|
CT TMJ w/o Contrast Right
|
Facility
|
IP
|
$2,760.00
|
|
|
Service Code
|
CPT 70486 RT,TC
|
| Hospital Charge Code |
1241332
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,406.50 |
| Max. Negotiated Rate |
$2,640.77 |
| Rate for Payer: Aetna Commercial |
$2,583.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.31
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$2,640.77
|
| Rate for Payer: Health EOS Commercial |
$2,554.66
|
| Rate for Payer: HFN Commercial |
$2,640.77
|
| Rate for Payer: Multiplan Commercial |
$2,296.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.50
|
| Rate for Payer: Quartz Commercial |
$1,722.24
|
| Rate for Payer: WEA Trust Commercial |
$1,578.72
|
| Rate for Payer: WPS Commercial |
$2,126.03
|
|
|
CT TMJ w/o Contrast Right
|
Facility
|
OP
|
$2,760.00
|
|
|
Service Code
|
CPT 70486 TC,RT
|
| Hospital Charge Code |
2979987
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$803.71 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,583.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.54
|
| Rate for Payer: Aetna Managed Medicare |
$803.71
|
| 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 |
$1,521.31
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$2,640.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,606.32
|
| Rate for Payer: Health EOS Commercial |
$2,554.66
|
| Rate for Payer: HFN Commercial |
$2,640.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$2,296.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,722.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.50
|
| Rate for Payer: Quartz Commercial |
$1,865.76
|
| Rate for Payer: Quartz Medicare Advantage |
$1,722.24
|
| Rate for Payer: The Alliance Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,578.72
|
| Rate for Payer: WPS Commercial |
$2,126.03
|
|
|
CT TMJ w/o Contrast Right
|
Facility
|
IP
|
$2,760.00
|
|
|
Service Code
|
CPT 70486 TC,RT
|
| Hospital Charge Code |
2979987
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,406.50 |
| Max. Negotiated Rate |
$2,640.77 |
| Rate for Payer: Aetna Commercial |
$2,583.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,521.31
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$2,640.77
|
| Rate for Payer: Health EOS Commercial |
$2,554.66
|
| Rate for Payer: HFN Commercial |
$2,640.77
|
| Rate for Payer: Multiplan Commercial |
$2,296.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.50
|
| Rate for Payer: Quartz Commercial |
$1,722.24
|
| Rate for Payer: WEA Trust Commercial |
$1,578.72
|
| Rate for Payer: WPS Commercial |
$2,126.03
|
|
|
CT TMJ w/o Contrast Right
|
Professional
|
Both
|
$2,760.00
|
|
|
Service Code
|
CPT 70486 TC,RT
|
| Hospital Charge Code |
2979987
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$488.49 |
| Max. Negotiated Rate |
$2,726.88 |
| Rate for Payer: Aetna Commercial |
$2,726.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.54
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$2,726.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,435.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,722.24
|
| Rate for Payer: Health EOS Commercial |
$2,612.06
|
| Rate for Payer: HFN Commercial |
$2,726.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$488.49
|
| Rate for Payer: Multiplan Commercial |
$2,296.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,726.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,262.98
|
| Rate for Payer: Quartz Commercial |
$1,636.13
|
| Rate for Payer: The Alliance Commercial |
$1,435.20
|
| Rate for Payer: WEA Trust Commercial |
$1,578.72
|
| Rate for Payer: WPS Commercial |
$2,126.03
|
|
|
CT TMJ w/o Contrast Right
|
Facility
|
OP
|
$2,760.00
|
|
|
Service Code
|
CPT 70486 RT,TC
|
| Hospital Charge Code |
1241332
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$803.71 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$2,583.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,468.54
|
| Rate for Payer: Aetna Managed Medicare |
$803.71
|
| 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 |
$1,521.31
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cash Price |
$828.00
|
| Rate for Payer: Cigna Commercial |
$2,640.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,606.32
|
| Rate for Payer: Health EOS Commercial |
$2,554.66
|
| Rate for Payer: HFN Commercial |
$2,640.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,152.80
|
| Rate for Payer: Multiplan Commercial |
$2,296.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,722.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,640.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,406.50
|
| Rate for Payer: Quartz Commercial |
$1,865.76
|
| Rate for Payer: Quartz Medicare Advantage |
$1,722.24
|
| Rate for Payer: The Alliance Commercial |
$1,435.20
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,578.72
|
| Rate for Payer: WPS Commercial |
$2,126.03
|
|
|
CT TMJ w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241308
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,108.89 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,108.89
|
| 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 |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,216.26
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,970.24
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,376.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,574.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2,376.19
|
| Rate for Payer: The Alliance Commercial |
$1,980.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$7,766.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711755
|
| Min. Negotiated Rate |
$3,957.55 |
| Max. Negotiated Rate |
$7,430.51 |
| Rate for Payer: Aetna Commercial |
$7,268.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,945.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,280.62
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$7,430.51
|
| Rate for Payer: Health EOS Commercial |
$7,188.21
|
| Rate for Payer: HFN Commercial |
$7,430.51
|
| Rate for Payer: Multiplan Commercial |
$6,461.31
|
| Rate for Payer: Preferred Network Access Commercial |
$7,430.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,957.55
|
| Rate for Payer: Quartz Commercial |
$4,845.98
|
| Rate for Payer: WEA Trust Commercial |
$4,442.15
|
| Rate for Payer: WPS Commercial |
$5,982.15
|
|
|
CT TMJ w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$7,766.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711755
|
| Min. Negotiated Rate |
$183.13 |
| Max. Negotiated Rate |
$7,672.81 |
| Rate for Payer: Aetna Commercial |
$7,672.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,945.91
|
| Rate for Payer: Aetna Managed Medicare |
$183.13
|
| Rate for Payer: Anthem Medicare Advantage |
