
| Rate for Payer: Multiplan Commercial |
$609.02
|
| Rate for Payer: NAPHCARE Commercial |
$44.09
|
| Rate for Payer: Preferred Network Access Commercial |
$723.22
|
| Rate for Payer: Quartz Beloit One Network |
$334.96
|
| Rate for Payer: Quartz Commercial |
$433.93
|
| Rate for Payer: Quartz Medicare Advantage |
$29.39
|
| Rate for Payer: The Alliance Commercial |
$111.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.39
|
| Rate for Payer: WEA Trust Commercial |
$418.70
|
| Rate for Payer: WPS Commercial |
$146.95
|
|
|
XR Spine Lumbosacral 2 or 3 Views
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| Min. Negotiated Rate |
$40.12 |
| Max. Negotiated Rate |
$669.86 |
| Rate for Payer: Aetna Commercial |
$669.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$40.12
|
| Rate for Payer: Anthem Medicare Advantage |
$40.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.12
|
| 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 |
$669.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$352.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.12
|
| Rate for Payer: Health EOS Commercial |
$641.66
|
| Rate for Payer: HFN Commercial |
$669.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$139.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.12
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$60.18
|
| Rate for Payer: Preferred Network Access Commercial |
$669.86
|
| Rate for Payer: Quartz Beloit One Network |
$310.25
|
| Rate for Payer: Quartz Commercial |
$401.92
|
| Rate for Payer: Quartz Medicare Advantage |
$40.12
|
| Rate for Payer: The Alliance Commercial |
$152.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.12
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$200.62
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
|
IP
|
$1,367.00
|
|
|
Service Code
|
CPT 72114 TC
|
| Hospital Charge Code |
1537351
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$696.62 |
| Max. Negotiated Rate |
$1,307.95 |
| Rate for Payer: Aetna Commercial |
$1,279.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,222.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$753.49
|
| Rate for Payer: Cash Price |
$410.10
|
| Rate for Payer: Cigna Commercial |
$1,307.95
|
| Rate for Payer: Health EOS Commercial |
$1,265.30
|
| Rate for Payer: HFN Commercial |
$1,307.95
|
| Rate for Payer: Multiplan Commercial |
$1,137.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,307.95
|
| Rate for Payer: Quartz Beloit One Network |
$696.62
|
| Rate for Payer: Quartz Commercial |
$853.01
|
| Rate for Payer: WEA Trust Commercial |
$781.92
|
| Rate for Payer: WPS Commercial |
$1,053.00
|
|
|
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 |
$47.03 |
| Max. Negotiated Rate |
$1,350.60 |
| Rate for Payer: Aetna Commercial |
$1,350.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,222.64
|
| Rate for Payer: Aetna Managed Medicare |
$47.03
|
| Rate for Payer: Anthem Medicare Advantage |
$47.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.03
|
| 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 |
$1,350.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$710.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.03
|
| Rate for Payer: Health EOS Commercial |
$1,293.73
|
| Rate for Payer: HFN Commercial |
$1,350.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.03
|
| Rate for Payer: Multiplan Commercial |
$1,137.34
|
| Rate for Payer: NAPHCARE Commercial |
$70.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,350.60
|
| Rate for Payer: Quartz Beloit One Network |
$625.54
|
| Rate for Payer: Quartz Commercial |
$810.36
|
| Rate for Payer: Quartz Medicare Advantage |
$47.03
|
| Rate for Payer: The Alliance Commercial |
$178.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.03
|
| Rate for Payer: WEA Trust Commercial |
$781.92
|
| Rate for Payer: WPS Commercial |
$235.14
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
|
OP
|
$1,367.00
|
|
|
Service Code
|
CPT 72114 TC
|
| Hospital Charge Code |
1537351
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$188.12 |
| Max. Negotiated Rate |
$1,307.95 |
| Rate for Payer: Aetna Commercial |
$1,279.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,222.64
|
| Rate for Payer: Aetna Managed Medicare |
$398.07
|
| 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 |
$753.49
|
| 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 |
$1,307.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$795.59
|
| Rate for Payer: Health EOS Commercial |
$1,265.30
|
| Rate for Payer: HFN Commercial |
$1,307.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,066.26
|
| Rate for Payer: Multiplan Commercial |
$1,137.34
|
| Rate for Payer: NAPHCARE Commercial |
$853.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,307.95
|
| Rate for Payer: Quartz Beloit One Network |
$696.62
|
| Rate for Payer: Quartz Commercial |
$924.09
|
| Rate for Payer: Quartz Medicare Advantage |
$853.01
|
| Rate for Payer: The Alliance Commercial |
$188.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$781.92
|
| Rate for Payer: WPS Commercial |
$1,053.00
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
