|
CT Elbow w/ Contrast Left
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241026
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/ Contrast Left
|
Facility
|
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629828
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,826.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.16
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,826.36
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Elbow w/ Contrast Left
|
Professional
|
Both
|
$4,181.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629828
|
| Min. Negotiated Rate |
$198.29 |
| Max. Negotiated Rate |
$4,130.83 |
| Rate for Payer: Aetna Commercial |
$4,130.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$198.29
|
| Rate for Payer: Anthem Medicare Advantage |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.29
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,130.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,174.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.29
|
| Rate for Payer: Health EOS Commercial |
$3,956.90
|
| Rate for Payer: HFN Commercial |
$4,130.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.29
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$297.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,913.23
|
| Rate for Payer: Quartz Commercial |
$2,478.50
|
| Rate for Payer: Quartz Medicare Advantage |
$198.29
|
| Rate for Payer: The Alliance Commercial |
$753.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.29
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$991.43
|
|
|
CT Elbow w/ Contrast Left
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73201 LT,TC
|
| Hospital Charge Code |
1241026
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/ Contrast Left
|
Facility
|
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629828
|
| Min. Negotiated Rate |
$2,130.64 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,608.94
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Elbow w/ Contrast Right
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/ Contrast Right
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/ Contrast Right
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$784.39 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/ Contrast Right
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/ Contrast Right
|
Facility
|
IP
|
$4,181.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629832
|
| Min. Negotiated Rate |
$2,130.64 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,608.94
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Elbow w/ Contrast Right
|
Facility
|
OP
|
$4,181.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629832
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$4,000.38 |
| Rate for Payer: Aetna Commercial |
$3,913.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,826.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,174.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,087.16
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,304.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,000.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,433.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$3,869.93
|
| Rate for Payer: HFN Commercial |
$4,000.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,000.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,130.64
|
| Rate for Payer: Quartz Commercial |
$2,826.36
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$3,220.62
|
|
|
CT Elbow w/ Contrast Right
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73201 TC,RT
|
| Hospital Charge Code |
2980012
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/ Contrast Right
|
Professional
|
Both
|
$4,181.00
|
|
|
Service Code
|
CPT 73201
|
| Hospital Charge Code |
629832
|
| Min. Negotiated Rate |
$198.29 |
| Max. Negotiated Rate |
$4,130.83 |
| Rate for Payer: Aetna Commercial |
$4,130.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,739.49
|
| Rate for Payer: Aetna Managed Medicare |
$198.29
|
| Rate for Payer: Anthem Medicare Advantage |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.29
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cash Price |
$1,254.30
|
| Rate for Payer: Cigna Commercial |
$4,130.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,174.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.29
|
| Rate for Payer: Health EOS Commercial |
$3,956.90
|
| Rate for Payer: HFN Commercial |
$4,130.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.29
|
| Rate for Payer: Multiplan Commercial |
$3,478.59
|
| Rate for Payer: NAPHCARE Commercial |
$297.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,913.23
|
| Rate for Payer: Quartz Commercial |
$2,478.50
|
| Rate for Payer: Quartz Medicare Advantage |
$198.29
|
| Rate for Payer: The Alliance Commercial |
$753.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.29
|
| Rate for Payer: WEA Trust Commercial |
$2,391.53
|
| Rate for Payer: WPS Commercial |
$991.43
|
|
|
CT Elbow w/ Contrast Right
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73201 RT,TC
|
| Hospital Charge Code |
1241028
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$784.39 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$784.39
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/o Contrast Bilateral
|
Facility
|
OP
|
$4,102.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,194.50 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Aetna Managed Medicare |
$1,194.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,387.36
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,199.56
