|
CT Lower Extremity w/o Contrast Right
|
Professional
|
Both
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 RT,TC
|
| Hospital Charge Code |
1241198
|
|
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
|
|
|
CT Lower Extremity w/o Contrast Right
|
Facility
|
IP
|
$2,804.00
|
|
|
Service Code
|
CPT 73700 TC,RT
|
| Hospital Charge Code |
2980074
|
|
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 Lower Extremity w/+w/o Contrast Bilat
|
Facility
|
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241188
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,922.72 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,354.35
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Bilat
|
Facility
|
OP
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630060
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$7,357.79 |
| Rate for Payer: Aetna Commercial |
$7,197.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,877.94
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,198.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,998.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,838.85
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,238.73
|
| 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 |
$2,307.00
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,357.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,475.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$7,117.86
|
| Rate for Payer: HFN Commercial |
$7,357.79
|
| 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 |
$6,398.08
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$7,357.79
|
| Rate for Payer: Quartz Beloit One Network |
$3,918.82
|
| Rate for Payer: Quartz Commercial |
$5,198.44
|
| 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 |
$4,398.68
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$5,923.61
|
|
|
CT Lower Extremity w/+w/o Contrast Bilat
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241188
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Bilat
|
Facility
|
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241188
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.70
|
| 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 |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.89
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,942.94
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,354.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,550.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,354.35
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Bilat
|
Facility
|
IP
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630060
|
| Min. Negotiated Rate |
$3,918.82 |
| Max. Negotiated Rate |
$7,357.79 |
| Rate for Payer: Aetna Commercial |
$7,197.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,877.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,238.73
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,357.79
|
| Rate for Payer: Health EOS Commercial |
$7,117.86
|
| Rate for Payer: HFN Commercial |
$7,357.79
|
| Rate for Payer: Multiplan Commercial |
$6,398.08
|
| Rate for Payer: Preferred Network Access Commercial |
$7,357.79
|
| Rate for Payer: Quartz Beloit One Network |
$3,918.82
|
| Rate for Payer: Quartz Commercial |
$4,798.56
|
| Rate for Payer: WEA Trust Commercial |
$4,398.68
|
| Rate for Payer: WPS Commercial |
$5,923.61
|
|
|
CT Lower Extremity w/+w/o Contrast Bilat
|
Professional
|
Both
|
$7,690.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630060
|
| Min. Negotiated Rate |
$193.71 |
| Max. Negotiated Rate |
$7,597.72 |
| Rate for Payer: Aetna Commercial |
$7,597.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,877.94
|
| Rate for Payer: Aetna Managed Medicare |
$193.71
|
| Rate for Payer: Anthem Medicare Advantage |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.71
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cash Price |
$2,307.00
|
| Rate for Payer: Cigna Commercial |
$7,597.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,998.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.71
|
| Rate for Payer: Health EOS Commercial |
$7,277.82
|
| Rate for Payer: HFN Commercial |
$7,597.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.71
|
| Rate for Payer: Multiplan Commercial |
$6,398.08
|
| Rate for Payer: NAPHCARE Commercial |
$290.57
|
| Rate for Payer: Preferred Network Access Commercial |
$7,597.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,518.94
|
| Rate for Payer: Quartz Commercial |
$4,558.63
|
| Rate for Payer: Quartz Medicare Advantage |
$193.71
|
| Rate for Payer: The Alliance Commercial |
$736.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.71
|
| Rate for Payer: WEA Trust Commercial |
$4,398.68
|
| Rate for Payer: WPS Commercial |
$968.55
|
|
|
CT Lower Extremity w/+w/o Contrast Left
|
Facility
|
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630062
|
| Min. Negotiated Rate |
$1,959.41 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,399.28
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Lower Extremity w/+w/o Contrast Left
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241190
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Left
|
Facility
|
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241190
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,922.72 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,354.35
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Left
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630062
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,599.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,999.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,919.42
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| 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 |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,237.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| 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 |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,599.22
|
| 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 |
$2,199.34
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Lower Extremity w/+w/o Contrast Left
|
Professional
|
Both
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630062
|
| Min. Negotiated Rate |
$193.71 |
| Max. Negotiated Rate |
$3,798.86 |
| Rate for Payer: Aetna Commercial |
$3,798.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$193.71
|
| Rate for Payer: Anthem Medicare Advantage |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.71
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,798.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,999.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.71
|
| Rate for Payer: Health EOS Commercial |
$3,638.91
|
| Rate for Payer: HFN Commercial |
$3,798.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.71
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$290.57
|
| Rate for Payer: Preferred Network Access Commercial |
$3,798.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,759.47
|
| Rate for Payer: Quartz Commercial |
$2,279.32
|
| Rate for Payer: Quartz Medicare Advantage |
$193.71
|
| Rate for Payer: The Alliance Commercial |
$736.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.71
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$968.55
|
|
|
CT Lower Extremity w/+w/o Contrast Left
|
Facility
|
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 LT,TC
|
| Hospital Charge Code |
1241190
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.70
|
| 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 |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.89
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,942.94
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,354.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,550.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,354.35
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Right
|
Facility
|
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980088
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.70
|
| 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 |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.89