$183.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$183.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$183.13
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$7,672.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,038.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.13
|
| Rate for Payer: Health EOS Commercial |
$7,349.74
|
| Rate for Payer: HFN Commercial |
$7,672.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$715.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$183.13
|
| Rate for Payer: Multiplan Commercial |
$6,461.31
|
| Rate for Payer: NAPHCARE Commercial |
$274.70
|
| Rate for Payer: Preferred Network Access Commercial |
$7,672.81
|
| Rate for Payer: Quartz Beloit One Network |
$3,553.72
|
| Rate for Payer: Quartz Commercial |
$4,603.68
|
| Rate for Payer: Quartz Medicare Advantage |
$183.13
|
| Rate for Payer: The Alliance Commercial |
$695.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$183.13
|
| Rate for Payer: WEA Trust Commercial |
$4,442.15
|
| Rate for Payer: WPS Commercial |
$915.67
|
|
|
CT TMJ w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241308
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,940.56 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,376.19
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241308
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$715.22 |
| Max. Negotiated Rate |
$3,762.30 |
| Rate for Payer: Aetna Commercial |
$3,762.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,762.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,980.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,376.19
|
| Rate for Payer: Health EOS Commercial |
$3,603.89
|
| Rate for Payer: HFN Commercial |
$3,762.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$715.22
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,762.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,742.54
|
| Rate for Payer: Quartz Commercial |
$2,257.38
|
| Rate for Payer: The Alliance Commercial |
$1,980.16
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$7,766.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711755
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$7,430.51 |
| Rate for Payer: Aetna Commercial |
$7,268.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,945.91
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,249.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,038.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,876.79
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,280.62
|
| 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 |
$2,329.80
|
| Rate for Payer: Cash Price |
$2,329.80
|
| Rate for Payer: Cigna Commercial |
$7,430.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,519.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$7,188.21
|
| Rate for Payer: HFN Commercial |
$7,430.51
|
| 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 |
$6,461.31
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$7,430.51
|
| Rate for Payer: Quartz Beloit One Network |
$3,957.55
|
| Rate for Payer: Quartz Commercial |
$5,249.82
|
| 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 |
$4,442.15
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$5,982.15
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Facility
|
IP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241311
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,940.56 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,376.19
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Facility
|
OP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241311
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,108.89 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,108.89
|
| 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 |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,216.26
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,970.24
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,376.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,574.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2,376.19
|
| Rate for Payer: The Alliance Commercial |
$1,980.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Professional
|
Both
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711756
|
| Min. Negotiated Rate |
$183.13 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,836.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$183.13
|
| Rate for Payer: Anthem Medicare Advantage |
$183.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$183.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$183.13
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,019.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.13
|
| Rate for Payer: Health EOS Commercial |
$3,674.87
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$715.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$183.13
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$274.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,776.86
|
| Rate for Payer: Quartz Commercial |
$2,301.84
|
| Rate for Payer: Quartz Medicare Advantage |
$183.13
|
| Rate for Payer: The Alliance Commercial |
$695.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$183.13
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$915.67
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Professional
|
Both
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 LT,TC
|
| Hospital Charge Code |
1241311
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$715.22 |
| Max. Negotiated Rate |
$3,762.30 |
| Rate for Payer: Aetna Commercial |
$3,762.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,762.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,980.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,376.19
|
| Rate for Payer: Health EOS Commercial |
$3,603.89
|
| Rate for Payer: HFN Commercial |
$3,762.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$715.22
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,762.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,742.54
|
| Rate for Payer: Quartz Commercial |
$2,257.38
|
| Rate for Payer: The Alliance Commercial |
$1,980.16
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711756
|
| Min. Negotiated Rate |
$1,978.78 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,422.99
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
CT TMJ w/ + w/o Contrast Left
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711756
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,624.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,019.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,938.39
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| 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 |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,259.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| 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 |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,624.91