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,559.65
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,772.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,559.65
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/o Contrast Bilateral
|
Facility
|
IP
|
$7,097.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
629830
|
| Min. Negotiated Rate |
$3,616.63 |
| Max. Negotiated Rate |
$6,790.41 |
| Rate for Payer: Aetna Commercial |
$6,642.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,347.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,911.87
|
| Rate for Payer: Cash Price |
$2,129.10
|
| Rate for Payer: Cigna Commercial |
$6,790.41
|
| Rate for Payer: Health EOS Commercial |
$6,568.98
|
| Rate for Payer: HFN Commercial |
$6,790.41
|
| Rate for Payer: Multiplan Commercial |
$5,904.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,790.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,616.63
|
| Rate for Payer: Quartz Commercial |
$4,428.53
|
| Rate for Payer: WEA Trust Commercial |
$4,059.48
|
| Rate for Payer: WPS Commercial |
$5,466.82
|
|
|
CT Elbow w/o Contrast Bilateral
|
Facility
|
OP
|
$7,097.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
629830
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$6,790.41 |
| Rate for Payer: Aetna Commercial |
$6,642.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,347.56
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,797.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,690.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,542.82
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,911.87
|
| 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 |
$2,129.10
|
| Rate for Payer: Cash Price |
$2,129.10
|
| Rate for Payer: Cigna Commercial |
$6,790.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,130.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$6,568.98
|
| Rate for Payer: HFN Commercial |
$6,790.41
|
| 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 |
$5,904.70
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,790.41
|
| Rate for Payer: Quartz Beloit One Network |
$3,616.63
|
| Rate for Payer: Quartz Commercial |
$4,797.57
|
| 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 |
$4,059.48
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$5,466.82
|
|
|
CT Elbow w/o Contrast Bilateral
|
Facility
|
IP
|
$4,102.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,090.38 |
| Max. Negotiated Rate |
$3,924.79 |
| Rate for Payer: Aetna Commercial |
$3,839.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,261.02
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$3,924.79
|
| Rate for Payer: Health EOS Commercial |
$3,796.81
|
| Rate for Payer: HFN Commercial |
$3,924.79
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,924.79
|
| Rate for Payer: Quartz Beloit One Network |
$2,090.38
|
| Rate for Payer: Quartz Commercial |
$2,559.65
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/o Contrast Bilateral
|
Professional
|
Both
|
$4,102.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241030
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$629.94 |
| Max. Negotiated Rate |
$4,052.78 |
| Rate for Payer: Aetna Commercial |
$4,052.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,668.83
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cash Price |
$1,230.60
|
| Rate for Payer: Cigna Commercial |
$4,052.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,133.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,559.65
|
| Rate for Payer: Health EOS Commercial |
$3,882.13
|
| Rate for Payer: HFN Commercial |
$4,052.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$629.94
|
| Rate for Payer: Multiplan Commercial |
$3,412.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,052.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,877.08
|
| Rate for Payer: Quartz Commercial |
$2,431.67
|
| Rate for Payer: The Alliance Commercial |
$2,133.04
|
| Rate for Payer: WEA Trust Commercial |
$2,346.34
|
| Rate for Payer: WPS Commercial |
$3,159.77
|
|
|
CT Elbow w/o Contrast Bilateral
|
Professional
|
Both
|
$7,097.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
629830
|
| Min. Negotiated Rate |
$159.69 |
| Max. Negotiated Rate |
$7,011.84 |
| Rate for Payer: Aetna Commercial |
$7,011.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,347.56
|
| Rate for Payer: Aetna Managed Medicare |
$159.69
|
| Rate for Payer: Anthem Medicare Advantage |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.69
|
| Rate for Payer: Cash Price |
$2,129.10
|
| Rate for Payer: Cash Price |
$2,129.10
|
| Rate for Payer: Cash Price |
$2,129.10
|
| Rate for Payer: Cigna Commercial |
$7,011.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,690.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.69
|
| Rate for Payer: Health EOS Commercial |
$6,716.60
|
| Rate for Payer: HFN Commercial |
$7,011.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$629.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.69
|
| Rate for Payer: Multiplan Commercial |
$5,904.70
|
| Rate for Payer: NAPHCARE Commercial |
$239.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,011.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,247.59
|
| Rate for Payer: Quartz Commercial |
$4,207.10
|
| Rate for Payer: Quartz Medicare Advantage |
$159.69
|
| Rate for Payer: The Alliance Commercial |
$606.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.69
|
| Rate for Payer: WEA Trust Commercial |
$4,059.48
|
| Rate for Payer: WPS Commercial |
$798.46
|
|
|
CT Elbow w/o Contrast Left
|
Facility
|
IP
|
