|
XR Spine Thoracic Minimum 4 Views
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
629994
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$493.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.42
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| 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 |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| 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 |
$607.36
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$493.48
|
| 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 |
$417.56
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Professional
|
Both
|
$730.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
629994
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$721.24 |
| Rate for Payer: Aetna Commercial |
$721.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Aetna Managed Medicare |
$43.83
|
| Rate for Payer: Anthem Medicare Advantage |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.83
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$721.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$379.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.83
|
| Rate for Payer: Health EOS Commercial |
$690.87
|
| Rate for Payer: HFN Commercial |
$721.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.83
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: NAPHCARE Commercial |
$65.74
|
| Rate for Payer: Preferred Network Access Commercial |
$721.24
|
| Rate for Payer: Quartz Beloit One Network |
$334.05
|
| Rate for Payer: Quartz Commercial |
$432.74
|
| Rate for Payer: Quartz Medicare Advantage |
$43.83
|
| Rate for Payer: The Alliance Commercial |
$166.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.83
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$219.13
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
CPT 72074
|
| Hospital Charge Code |
629994
|
| Min. Negotiated Rate |
$372.01 |
| Max. Negotiated Rate |
$698.46 |
| Rate for Payer: Aetna Commercial |
$683.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$652.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.38
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$698.46
|
| Rate for Payer: Health EOS Commercial |
$675.69
|
| Rate for Payer: HFN Commercial |
$698.46
|
| Rate for Payer: Multiplan Commercial |
$607.36
|
| Rate for Payer: Preferred Network Access Commercial |
$698.46
|
| Rate for Payer: Quartz Beloit One Network |
$372.01
|
| Rate for Payer: Quartz Commercial |
$455.52
|
| Rate for Payer: WEA Trust Commercial |
$417.56
|
| Rate for Payer: WPS Commercial |
$562.32
|
|
|
XR Spine Thoracolumbar 2 Views
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
629986
|
| Min. Negotiated Rate |
$34.78 |
| Max. Negotiated Rate |
$528.58 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$34.78
|
| Rate for Payer: Anthem Medicare Advantage |
$34.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.78
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$528.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.78
|
| Rate for Payer: Health EOS Commercial |
$506.32
|
| Rate for Payer: HFN Commercial |
$528.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$121.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.78
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$52.17
|
| Rate for Payer: Preferred Network Access Commercial |
$528.58
|
| Rate for Payer: Quartz Beloit One Network |
$244.82
|
| Rate for Payer: Quartz Commercial |
$317.15
|
| Rate for Payer: Quartz Medicare Advantage |
$34.78
|
| Rate for Payer: The Alliance Commercial |
$132.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.78
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$173.89
|
|
|
XR Spine Thoracolumbar 2 Views
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
CPT 72080 TC
|
| Hospital Charge Code |
1537367
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$24.73 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna Commercial |
$570.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$24.73
|
| Rate for Payer: Anthem Medicare Advantage |
$24.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.73
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$570.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.73
|
| Rate for Payer: Health EOS Commercial |
$546.07
|
| Rate for Payer: HFN Commercial |
$570.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.73
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$37.10
|
| Rate for Payer: Preferred Network Access Commercial |
$570.08
|
| Rate for Payer: Quartz Beloit One Network |
$264.04
|
| Rate for Payer: Quartz Commercial |
$342.05
|
| Rate for Payer: Quartz Medicare Advantage |
$24.73
|
| Rate for Payer: The Alliance Commercial |
$93.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.73
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$123.66
|
|
|
XR Spine Thoracolumbar 2 Views
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
629986
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| 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 |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| 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 |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| 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 |
$306.02
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Spine Thoracolumbar 2 Views
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 72080
|
| Hospital Charge Code |
629986
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
XR Spine Thoracolumbar 2 Views
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
CPT 72080 TC
|
| Hospital Charge Code |
1537367
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$294.04 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$360.05
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Spine Thoracolumbar 2 Views
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
CPT 72080 TC
|
| Hospital Charge Code |
1537367
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$98.92 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$168.02
|
| 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 |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.81
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.06
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$360.05
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$390.05
|
| Rate for Payer: Quartz Medicare Advantage |
$360.05
|
| Rate for Payer: The Alliance Commercial |
$98.92
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
|
OP
|
$598.00
|
|
|
Service Code
|
CPT 71130 TC
|
| Hospital Charge Code |
1537371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$122.89 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Aetna Managed Medicare |
$174.14
|
