|
CT Foot w/ Contrast Bilateral
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241062
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$817.69 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Aetna Managed Medicare |
$817.69
|
| 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 |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,634.26
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,190.24
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,752.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,898.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,752.19
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Foot w/ Contrast Bilateral
|
Professional
|
Both
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629868
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$5,668.16 |
| Rate for Payer: Aetna Commercial |
$5,668.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Aetna Managed Medicare |
$165.01
|
| Rate for Payer: Anthem Medicare Advantage |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.01
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,668.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,983.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.01
|
| Rate for Payer: Health EOS Commercial |
$5,429.50
|
| Rate for Payer: HFN Commercial |
$5,668.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| Rate for Payer: NAPHCARE Commercial |
$247.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,668.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.25
|
| Rate for Payer: Quartz Commercial |
$3,400.89
|
| Rate for Payer: Quartz Medicare Advantage |
$165.01
|
| Rate for Payer: The Alliance Commercial |
$627.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.01
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: WPS Commercial |
$825.03
|
|
|
CT Foot w/ Contrast Bilateral
|
Facility
|
IP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629868
|
| Min. Negotiated Rate |
$2,923.58 |
| Max. Negotiated Rate |
$5,489.16 |
| Rate for Payer: Aetna Commercial |
$5,369.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,162.23
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,489.16
|
| Rate for Payer: Health EOS Commercial |
$5,310.17
|
| Rate for Payer: HFN Commercial |
$5,489.16
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,489.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.58
|
| Rate for Payer: Quartz Commercial |
$3,579.89
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: WPS Commercial |
$4,419.21
|
|
|
CT Foot w/ Contrast Bilateral
|
Facility
|
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241062
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,430.96 |
| Max. Negotiated Rate |
$2,686.69 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,752.19
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Foot w/ Contrast Bilateral
|
Professional
|
Both
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241062
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$640.81 |
| Max. Negotiated Rate |
$2,774.30 |
| Rate for Payer: Aetna Commercial |
$2,774.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,774.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,460.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.19
|
| Rate for Payer: Health EOS Commercial |
$2,657.49
|
| Rate for Payer: HFN Commercial |
$2,774.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,774.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.94
|
| Rate for Payer: Quartz Commercial |
$1,664.58
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Foot w/ Contrast Bilateral
|
Facility
|
OP
|
$5,737.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629868
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$5,489.16 |
| Rate for Payer: Aetna Commercial |
$5,369.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,131.17
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,878.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,983.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,863.91
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,162.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cash Price |
$1,721.10
|
| Rate for Payer: Cigna Commercial |
$5,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$5,310.17
|
| Rate for Payer: HFN Commercial |
$5,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$4,773.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,489.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.58
|
| Rate for Payer: Quartz Commercial |
$3,878.21
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$3,281.56
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$4,419.21
|
|
|
CT Foot w/ Contrast Left
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241064
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$640.81 |
| Max. Negotiated Rate |
$2,881.01 |
| Rate for Payer: Aetna Commercial |
$2,881.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,881.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,516.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,819.58
|
| Rate for Payer: Health EOS Commercial |
$2,759.70
|
| Rate for Payer: HFN Commercial |
$2,881.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.36
|
| Rate for Payer: Quartz Commercial |
$1,728.60
|
| Rate for Payer: The Alliance Commercial |
$1,516.32
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Foot w/ Contrast Left
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241064
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,485.99 |
| Max. Negotiated Rate |
