|
XR Spine Cervical w/ Flext and/or Ext
|
Professional
|
Both
|
$1,138.00
|
|
|
Service Code
|
CPT 72052
|
| Hospital Charge Code |
629614
|
| 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 w/ Flext and/or Ext
|
Facility
|
IP
|
$1,481.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
1537340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$754.72 |
| Max. Negotiated Rate |
$1,417.02 |
| Rate for Payer: Aetna Commercial |
$1,386.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$816.33
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,417.02
|
| Rate for Payer: Health EOS Commercial |
$1,370.81
|
| Rate for Payer: HFN Commercial |
$1,417.02
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.02
|
| Rate for Payer: Quartz Beloit One Network |
$754.72
|
| Rate for Payer: Quartz Commercial |
$924.14
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$1,140.81
|
|
|
XR Spine Cervical w/ Flext and/or Ext
|
Professional
|
Both
|
$1,481.00
|
|
|
Service Code
|
CPT 72052 TC
|
| Hospital Charge Code |
1537340
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$48.03 |
| Max. Negotiated Rate |
$1,463.23 |
| Rate for Payer: Aetna Commercial |
$1,463.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,324.61
|
| Rate for Payer: Aetna Managed Medicare |
$48.03
|
| Rate for Payer: Anthem Medicare Advantage |
$48.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.03
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cash Price |
$444.30
|
| Rate for Payer: Cigna Commercial |
$1,463.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$770.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.03
|
| Rate for Payer: Health EOS Commercial |
$1,401.62
|
| Rate for Payer: HFN Commercial |
$1,463.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.03
|
| Rate for Payer: Multiplan Commercial |
$1,232.19
|
| Rate for Payer: NAPHCARE Commercial |
$72.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,463.23
|
| Rate for Payer: Quartz Beloit One Network |
$677.71
|
| Rate for Payer: Quartz Commercial |
$877.94
|
| Rate for Payer: Quartz Medicare Advantage |
$48.03
|
| Rate for Payer: The Alliance Commercial |
$182.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.03
|
| Rate for Payer: WEA Trust Commercial |
$847.13
|
| Rate for Payer: WPS Commercial |
$240.14
|
|
|
XR Spine Entire Survey AP/Lat
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 72084 TC
|
| Hospital Charge Code |
1537342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$620.69 |
| Max. Negotiated Rate |
$1,165.38 |
| Rate for Payer: Aetna Commercial |
$1,140.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.36
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,165.38
|
| Rate for Payer: Health EOS Commercial |
$1,127.38
|
| Rate for Payer: HFN Commercial |
$1,165.38
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.38
|
| Rate for Payer: Quartz Beloit One Network |
$620.69
|
| Rate for Payer: Quartz Commercial |
$760.03
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$938.23
|
|
|
XR Spine Entire Survey AP/Lat
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
CPT 72084 TC
|
| Hospital Charge Code |
1537342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.08 |
| Max. Negotiated Rate |
$1,203.38 |
| Rate for Payer: Aetna Commercial |
$1,203.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$78.08
|
| Rate for Payer: Anthem Medicare Advantage |
$78.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.08
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,203.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$633.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.08
|
| Rate for Payer: Health EOS Commercial |
$1,152.72
|
| Rate for Payer: HFN Commercial |
$1,203.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.08
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$117.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.38
|
| Rate for Payer: Quartz Beloit One Network |
$557.36
|
| Rate for Payer: Quartz Commercial |
$722.03
|
| Rate for Payer: Quartz Medicare Advantage |
$78.08
|
| Rate for Payer: The Alliance Commercial |
$296.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.08
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$390.42
|
|
|
XR Spine Entire Survey AP/Lat
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 72084 TC
|
| Hospital Charge Code |
1537342
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$312.33 |
| Max. Negotiated Rate |
$1,165.38 |
| Rate for Payer: Aetna Commercial |
$1,140.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$354.68
|
| 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 |
$671.36
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,165.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$708.88
|
| Rate for Payer: Health EOS Commercial |
$1,127.38
|
| Rate for Payer: HFN Commercial |
$1,165.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$950.04
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$760.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.38
|
| Rate for Payer: Quartz Beloit One Network |
$620.69
|
| Rate for Payer: Quartz Commercial |
$823.37
|
| Rate for Payer: Quartz Medicare Advantage |
$760.03
|
| Rate for Payer: The Alliance Commercial |
$312.33
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$938.23
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
1537344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$124.22 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$168.90
|
| 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 |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.56
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$452.40
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$361.92
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| Rate for Payer: Quartz Medicare Advantage |
$361.92
|
| Rate for Payer: The Alliance Commercial |
$124.22
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
XR Spine Lumbar Flexion + Extension
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
1537344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$31.05 |
| Max. Negotiated Rate |
$573.04 |
| Rate for Payer: Aetna Commercial |
$573.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| 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 |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$573.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.05
|
| Rate for Payer: Health EOS Commercial |
$548.91
|
| Rate for Payer: HFN Commercial |
$573.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$104.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.05
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$46.58
|
| Rate for Payer: Preferred Network Access Commercial |
$573.04
|
| Rate for Payer: Quartz Beloit One Network |
$265.41
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| 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 |
$331.76
|
| Rate for Payer: WPS Commercial |
$155.27
|
|
|
XR Spine Lumbar Flexion + Extension
|
Professional
|
Both
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| 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 Lumbar Flexion + Extension
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.46
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| 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 |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| 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 |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$458.33
|
| 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 |
$387.82
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 72120 TC
|
| Hospital Charge Code |
1537344
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
XR Spine Lumbar Flexion + Extension
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
711796
|
| 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
|
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 |
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
|
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
|
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
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 72100
|
| Hospital Charge Code |
630048
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.46
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| 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 |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| 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 |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$458.33
|
| 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 |
$387.82
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| 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 |
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
|
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
|
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 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 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
|
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 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
|
|
