|
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
|
$3,773.00
|
|
|
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
|
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
|
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 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 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
|
|
|
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
|
IP
|
$3,632.00
|
|
|
Service Code
|
CPT 62304 TC
|
| Hospital Charge Code |
4558955
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,850.87 |
| Max. Negotiated Rate |
$3,475.10 |
| Rate for Payer: Aetna Commercial |
$3,399.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,248.46
|
| 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: Cigna Commercial |
$3,475.10
|
| Rate for Payer: Health EOS Commercial |
$3,361.78
|
| Rate for Payer: HFN Commercial |
$3,475.10
|
| Rate for Payer: Multiplan Commercial |
$3,021.82
|
| 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 |
$2,266.37
|
| Rate for Payer: WEA Trust Commercial |
$2,077.50
|
| Rate for Payer: WPS Commercial |
$2,797.73
|
|
|
CT Lumbar Spine Unenhanced
|
Facility
|
IP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
3072665
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,906.92 |
| Max. Negotiated Rate |
$3,580.35 |
| Rate for Payer: Aetna Commercial |
$3,502.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,346.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,062.59
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,580.35
|
| Rate for Payer: Health EOS Commercial |
$3,463.60
|
| Rate for Payer: HFN Commercial |
$3,580.35
|
| Rate for Payer: Multiplan Commercial |
$3,113.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,580.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,906.92
|
| Rate for Payer: Quartz Commercial |
$2,335.01
|
| Rate for Payer: WEA Trust Commercial |
$2,140.42
|
| Rate for Payer: WPS Commercial |
$2,882.46
|
|
|
CT Lumbar Spine Unenhanced
|
Professional
|
Both
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
3072665
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$82.97 |
| Max. Negotiated Rate |
$3,697.10 |
| Rate for Payer: Aetna Commercial |
$3,697.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,346.84
|
| Rate for Payer: Aetna Managed Medicare |
$82.97
|
| Rate for Payer: Anthem Medicare Advantage |
$82.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.97
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,697.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,945.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.97
|
| Rate for Payer: Health EOS Commercial |
$3,541.43
|
| Rate for Payer: HFN Commercial |
$3,697.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$321.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$321.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.97
|
| Rate for Payer: Multiplan Commercial |
$3,113.34
|
| Rate for Payer: NAPHCARE Commercial |
$124.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,697.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,712.34
|
| Rate for Payer: Quartz Commercial |
$2,218.26
|
| Rate for Payer: Quartz Medicare Advantage |
$82.97
|
| Rate for Payer: The Alliance Commercial |
$315.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.97
|
| Rate for Payer: WEA Trust Commercial |
$2,140.42
|
| Rate for Payer: WPS Commercial |
$414.86
|
|
|
CT Lumbar Spine Unenhanced
|
Facility
|
OP
|
$3,742.00
|
|
|
Service Code
|
CPT 72131 TC
|
| Hospital Charge Code |
3072665
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$331.88 |
| Max. Negotiated Rate |
$3,580.35 |
| Rate for Payer: Aetna Commercial |
$3,502.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,346.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,089.67
|
| 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 |
$2,062.59
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cash Price |
$1,122.60
|
| Rate for Payer: Cigna Commercial |
$3,580.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,177.84
|
| Rate for Payer: Health EOS Commercial |
$3,463.60
|
| Rate for Payer: HFN Commercial |
$3,580.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,918.76
|
| Rate for Payer: Multiplan Commercial |
$3,113.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,335.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,580.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,906.92
|
| Rate for Payer: Quartz Commercial |
$2,529.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,335.01
|
| Rate for Payer: The Alliance Commercial |
$331.88
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,140.42
|
| Rate for Payer: WPS Commercial |
$580.80
|
|
|
CT Lung Screening Follow Up 12 Months
|
Facility
|
OP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595330
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$986.00
|
| 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 |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.65
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,641.08
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,112.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,288.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,112.86
|
| Rate for Payer: The Alliance Commercial |
$344.28
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$602.49
|
|
|
CT Lung Screening Follow Up 12 Months
|
Facility
|
IP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595330
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,725.51 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,112.86
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Lung Screening Follow Up 12 Months
|
Professional
|
Both
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595330
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$86.07 |
| Max. Negotiated Rate |
$3,345.37 |
| Rate for Payer: Aetna Commercial |
$3,345.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$86.07
|
| Rate for Payer: Anthem Medicare Advantage |
$86.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.07
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,345.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,760.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.07
|
| Rate for Payer: Health EOS Commercial |
$3,204.51
|
| Rate for Payer: HFN Commercial |
$3,345.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$337.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$337.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.07
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$129.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,345.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,549.43
|
| Rate for Payer: Quartz Commercial |
$2,007.22
|
| Rate for Payer: Quartz Medicare Advantage |
$86.07
|
| Rate for Payer: The Alliance Commercial |
$327.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.07
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$430.35
|
|
|
CT Lung Screening Follow Up 3-6 Months
|
Facility
|
IP
|
$3,386.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5595333
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,725.51 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,112.86
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Lung Screening Follow Up 3-6 Months
|
Facility
|
OP
|
$3,386.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5595333
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$330.55 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$986.00
|
| 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 |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.65
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,641.08