$2,790.03 |
| Rate for Payer: Aetna Commercial |
$2,729.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,607.30
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,790.03
|
| Rate for Payer: Health EOS Commercial |
$2,699.05
|
| Rate for Payer: HFN Commercial |
$2,790.03
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,790.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.99
|
| Rate for Payer: Quartz Commercial |
$1,819.58
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Foot w/ Contrast Left
|
Facility
|
OP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629870
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$2,744.10 |
| Rate for Payer: Aetna Commercial |
$2,684.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,938.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,491.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,431.71
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,744.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,669.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,654.62
|
| Rate for Payer: HFN Commercial |
$2,744.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.53
|
| Rate for Payer: Quartz Commercial |
$1,938.77
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,209.22
|
|
|
CT Foot w/ Contrast Left
|
Professional
|
Both
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629870
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$2,833.58 |
| Rate for Payer: Aetna Commercial |
$2,833.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$165.01
|
| Rate for Payer: Anthem Medicare Advantage |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.01
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,833.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,491.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.01
|
| Rate for Payer: Health EOS Commercial |
$2,714.28
|
| Rate for Payer: HFN Commercial |
$2,833.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$247.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,833.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,312.40
|
| Rate for Payer: Quartz Commercial |
$1,700.15
|
| Rate for Payer: Quartz Medicare Advantage |
$165.01
|
| Rate for Payer: The Alliance Commercial |
$627.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.01
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: WPS Commercial |
$825.03
|
|
|
CT Foot w/ Contrast Left
|
Facility
|
IP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629870
|
| Min. Negotiated Rate |
$1,461.53 |
| Max. Negotiated Rate |
$2,744.10 |
| Rate for Payer: Aetna Commercial |
$2,684.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.84
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,744.10
|
| Rate for Payer: Health EOS Commercial |
$2,654.62
|
| Rate for Payer: HFN Commercial |
$2,744.10
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.53
|
| Rate for Payer: Quartz Commercial |
$1,789.63
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: WPS Commercial |
$2,209.22
|
|
|
CT Foot w/ Contrast Left
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 LT,TC
|
| Hospital Charge Code |
1241064
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$849.14 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,729.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Aetna Managed Medicare |
$849.14
|
| 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 |
$1,607.30
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,790.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,697.11
|
| Rate for Payer: Health EOS Commercial |
$2,699.05
|
| Rate for Payer: HFN Commercial |
$2,790.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,274.48
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,819.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,790.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.99
|
| Rate for Payer: Quartz Commercial |
$1,971.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,819.58
|
| Rate for Payer: The Alliance Commercial |
$1,516.32
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Foot w/ Contrast Right
|
Professional
|
Both
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 RT,TC
|
| Hospital Charge Code |
1241066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$640.81 |
| Max. Negotiated Rate |
$2,881.01 |
| Rate for Payer: Aetna Commercial |
$2,881.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,881.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,516.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,819.58
|
| Rate for Payer: Health EOS Commercial |
$2,759.70
|
| Rate for Payer: HFN Commercial |
$2,881.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,334.36
|
| Rate for Payer: Quartz Commercial |
$1,728.60
|
| Rate for Payer: The Alliance Commercial |
$1,516.32
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Foot w/ Contrast Right
|
Facility
|
OP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 RT,TC
|
| Hospital Charge Code |
1241066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$849.14 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,729.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Aetna Managed Medicare |
$849.14
|
| 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 |
$1,607.30
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,790.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,697.11
|
| Rate for Payer: Health EOS Commercial |
$2,699.05
|
| Rate for Payer: HFN Commercial |
$2,790.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,274.48