$3,761.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241032
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,916.61 |
| Max. Negotiated Rate |
$3,598.52 |
| Rate for Payer: Aetna Commercial |
$3,520.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,363.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,073.06
|
| Rate for Payer: Cash Price |
$1,128.30
|
| Rate for Payer: Cigna Commercial |
$3,598.52
|
| Rate for Payer: Health EOS Commercial |
$3,481.18
|
| Rate for Payer: HFN Commercial |
$3,598.52
|
| Rate for Payer: Multiplan Commercial |
$3,129.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,598.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,916.61
|
| Rate for Payer: Quartz Commercial |
$2,346.86
|
| Rate for Payer: WEA Trust Commercial |
$2,151.29
|
| Rate for Payer: WPS Commercial |
$2,897.10
|
|
|
CT Elbow w/o Contrast Left
|
Facility
|
IP
|
$3,547.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
629834
|
| Min. Negotiated Rate |
$1,807.55 |
| Max. Negotiated Rate |
$3,393.77 |
| Rate for Payer: Aetna Commercial |
$3,319.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,172.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,955.11
|
| Rate for Payer: Cash Price |
$1,064.10
|
| Rate for Payer: Cigna Commercial |
$3,393.77
|
| Rate for Payer: Health EOS Commercial |
$3,283.10
|
| Rate for Payer: HFN Commercial |
$3,393.77
|
| Rate for Payer: Multiplan Commercial |
$2,951.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,393.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.55
|
| Rate for Payer: Quartz Commercial |
$2,213.33
|
| Rate for Payer: WEA Trust Commercial |
$2,028.88
|
| Rate for Payer: WPS Commercial |
$2,732.25
|
|
|
CT Elbow w/o Contrast Left
|
Professional
|
Both
|
$3,547.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
629834
|
| Min. Negotiated Rate |
$159.69 |
| Max. Negotiated Rate |
$3,504.44 |
| Rate for Payer: Aetna Commercial |
$3,504.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,172.44
|
| Rate for Payer: Aetna Managed Medicare |
$159.69
|
| Rate for Payer: Anthem Medicare Advantage |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$159.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$159.69
|
| Rate for Payer: Cash Price |
$1,064.10
|
| Rate for Payer: Cash Price |
$1,064.10
|
| Rate for Payer: Cash Price |
$1,064.10
|
| Rate for Payer: Cigna Commercial |
$3,504.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,844.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.69
|
| Rate for Payer: Health EOS Commercial |
$3,356.88
|
| Rate for Payer: HFN Commercial |
$3,504.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$629.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$159.69
|
| Rate for Payer: Multiplan Commercial |
$2,951.10
|
| Rate for Payer: NAPHCARE Commercial |
$239.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,504.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,623.11
|
| Rate for Payer: Quartz Commercial |
$2,102.66
|
| Rate for Payer: Quartz Medicare Advantage |
$159.69
|
| Rate for Payer: The Alliance Commercial |
$606.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$159.69
|
| Rate for Payer: WEA Trust Commercial |
$2,028.88
|
| Rate for Payer: WPS Commercial |
$798.46
|
|
|
CT Elbow w/o Contrast Left
|
Facility
|
OP
|
$3,547.00
|
|
|
Service Code
|
CPT 73200
|
| Hospital Charge Code |
629834
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$3,393.77 |
| Rate for Payer: Aetna Commercial |
$3,319.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,172.44
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,397.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,844.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,770.66
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,955.11
|
| 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 |
$1,064.10
|
| Rate for Payer: Cash Price |
$1,064.10
|
| Rate for Payer: Cigna Commercial |
$3,393.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,064.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$3,283.10
|
| Rate for Payer: HFN Commercial |
$3,393.77
|
| 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 |
$2,951.10
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,393.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.55
|
| Rate for Payer: Quartz Commercial |
$2,397.77
|
| 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 |
$2,028.88
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$2,732.25
|
|
|
CT Elbow w/o Contrast Left
|
Professional
|
Both
|
$3,761.00
|
|
|
Service Code
|
CPT 73200 LT,TC
|
| Hospital Charge Code |
1241032
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$629.94 |
| Max. Negotiated Rate |
$3,715.87 |
| Rate for Payer: Aetna Commercial |
$3,715.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,363.84
|
| Rate for Payer: Cash Price |
$1,128.30
|
| Rate for Payer: Cash Price |
$1,128.30
|
| Rate for Payer: Cash Price |
$1,128.30
|
| Rate for Payer: Cigna Commercial |
$3,715.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,955.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,346.86
|
| Rate for Payer: Health EOS Commercial |
$3,559.41
|
| Rate for Payer: HFN Commercial |
$3,715.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$629.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$629.94
|
| Rate for Payer: Multiplan Commercial |
$3,129.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,721.03
|
| Rate for Payer: Quartz Commercial |
$2,229.52
|
| Rate for Payer: The Alliance Commercial |
$1,955.72
|
| Rate for Payer: WEA Trust Commercial |
$2,151.29
|
| Rate for Payer: WPS Commercial |
$2,897.10
|
|