|
OP
|
$1,265.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
630028
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,210.35 |
| Rate for Payer: Aetna Commercial |
$1,184.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,131.42
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$855.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.49
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.27
|
| 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 |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,210.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,170.88
|
| Rate for Payer: HFN Commercial |
$1,210.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,052.48
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,210.35
|
| Rate for Payer: Quartz Beloit One Network |
$644.64
|
| Rate for Payer: Quartz Commercial |
$855.14
|
| 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 |
$723.58
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$974.43
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Professional
|
Both
|
$1,265.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
630028
|
| Min. Negotiated Rate |
$61.31 |
| Max. Negotiated Rate |
$1,249.82 |
| Rate for Payer: Aetna Commercial |
$1,249.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,131.42
|
| Rate for Payer: Aetna Managed Medicare |
$61.31
|
| Rate for Payer: Anthem Medicare Advantage |
$61.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$61.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$61.31
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,249.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$657.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.31
|
| Rate for Payer: Health EOS Commercial |
$1,197.20
|
| Rate for Payer: HFN Commercial |
$1,249.82
|
| 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 |
$61.31
|
| Rate for Payer: Multiplan Commercial |
$1,052.48
|
| Rate for Payer: NAPHCARE Commercial |
$91.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,249.82
|
| Rate for Payer: Quartz Beloit One Network |
$578.86
|
| Rate for Payer: Quartz Commercial |
$749.89
|
| Rate for Payer: Quartz Medicare Advantage |
$61.31
|
| Rate for Payer: The Alliance Commercial |
$232.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.31
|
| Rate for Payer: WEA Trust Commercial |
$723.58
|
| Rate for Payer: WPS Commercial |
$306.54
|
|
|
XR Spine Lumbosacral Complete w/ Bending
|
Facility
|
IP
|
$1,265.00
|
|
|
Service Code
|
CPT 72114
|
| Hospital Charge Code |
630028
|
| Min. Negotiated Rate |
$644.64 |
| Max. Negotiated Rate |
$1,210.35 |
| Rate for Payer: Aetna Commercial |
$1,184.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,131.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.27
|
| Rate for Payer: Cash Price |
$379.50
|
| Rate for Payer: Cigna Commercial |
$1,210.35
|
| Rate for Payer: Health EOS Commercial |
$1,170.88
|
| Rate for Payer: HFN Commercial |
$1,210.35
|
| Rate for Payer: Multiplan Commercial |
$1,052.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,210.35
|
| Rate for Payer: Quartz Beloit One Network |
$644.64
|
| Rate for Payer: Quartz Commercial |
$789.36
|
| Rate for Payer: WEA Trust Commercial |
$723.58
|
| Rate for Payer: WPS Commercial |
$974.43
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Professional
|
Both
|
$940.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
630022
|
| Min. Negotiated Rate |
$52.94 |
| Max. Negotiated Rate |
$928.72 |
| Rate for Payer: Aetna Commercial |
$928.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.74
|
| Rate for Payer: Aetna Managed Medicare |
$52.94
|
| Rate for Payer: Anthem Medicare Advantage |
$52.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.94
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$928.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$488.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.94
|
| Rate for Payer: Health EOS Commercial |
$889.62
|
| Rate for Payer: HFN Commercial |
$928.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$178.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.94
|
| Rate for Payer: Multiplan Commercial |
$782.08
|
| Rate for Payer: NAPHCARE Commercial |
$79.40
|
| Rate for Payer: Preferred Network Access Commercial |
$928.72
|
| Rate for Payer: Quartz Beloit One Network |
$430.14
|
| Rate for Payer: Quartz Commercial |
$557.23
|
| Rate for Payer: Quartz Medicare Advantage |
$52.94
|
| Rate for Payer: The Alliance Commercial |
$201.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.94
|
| Rate for Payer: WEA Trust Commercial |
$537.68
|
| Rate for Payer: WPS Commercial |
$264.68
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
|
OP
|
$918.00
|
|
|
Service Code
|
CPT 72110 TC
|
| Hospital Charge Code |
1537353
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$161.49 |
| Max. Negotiated Rate |
$878.34 |
| Rate for Payer: Aetna Commercial |
$859.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.06
|
| Rate for Payer: Aetna Managed Medicare |
$267.32
|
| 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 |
$506.00