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,942.94
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,354.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,550.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,354.35
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Right
|
Facility
|
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241192
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,922.72 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,354.35
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Right
|
Facility
|
IP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630064
|
| Min. Negotiated Rate |
$1,959.41 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,399.28
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Lower Extremity w/+w/o Contrast Right
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241192
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Right
|
Facility
|
OP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 RT,TC
|
| Hospital Charge Code |
1241192
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,098.70 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,098.70
|
| 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 |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,195.89
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,942.94
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,354.35
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,550.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,354.35
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Right
|
Professional
|
Both
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630064
|
| Min. Negotiated Rate |
$193.71 |
| Max. Negotiated Rate |
$3,798.86 |
| Rate for Payer: Aetna Commercial |
$3,798.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$193.71
|
| Rate for Payer: Anthem Medicare Advantage |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.71
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,798.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,999.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.71
|
| Rate for Payer: Health EOS Commercial |
$3,638.91
|
| Rate for Payer: HFN Commercial |
$3,798.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.71
|
| Rate for Payer: Multiplan Commercial |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$290.57
|
| Rate for Payer: Preferred Network Access Commercial |
$3,798.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,759.47
|
| Rate for Payer: Quartz Commercial |
$2,279.32
|
| Rate for Payer: Quartz Medicare Advantage |
$193.71
|
| Rate for Payer: The Alliance Commercial |
$736.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.71
|
| Rate for Payer: WEA Trust Commercial |
$2,199.34
|
| Rate for Payer: WPS Commercial |
$968.55
|
|
|
CT Lower Extremity w/+w/o Contrast Right
|
Professional
|
Both
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980088
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$747.42 |
| Max. Negotiated Rate |
$3,727.72 |
| Rate for Payer: Aetna Commercial |
$3,727.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,727.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,354.35
|
| Rate for Payer: Health EOS Commercial |
$3,570.77
|
| Rate for Payer: HFN Commercial |
$3,727.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$747.42
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,727.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,726.52
|
| Rate for Payer: Quartz Commercial |
$2,236.63
|
| Rate for Payer: The Alliance Commercial |
$1,961.96
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Right
|
Facility
|
IP
|
$3,773.00
|
|
|
Service Code
|
CPT 73702 TC,RT
|
| Hospital Charge Code |
2980088
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,922.72 |
| Max. Negotiated Rate |
$3,610.01 |
| Rate for Payer: Aetna Commercial |
$3,531.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,374.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,079.68
|
| Rate for Payer: Cash Price |
$1,131.90
|
| Rate for Payer: Cigna Commercial |
$3,610.01
|
| Rate for Payer: Health EOS Commercial |
$3,492.29
|
| Rate for Payer: HFN Commercial |
$3,610.01
|
| Rate for Payer: Multiplan Commercial |
$3,139.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,610.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,922.72
|
| Rate for Payer: Quartz Commercial |
$2,354.35
|
| Rate for Payer: WEA Trust Commercial |
$2,158.16
|
| Rate for Payer: WPS Commercial |
$2,906.34
|
|
|
CT Lower Extremity w/+w/o Contrast Right
|
Facility
|
OP
|
$3,845.00
|
|
|
Service Code
|
CPT 73702
|
| Hospital Charge Code |
630064
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,678.90 |
| Rate for Payer: Aetna Commercial |
$3,598.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,438.97
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,599.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,999.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,919.42
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.36
|
| 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 |
$1,153.50
|
| Rate for Payer: Cash Price |
$1,153.50
|
| Rate for Payer: Cigna Commercial |
$3,678.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,237.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,558.93
|
| Rate for Payer: HFN Commercial |
$3,678.90
|
| 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 |
$3,199.04
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,678.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.41
|
| Rate for Payer: Quartz Commercial |
$2,599.22
|
| 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 |
$2,199.34
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,961.80
|
|
|
CT Lumbar Myelography via Lumbar Inj
|
Professional
|
Both
|
$3,632.00
|
|
|
Service Code
|
CPT 62304 TC
|
| Hospital Charge Code |
4558955
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$193.51 |
| Max. Negotiated Rate |
$3,588.42 |
| Rate for Payer: Aetna Commercial |
$3,588.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,248.46
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cigna Commercial |
$3,588.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,266.37
|
| Rate for Payer: Health EOS Commercial |
$3,437.32
|
| Rate for Payer: HFN Commercial |
$3,588.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$415.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$415.28
|
| Rate for Payer: Multiplan Commercial |
$3,021.82
|
| Rate for Payer: Preferred Network Access Commercial |
$3,588.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,662.00
|
| Rate for Payer: Quartz Commercial |
$2,153.05
|
| Rate for Payer: The Alliance Commercial |
$1,888.64
|
| Rate for Payer: United Healthcare Medicaid |
$193.51
|
| Rate for Payer: WEA Trust Commercial |
$2,077.50
|
| Rate for Payer: WPS Commercial |
$2,797.73
|
|
|
CT Lumbar Myelography via Lumbar Inj
|
Facility
|
OP
|
$3,632.00
|
|
|
Service Code
|
CPT 62304 TC
|
| Hospital Charge Code |
4558955
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,057.64 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$3,399.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,248.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,057.64
|
| 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 |
$2,001.96
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cash Price |
$1,089.60
|
| Rate for Payer: Cigna Commercial |
$3,475.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$3,361.78
|
| Rate for Payer: HFN Commercial |
$3,475.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,832.96
|
| Rate for Payer: Multiplan Commercial |
$3,021.82
|
| Rate for Payer: NAPHCARE Commercial |
$2,266.37
|
| Rate for Payer: Preferred Network Access Commercial |
$3,475.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,850.87
|
| Rate for Payer: Quartz Commercial |
$2,455.23
|
| Rate for Payer: Quartz Medicare Advantage |
$2,266.37
|
| Rate for Payer: The Alliance Commercial |
$1,888.64
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,077.50
|
| Rate for Payer: WPS Commercial |
$2,797.73
|
|