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,819.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,790.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.99
|
| Rate for Payer: Quartz Commercial |
$1,971.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,819.58
|
| Rate for Payer: The Alliance Commercial |
$1,516.32
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Foot w/ Contrast Right
|
Facility
|
IP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980078
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,430.96 |
| Max. Negotiated Rate |
$2,686.69 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,752.19
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Foot w/ Contrast Right
|
Facility
|
IP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629872
|
| Min. Negotiated Rate |
$1,461.53 |
| Max. Negotiated Rate |
$2,744.10 |
| Rate for Payer: Aetna Commercial |
$2,684.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.84
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,744.10
|
| Rate for Payer: Health EOS Commercial |
$2,654.62
|
| Rate for Payer: HFN Commercial |
$2,744.10
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.53
|
| Rate for Payer: Quartz Commercial |
$1,789.63
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: WPS Commercial |
$2,209.22
|
|
|
CT Foot w/ Contrast Right
|
Professional
|
Both
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629872
|
| Min. Negotiated Rate |
$165.01 |
| Max. Negotiated Rate |
$2,833.58 |
| Rate for Payer: Aetna Commercial |
$2,833.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$165.01
|
| Rate for Payer: Anthem Medicare Advantage |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.01
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,833.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,491.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.01
|
| Rate for Payer: Health EOS Commercial |
$2,714.28
|
| Rate for Payer: HFN Commercial |
$2,833.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.01
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$247.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,833.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,312.40
|
| Rate for Payer: Quartz Commercial |
$1,700.15
|
| Rate for Payer: Quartz Medicare Advantage |
$165.01
|
| Rate for Payer: The Alliance Commercial |
$627.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.01
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: WPS Commercial |
$825.03
|
|
|
CT Foot w/ Contrast Right
|
Facility
|
IP
|
$2,916.00
|
|
|
Service Code
|
CPT 73701 RT,TC
|
| Hospital Charge Code |
1241066
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,485.99 |
| Max. Negotiated Rate |
$2,790.03 |
| Rate for Payer: Aetna Commercial |
$2,729.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,608.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,607.30
|
| Rate for Payer: Cash Price |
$874.80
|
| Rate for Payer: Cigna Commercial |
$2,790.03
|
| Rate for Payer: Health EOS Commercial |
$2,699.05
|
| Rate for Payer: HFN Commercial |
$2,790.03
|
| Rate for Payer: Multiplan Commercial |
$2,426.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,790.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,485.99
|
| Rate for Payer: Quartz Commercial |
$1,819.58
|
| Rate for Payer: WEA Trust Commercial |
$1,667.95
|
| Rate for Payer: WPS Commercial |
$2,246.19
|
|
|
CT Foot w/ Contrast Right
|
Facility
|
OP
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980078
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$817.69 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,628.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Aetna Managed Medicare |
$817.69
|
| 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 |
$1,547.77
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,686.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,634.26
|
| Rate for Payer: Health EOS Commercial |
$2,599.08
|
| Rate for Payer: HFN Commercial |
$2,686.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,190.24
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,752.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,686.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,430.96
|
| Rate for Payer: Quartz Commercial |
$1,898.21
|
| Rate for Payer: Quartz Medicare Advantage |
$1,752.19
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Foot w/ Contrast Right
|
Professional
|
Both
|
$2,808.00
|
|
|
Service Code
|
CPT 73701 TC,RT
|
| Hospital Charge Code |
2980078
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$640.81 |
| Max. Negotiated Rate |
$2,774.30 |
| Rate for Payer: Aetna Commercial |
$2,774.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,511.48
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cash Price |
$842.40
|
| Rate for Payer: Cigna Commercial |
$2,774.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,460.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.19
|
| Rate for Payer: Health EOS Commercial |
$2,657.49
|
| Rate for Payer: HFN Commercial |
$2,774.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$640.81
|
| Rate for Payer: Multiplan Commercial |
$2,336.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,774.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,284.94
|
| Rate for Payer: Quartz Commercial |
$1,664.58
|
| Rate for Payer: The Alliance Commercial |
$1,460.16
|
| Rate for Payer: WEA Trust Commercial |
$1,606.18
|
| Rate for Payer: WPS Commercial |
$2,163.00
|
|
|
CT Foot w/ Contrast Right
|
Facility
|
OP
|
$2,868.00
|
|
|
Service Code
|