| 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 |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.04
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.44
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: NAPHCARE Commercial |
$373.15
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$404.25
|
| Rate for Payer: Quartz Medicare Advantage |
$373.15
|
| Rate for Payer: The Alliance Commercial |
$122.89
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
XR Sternoclavicular Joint(s)
|
Professional
|
Both
|
$555.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
629976
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$548.34 |
| Rate for Payer: Aetna Commercial |
$548.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.39
|
| Rate for Payer: Aetna Managed Medicare |
$41.12
|
| Rate for Payer: Anthem Medicare Advantage |
$41.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.12
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$548.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$288.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.12
|
| Rate for Payer: Health EOS Commercial |
$525.25
|
| Rate for Payer: HFN Commercial |
$548.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$146.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.12
|
| Rate for Payer: Multiplan Commercial |
$461.76
|
| Rate for Payer: NAPHCARE Commercial |
$61.68
|
| Rate for Payer: Preferred Network Access Commercial |
$548.34
|
| Rate for Payer: Quartz Beloit One Network |
$253.97
|
| Rate for Payer: Quartz Commercial |
$329.00
|
| Rate for Payer: Quartz Medicare Advantage |
$41.12
|
| Rate for Payer: The Alliance Commercial |
$156.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.12
|
| Rate for Payer: WEA Trust Commercial |
$317.46
|
| Rate for Payer: WPS Commercial |
$205.61
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
|
OP
|
$555.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
629976
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$531.02 |
| Rate for Payer: Aetna Commercial |
$519.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.39
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$288.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.06
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.92
|
| 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 |
$166.50
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$531.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$513.71
|
| Rate for Payer: HFN Commercial |
$531.02
|
| 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 |
$461.76
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$531.02
|
| Rate for Payer: Quartz Beloit One Network |
$282.83
|
| Rate for Payer: Quartz Commercial |
$375.18
|
| 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 |
$317.46
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$427.52
|
|
|
XR Sternoclavicular Joint(s)
|
Professional
|
Both
|
$598.00
|
|
|
Service Code
|
CPT 71130 TC
|
| Hospital Charge Code |
1537371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$30.72 |
| Max. Negotiated Rate |
$590.82 |
| Rate for Payer: Aetna Commercial |
$590.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Aetna Managed Medicare |
$30.72
|
| Rate for Payer: Anthem Medicare Advantage |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.72
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$590.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.72
|
| Rate for Payer: Health EOS Commercial |
$565.95
|
| Rate for Payer: HFN Commercial |
$590.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$107.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.72
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: NAPHCARE Commercial |
$46.08
|
| Rate for Payer: Preferred Network Access Commercial |
$590.82
|
| Rate for Payer: Quartz Beloit One Network |
$273.64
|
| Rate for Payer: Quartz Commercial |
$354.49
|
| Rate for Payer: Quartz Medicare Advantage |
$30.72
|
| Rate for Payer: The Alliance Commercial |
$116.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.72
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$153.61
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
|
IP
|
$598.00
|
|
|
Service Code
|
CPT 71130 TC
|
| Hospital Charge Code |
1537371
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$304.74 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
XR Sternoclavicular Joint(s)
|
Facility
|
IP
|
$555.00
|
|
|
Service Code
|
CPT 71130
|
| Hospital Charge Code |
629976
|
| Min. Negotiated Rate |
$282.83 |
| Max. Negotiated Rate |
$531.02 |
| Rate for Payer: Aetna Commercial |
$519.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.92
|
| Rate for Payer: Cash Price |
$166.50
|
| Rate for Payer: Cigna Commercial |
$531.02
|
| Rate for Payer: Health EOS Commercial |
$513.71
|
| Rate for Payer: HFN Commercial |
$531.02
|
| Rate for Payer: Multiplan Commercial |
$461.76
|
| Rate for Payer: Preferred Network Access Commercial |
$531.02
|
| Rate for Payer: Quartz Beloit One Network |
$282.83
|
| Rate for Payer: Quartz Commercial |
$346.32
|
| Rate for Payer: WEA Trust Commercial |
$317.46
|
| Rate for Payer: WPS Commercial |
$427.52
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
IP
|
$460.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
629974
|
| Min. Negotiated Rate |
$234.42 |
| Max. Negotiated Rate |
$440.13 |
| Rate for Payer: Aetna Commercial |
$430.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.55
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$440.13
|
| Rate for Payer: Health EOS Commercial |
$425.78
|
| Rate for Payer: HFN Commercial |
$440.13
|
| Rate for Payer: Multiplan Commercial |
$382.72
|
| Rate for Payer: Preferred Network Access Commercial |
$440.13
|
| Rate for Payer: Quartz Beloit One Network |
$234.42
|
| Rate for Payer: Quartz Commercial |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$263.12
|
| Rate for Payer: WPS Commercial |
$354.34
|
|
|
XR Sternum Minimum 2 Views
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 71120 TC
|
| Hospital Charge Code |
1537373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$491.04 |
| Rate for Payer: Aetna Commercial |
$491.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$23.40
|
| Rate for Payer: Anthem Medicare Advantage |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.40
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$491.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$258.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.40
|
| Rate for Payer: Health EOS Commercial |
$470.36
|
| Rate for Payer: HFN Commercial |
$491.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$35.10
|
| Rate for Payer: Preferred Network Access Commercial |
$491.04
|
| Rate for Payer: Quartz Beloit One Network |
$227.43
|
| Rate for Payer: Quartz Commercial |