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$878.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.28
|
| Rate for Payer: Health EOS Commercial |
$849.70
|
| Rate for Payer: HFN Commercial |
$878.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.04
|
| Rate for Payer: Multiplan Commercial |
$763.78
|
| Rate for Payer: NAPHCARE Commercial |
$572.83
|
| Rate for Payer: Preferred Network Access Commercial |
$878.34
|
| Rate for Payer: Quartz Beloit One Network |
$467.81
|
| Rate for Payer: Quartz Commercial |
$620.57
|
| Rate for Payer: Quartz Medicare Advantage |
$572.83
|
| Rate for Payer: The Alliance Commercial |
$161.49
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$525.10
|
| Rate for Payer: WPS Commercial |
$707.14
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
|
OP
|
$940.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
630022
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$899.39 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.74
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$469.25
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.13
|
| 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 |
$282.00
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$899.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$547.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$870.06
|
| Rate for Payer: HFN Commercial |
$899.39
|
| 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 |
$782.08
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$899.39
|
| Rate for Payer: Quartz Beloit One Network |
$479.02
|
| Rate for Payer: Quartz Commercial |
$635.44
|
| 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 |
$537.68
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$724.08
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Professional
|
Both
|
$918.00
|
|
|
Service Code
|
CPT 72110 TC
|
| Hospital Charge Code |
1537353
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$40.37 |
| Max. Negotiated Rate |
$906.98 |
| Rate for Payer: Aetna Commercial |
$906.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.06
|
| Rate for Payer: Aetna Managed Medicare |
$40.37
|
| Rate for Payer: Anthem Medicare Advantage |
$40.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.37
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$906.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$477.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.37
|
| Rate for Payer: Health EOS Commercial |
$868.80
|
| Rate for Payer: HFN Commercial |
$906.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.37
|
| Rate for Payer: Multiplan Commercial |
$763.78
|
| Rate for Payer: NAPHCARE Commercial |
$60.56
|
| Rate for Payer: Preferred Network Access Commercial |
$906.98
|
| Rate for Payer: Quartz Beloit One Network |
$420.08
|
| Rate for Payer: Quartz Commercial |
$544.19
|
| Rate for Payer: Quartz Medicare Advantage |
$40.37
|
| Rate for Payer: The Alliance Commercial |
$153.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.37
|
| Rate for Payer: WEA Trust Commercial |
$525.10
|
| Rate for Payer: WPS Commercial |
$201.86
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
|
IP
|
$918.00
|
|
|
Service Code
|
CPT 72110 TC
|
| Hospital Charge Code |
1537353
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$467.81 |
| Max. Negotiated Rate |
$878.34 |
| Rate for Payer: Aetna Commercial |
$859.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.00
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$878.34
|
| Rate for Payer: Health EOS Commercial |
$849.70
|
| Rate for Payer: HFN Commercial |
$878.34
|
| Rate for Payer: Multiplan Commercial |
$763.78
|
| Rate for Payer: Preferred Network Access Commercial |
$878.34
|
| Rate for Payer: Quartz Beloit One Network |
$467.81
|
| Rate for Payer: Quartz Commercial |
$572.83
|
| Rate for Payer: WEA Trust Commercial |
$525.10
|
| Rate for Payer: WPS Commercial |
$707.14
|
|
|
XR Spine Lumbosacral Minimum 4 Views
|
Facility
|
IP
|
$940.00
|
|
|
Service Code
|
CPT 72110
|
| Hospital Charge Code |
630022
|
| Min. Negotiated Rate |
$479.02 |
| Max. Negotiated Rate |
$899.39 |
| Rate for Payer: Aetna Commercial |
$879.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$518.13
|
| Rate for Payer: Cash Price |
$282.00
|
| Rate for Payer: Cigna Commercial |
$899.39
|
| Rate for Payer: Health EOS Commercial |
$870.06
|
| Rate for Payer: HFN Commercial |
$899.39
|
| Rate for Payer: Multiplan Commercial |
$782.08
|
| Rate for Payer: Preferred Network Access Commercial |
$899.39
|
| Rate for Payer: Quartz Beloit One Network |
$479.02
|
| Rate for Payer: Quartz Commercial |
$586.56
|
| Rate for Payer: WEA Trust Commercial |
$537.68
|
| Rate for Payer: WPS Commercial |
$724.08
|
|
|
XR Spine Scoliosis Study Standing
|
Professional
|
Both
|
$650.00
|
|
|
Service Code
|
CPT 72081 TC
|
| Hospital Charge Code |
1537355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$642.20 |
| Rate for Payer: Aetna Commercial |
$642.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$581.36
|
| Rate for Payer: Aetna Managed Medicare |
$31.05
|
| Rate for Payer: Anthem Medicare Advantage |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.05