CPT 73701
|
| Hospital Charge Code |
629872
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$2,744.10 |
| Rate for Payer: Aetna Commercial |
$2,684.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,565.14
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,938.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,491.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,431.71
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,580.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cash Price |
$860.40
|
| Rate for Payer: Cigna Commercial |
$2,744.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,669.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,654.62
|
| Rate for Payer: HFN Commercial |
$2,744.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$2,386.18
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,744.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,461.53
|
| Rate for Payer: Quartz Commercial |
$1,938.77
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$1,640.50
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,209.22
|
|
|
CT Foot w/o Contrast Bilateral
|
Facility
|
IP
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 LT,TC
|
| Hospital Charge Code |
1241068
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,428.92 |
| Max. Negotiated Rate |
$2,682.87 |
| Rate for Payer: Aetna Commercial |
$2,624.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,545.56
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,682.87
|
| Rate for Payer: Health EOS Commercial |
$2,595.38
|
| Rate for Payer: HFN Commercial |
$2,682.87
|
| Rate for Payer: Multiplan Commercial |
$2,332.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,682.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,428.92
|
| Rate for Payer: Quartz Commercial |
$1,749.70
|
| Rate for Payer: WEA Trust Commercial |
$1,603.89
|
| Rate for Payer: WPS Commercial |
$2,159.92
|
|
|
CT Foot w/o Contrast Bilateral
|
Facility
|
OP
|
$5,171.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629874
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$4,947.61 |
| Rate for Payer: Aetna Commercial |
$4,840.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,495.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,688.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,581.36
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,850.26
|
| 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 |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$4,947.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,009.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$4,786.28
|
| Rate for Payer: HFN Commercial |
$4,947.61
|
| 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 |
$4,302.27
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$4,947.61
|
| Rate for Payer: Quartz Beloit One Network |
$2,635.14
|
| Rate for Payer: Quartz Commercial |
$3,495.60
|
| 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 |
$2,957.81
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$3,983.22
|
|
|
CT Foot w/o Contrast Bilateral
|
Professional
|
Both
|
$5,171.00
|
|
|
Service Code
|
CPT 73700
|
| Hospital Charge Code |
629874
|
| Min. Negotiated Rate |
$129.64 |
| Max. Negotiated Rate |
$5,108.95 |
| Rate for Payer: Aetna Commercial |
$5,108.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,624.94
|
| Rate for Payer: Aetna Managed Medicare |
$129.64
|
| Rate for Payer: Anthem Medicare Advantage |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.64
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cash Price |
$1,551.30
|
| Rate for Payer: Cigna Commercial |
$5,108.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,688.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.64
|
| Rate for Payer: Health EOS Commercial |
$4,893.83
|
| Rate for Payer: HFN Commercial |
$5,108.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.64
|
| Rate for Payer: Multiplan Commercial |
$4,302.27
|
| Rate for Payer: NAPHCARE Commercial |
$194.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,108.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.25
|
| Rate for Payer: Quartz Commercial |
$3,065.37
|
| Rate for Payer: Quartz Medicare Advantage |
$129.64
|
| Rate for Payer: The Alliance Commercial |
$492.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.64
|
| Rate for Payer: WEA Trust Commercial |
$2,957.81
|
| Rate for Payer: WPS Commercial |
$648.18
|
|
|
CT Foot w/o Contrast Bilateral
|
Professional
|
Both
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 LT,TC
|
| Hospital Charge Code |
1241068
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$494.80 |
| Max. Negotiated Rate |
$2,770.35 |
| Rate for Payer: Aetna Commercial |
$2,770.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,507.90
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cash Price |
$841.20
|
| Rate for Payer: Cigna Commercial |
$2,770.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,458.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,749.70
|
| Rate for Payer: Health EOS Commercial |
$2,653.71
|
| Rate for Payer: HFN Commercial |
$2,770.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$494.80
|
| Rate for Payer: Multiplan Commercial |
$2,332.93
|
| Rate for Payer: Preferred Network Access Commercial |
$2,770.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,283.11
|
| Rate for Payer: Quartz Commercial |
$1,662.21
|
| Rate for Payer: The Alliance Commercial |
$1,458.08
|
| Rate for Payer: WEA Trust Commercial |
$1,603.89
|
| Rate for Payer: WPS Commercial |
$2,159.92
|
|