$294.62
|
| Rate for Payer: Quartz Medicare Advantage |
$23.40
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.40
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$117.00
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 71120 TC
|
| Hospital Charge Code |
1537373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 71120 TC
|
| Hospital Charge Code |
1537373
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$144.73
|
| 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 |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.25
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.66
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$310.13
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$310.13
|
| Rate for Payer: The Alliance Commercial |
$93.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
XR Sternum Minimum 2 Views
|
Facility
|
OP
|
$460.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
629974
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$440.13 |
| Rate for Payer: Aetna Commercial |
$430.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$310.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.63
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.55
|
| 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 |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$440.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$425.78
|
| Rate for Payer: HFN Commercial |
$440.13
|
| 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 |
$382.72
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$440.13
|
| Rate for Payer: Quartz Beloit One Network |
$234.42
|
| Rate for Payer: Quartz Commercial |
$310.96
|
| 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 |
$263.12
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$354.34
|
|
|
XR Sternum Minimum 2 Views
|
Professional
|
Both
|
$460.00
|
|
|
Service Code
|
CPT 71120
|
| Hospital Charge Code |
629974
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$454.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.42
|
| Rate for Payer: Aetna Managed Medicare |
$32.78
|
| Rate for Payer: Anthem Medicare Advantage |
$32.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.78
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cash Price |
$138.00
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.78
|
| Rate for Payer: Health EOS Commercial |
$435.34
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.78
|
| Rate for Payer: Multiplan Commercial |
$382.72
|
| Rate for Payer: NAPHCARE Commercial |
$49.17
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$210.50
|
| Rate for Payer: Quartz Commercial |
$272.69
|
| Rate for Payer: Quartz Medicare Advantage |
$32.78
|
| Rate for Payer: The Alliance Commercial |
$124.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.78
|
| Rate for Payer: WEA Trust Commercial |
$263.12
|
| Rate for Payer: WPS Commercial |
$163.90
|
|
|
XR Swallow Function w/Video Pediatric
|
Facility
|
IP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
4596975
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$564.13 |
| Max. Negotiated Rate |
$1,059.18 |
| Rate for Payer: Aetna Commercial |
$1,036.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.18
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,059.18
|
| Rate for Payer: Health EOS Commercial |
$1,024.64
|
| Rate for Payer: HFN Commercial |
$1,059.18
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.18
|
| Rate for Payer: Quartz Beloit One Network |
$564.13
|
| Rate for Payer: Quartz Commercial |
$690.77
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$852.72
|
|
|
XR Swallow Function w/Video Pediatric
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
4596975
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$94.95 |
| Max. Negotiated Rate |
$1,093.72 |
| Rate for Payer: Aetna Commercial |
$1,093.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Aetna Managed Medicare |
$94.95
|
| Rate for Payer: Anthem Medicare Advantage |
$94.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.95
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,093.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$575.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.95
|
| Rate for Payer: Health EOS Commercial |
$1,047.66
|
| Rate for Payer: HFN Commercial |
$1,093.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.95
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: NAPHCARE Commercial |
$142.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,093.72
|
| Rate for Payer: Quartz Beloit One Network |
$506.56
|
| Rate for Payer: Quartz Commercial |
$656.23
|
| Rate for Payer: Quartz Medicare Advantage |
$94.95
|
| Rate for Payer: The Alliance Commercial |
$360.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.95
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$474.76
|
|
|
XR Swallow Function w/Video Pediatric
|
Facility
|
OP
|
$1,107.00
|
|
|
Service Code
|
CPT 74230 TC
|
| Hospital Charge Code |
4596975
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,059.18 |
| Rate for Payer: Aetna Commercial |
$1,036.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Aetna Managed Medicare |
$322.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.18
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,059.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.27
|
| Rate for Payer: Health EOS Commercial |
$1,024.64
|
| Rate for Payer: HFN Commercial |
$1,059.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$863.46
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: NAPHCARE Commercial |
$690.77
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.18
|
| Rate for Payer: Quartz Beloit One Network |
$564.13
|
| Rate for Payer: Quartz Commercial |
$748.33
|
| Rate for Payer: Quartz Medicare Advantage |
$690.77
|
| Rate for Payer: The Alliance Commercial |
$379.81
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$852.72
|
|
|
XR Swallowing Function w/ Video
|
Facility
|
IP
|
$992.00
|
|
|
Service Code
|
CPT 74230
|
| Hospital Charge Code |
629964
|
| Min. Negotiated Rate |
$505.52 |
| Max. Negotiated Rate |
$949.15 |
| Rate for Payer: Aetna Commercial |
$928.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$887.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.79
|
| Rate for Payer: Cash Price |
$297.60
|
| Rate for Payer: Cigna Commercial |
$949.15
|
| Rate for Payer: Health EOS Commercial |
$918.20
|
| Rate for Payer: HFN Commercial |
$949.15
|
| Rate for Payer: Multiplan Commercial |
$825.34
|
| Rate for Payer: Preferred Network Access Commercial |
$949.15
|
| Rate for Payer: Quartz Beloit One Network |
$505.52
|
| Rate for Payer: Quartz Commercial |
$619.01
|
| Rate for Payer: WEA Trust Commercial |
$567.42
|
| Rate for Payer: WPS Commercial |
$764.14
|
|