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,112.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,288.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,112.86
|
| Rate for Payer: The Alliance Commercial |
$330.55
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$578.47
|
|
|
CT Lung Screening Follow Up 3-6 Months
|
Professional
|
Both
|
$3,386.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
5595333
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$82.64 |
| Max. Negotiated Rate |
$3,345.37 |
| Rate for Payer: Aetna Commercial |
$3,345.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$82.64
|
| Rate for Payer: Anthem Medicare Advantage |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.64
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,345.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,760.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$3,204.51
|
| Rate for Payer: HFN Commercial |
$3,345.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.64
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$123.96
|
| Rate for Payer: Preferred Network Access Commercial |
$3,345.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,549.43
|
| Rate for Payer: Quartz Commercial |
$2,007.22
|
| Rate for Payer: Quartz Medicare Advantage |
$82.64
|
| Rate for Payer: The Alliance Commercial |
$314.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.64
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$413.19
|
|
|
CT Lung Screening Low Dose Initial
|
Facility
|
OP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595336
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$344.28 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$986.00
|
| 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 |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.65
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,641.08
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,112.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,288.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,112.86
|
| Rate for Payer: The Alliance Commercial |
$344.28
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$602.49
|
|
|
CT Lung Screening Low Dose Initial
|
Facility
|
IP
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595336
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,725.51 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,112.86
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Lung Screening Low Dose Initial
|
Facility
|
IP
|
$3,386.00
|
|
| Hospital Charge Code |
5595337
|
| Min. Negotiated Rate |
$1,725.51 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,112.86
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Lung Screening Low Dose Initial
|
Facility
|
OP
|
$3,386.00
|
|
| Hospital Charge Code |
5595337
|
| Min. Negotiated Rate |
$986.00 |
| Max. Negotiated Rate |
$3,239.72 |
| Rate for Payer: Aetna Commercial |
$3,169.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$986.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,288.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,760.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,690.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,866.36
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,970.65
|
| Rate for Payer: Health EOS Commercial |
$3,134.08
|
| Rate for Payer: HFN Commercial |
$3,239.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,641.08
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,112.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,239.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.51
|
| Rate for Payer: Quartz Commercial |
$2,288.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,112.86
|
| Rate for Payer: The Alliance Commercial |
$1,760.72
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$2,608.24
|
|
|
CT Lung Screening Low Dose Initial
|
Professional
|
Both
|
$3,386.00
|
|
|
Service Code
|
CPT 71271 TC
|
| Hospital Charge Code |
5595336
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$86.07 |
| Max. Negotiated Rate |
$3,345.37 |
| Rate for Payer: Aetna Commercial |
$3,345.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,028.44
|
| Rate for Payer: Aetna Managed Medicare |
$86.07
|
| Rate for Payer: Anthem Medicare Advantage |
$86.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.07
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cash Price |
$1,015.80
|
| Rate for Payer: Cigna Commercial |
$3,345.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,760.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.07
|
| Rate for Payer: Health EOS Commercial |
$3,204.51
|
| Rate for Payer: HFN Commercial |
$3,345.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$337.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$337.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.07
|
| Rate for Payer: Multiplan Commercial |
$2,817.15
|
| Rate for Payer: NAPHCARE Commercial |
$129.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,345.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,549.43
|
| Rate for Payer: Quartz Commercial |
$2,007.22
|
| Rate for Payer: Quartz Medicare Advantage |
$86.07
|
| Rate for Payer: The Alliance Commercial |
$327.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.07
|
| Rate for Payer: WEA Trust Commercial |
$1,936.79
|
| Rate for Payer: WPS Commercial |
$430.35
|
|
|
CT Maxillofacial w/ Contrast
|
Facility
|
OP
|
$3,307.00
|
|
|
Service Code
|
CPT 70487 TC
|
| Hospital Charge Code |
1241202
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$394.87 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$3,095.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,957.78
|
| Rate for Payer: Aetna Managed Medicare |
$963.00
|
| 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 |
$1,822.82
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cash Price |
$992.10
|
| Rate for Payer: Cigna Commercial |
$3,164.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,924.67
|
| Rate for Payer: Health EOS Commercial |
$3,060.96
|
| Rate for Payer: HFN Commercial |
$3,164.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,579.46
|
| Rate for Payer: Multiplan Commercial |
$2,751.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,063.57
|
| Rate for Payer: Preferred Network Access Commercial |
$3,164.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,685.25
|
| Rate for Payer: Quartz Commercial |
$2,235.53
|
| Rate for Payer: Quartz Medicare Advantage |
$2,063.57
|
| Rate for Payer: The Alliance Commercial |
$394.87
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,891.60
|
| Rate for Payer: WPS Commercial |
$691.02
|
|
|
CT Maxillofacial w/ Contrast
|
Facility
|
OP
|
$3,148.00
|
|
|
Service Code
|
CPT 70487
|
| Hospital Charge Code |
630090
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,012.01 |
| Rate for Payer: Aetna Commercial |
$2,946.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,815.57
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,636.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,571.48
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,735.18
|
| 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 |
$944.40
|
| Rate for Payer: Cash Price |
$944.40
|
| Rate for Payer: Cigna Commercial |
$3,012.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,832.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$2,913.79
|
| Rate for Payer: HFN Commercial |
$3,012.01
|
| 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 |
$2,619.14
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,012.01
|
| Rate for Payer: Quartz Beloit One Network |
$1,604.22
|
| Rate for Payer: Quartz Commercial |
$2,128.05
|
| 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 |
$1,800.66
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,424.90
|
|