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$642.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$338.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.05
|
| Rate for Payer: Health EOS Commercial |
$615.16
|
| Rate for Payer: HFN Commercial |
$642.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: NAPHCARE Commercial |
$46.58
|
| Rate for Payer: Preferred Network Access Commercial |
$642.20
|
| Rate for Payer: Quartz Beloit One Network |
$297.44
|
| Rate for Payer: Quartz Commercial |
$385.32
|
| Rate for Payer: Quartz Medicare Advantage |
$31.05
|
| Rate for Payer: The Alliance Commercial |
$118.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.05
|
| Rate for Payer: WEA Trust Commercial |
$371.80
|
| Rate for Payer: WPS Commercial |
$155.27
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
|
IP
|
$650.00
|
|
|
Service Code
|
CPT 72081 TC
|
| Hospital Charge Code |
1537355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$331.24 |
| Max. Negotiated Rate |
$621.92 |
| Rate for Payer: Aetna Commercial |
$608.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$581.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$358.28
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: Health EOS Commercial |
$601.64
|
| Rate for Payer: HFN Commercial |
$621.92
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: Preferred Network Access Commercial |
$621.92
|
| Rate for Payer: Quartz Beloit One Network |
$331.24
|
| Rate for Payer: Quartz Commercial |
$405.60
|
| Rate for Payer: WEA Trust Commercial |
$371.80
|
| Rate for Payer: WPS Commercial |
$500.69
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
|
OP
|
$650.00
|
|
|
Service Code
|
CPT 72081 TC
|
| Hospital Charge Code |
1537355
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$621.92 |
| Rate for Payer: Aetna Commercial |
$608.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$581.36
|
| Rate for Payer: Aetna Managed Medicare |
$189.28
|
| 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 |
$358.28
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$621.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.30
|
| Rate for Payer: Health EOS Commercial |
$601.64
|
| Rate for Payer: HFN Commercial |
$621.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$507.00
|
| Rate for Payer: Multiplan Commercial |
$540.80
|
| Rate for Payer: NAPHCARE Commercial |
$405.60
|
| Rate for Payer: Preferred Network Access Commercial |
$621.92
|
| Rate for Payer: Quartz Beloit One Network |
$331.24
|
| Rate for Payer: Quartz Commercial |
$439.40
|
| Rate for Payer: Quartz Medicare Advantage |
$405.60
|
| Rate for Payer: The Alliance Commercial |
$124.22
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$371.80
|
| Rate for Payer: WPS Commercial |
$500.69
|
|
|
XR Spine Scoliosis Study Standing
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
630017
|
| Min. Negotiated Rate |
$43.62 |
| Max. Negotiated Rate |
$593.79 |
| Rate for Payer: Aetna Commercial |
$593.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$537.53
|
| Rate for Payer: Aetna Managed Medicare |
$43.62
|
| Rate for Payer: Anthem Medicare Advantage |
$43.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.62
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$593.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$312.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.62
|
| Rate for Payer: Health EOS Commercial |
$568.79
|
| Rate for Payer: HFN Commercial |
$593.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.62
|
| Rate for Payer: Multiplan Commercial |
$500.03
|
| Rate for Payer: NAPHCARE Commercial |
$65.43
|
| Rate for Payer: Preferred Network Access Commercial |
$593.79
|
| Rate for Payer: Quartz Beloit One Network |
$275.02
|
| Rate for Payer: Quartz Commercial |
$356.27
|
| Rate for Payer: Quartz Medicare Advantage |
$43.62
|
| Rate for Payer: The Alliance Commercial |
$165.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.62
|
| Rate for Payer: WEA Trust Commercial |
$343.77
|
| Rate for Payer: WPS Commercial |
$218.09
|
|
|
XR Spine Scoliosis Study Standing
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
630017
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$562.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$537.53
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$406.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$312.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$300.02
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.27
|
| 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 |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$575.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$556.29
|
| Rate for Payer: HFN Commercial |
$575.04
|
| 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 |
$500.03
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$575.04
|
| Rate for Payer: Quartz Beloit One Network |
$306.27
|
| Rate for Payer: Quartz Commercial |
$406.28
|
| 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 |
$343.77
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$462.95
|
|