|
| 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 |
$2,221.08
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
|
OP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711752
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,624.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,019.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,938.39
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| 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 |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,259.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| 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 |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,624.91
|
| 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 |
$2,221.08
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
|
IP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 RT,TC
|
| Hospital Charge Code |
1241314
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,940.56 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,376.19
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Professional
|
Both
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 RT,TC
|
| Hospital Charge Code |
1241314
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$715.22 |
| Max. Negotiated Rate |
$3,762.30 |
| Rate for Payer: Aetna Commercial |
$3,762.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,762.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,980.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,376.19
|
| Rate for Payer: Health EOS Commercial |
$3,603.89
|
| Rate for Payer: HFN Commercial |
$3,762.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$715.22
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,762.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,742.54
|
| Rate for Payer: Quartz Commercial |
$2,257.38
|
| Rate for Payer: The Alliance Commercial |
$1,980.16
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
|
OP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 RT,TC
|
| Hospital Charge Code |
1241314
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,108.89 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,108.89
|
| 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 |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,216.26
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,970.24
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,376.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,574.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2,376.19
|
| Rate for Payer: The Alliance Commercial |
$1,980.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Professional
|
Both
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 TC,RT
|
| Hospital Charge Code |
2979989
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$715.22 |
| Max. Negotiated Rate |
$3,762.30 |
| Rate for Payer: Aetna Commercial |
$3,762.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,762.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,980.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,376.19
|
| Rate for Payer: Health EOS Commercial |
$3,603.89
|
| Rate for Payer: HFN Commercial |
$3,762.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$715.22
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,762.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,742.54
|
| Rate for Payer: Quartz Commercial |
$2,257.38
|
| Rate for Payer: The Alliance Commercial |
$1,980.16
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
|
OP
|
$3,808.00
|
|
|
Service Code
|
CPT 70488 TC,RT
|
| Hospital Charge Code |
2979989
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,108.89 |
| Max. Negotiated Rate |
$3,643.49 |
| Rate for Payer: Aetna Commercial |
$3,564.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,405.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,108.89
|
| 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 |
$2,098.97
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cash Price |
$1,142.40
|
| Rate for Payer: Cigna Commercial |
$3,643.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,216.26
|
| Rate for Payer: Health EOS Commercial |
$3,524.68
|
| Rate for Payer: HFN Commercial |
$3,643.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,970.24
|
| Rate for Payer: Multiplan Commercial |
$3,168.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,376.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,643.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,940.56
|
| Rate for Payer: Quartz Commercial |
$2,574.21
|
| Rate for Payer: Quartz Medicare Advantage |
$2,376.19
|
| Rate for Payer: The Alliance Commercial |
$1,980.16
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$2,178.18
|
| Rate for Payer: WPS Commercial |
$2,933.30
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Facility
|
IP
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711752
|
| Min. Negotiated Rate |
$1,978.78 |
| Max. Negotiated Rate |
$3,715.25 |
| Rate for Payer: Aetna Commercial |
$3,634.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,140.31
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,715.25
|
| Rate for Payer: Health EOS Commercial |
$3,594.10
|
| Rate for Payer: HFN Commercial |
$3,715.25
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,715.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,978.78
|
| Rate for Payer: Quartz Commercial |
$2,422.99
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$2,991.07
|
|
|
CT TMJ w/ + w/o Contrast Right
|
Professional
|
Both
|
$3,883.00
|
|
|
Service Code
|
CPT 70488
|
| Hospital Charge Code |
711752
|
| Min. Negotiated Rate |
$183.13 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,836.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,472.96
|
| Rate for Payer: Aetna Managed Medicare |
$183.13
|
| Rate for Payer: Anthem Medicare Advantage |
$183.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$183.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$183.13
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cash Price |
$1,164.90
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,019.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.13
|
| Rate for Payer: Health EOS Commercial |
$3,674.87
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$715.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$183.13
|
| Rate for Payer: Multiplan Commercial |
$3,230.66
|
| Rate for Payer: NAPHCARE Commercial |
$274.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,776.86
|
| Rate for Payer: Quartz Commercial |
$2,301.84
|
| Rate for Payer: Quartz Medicare Advantage |
$183.13
|
| Rate for Payer: The Alliance Commercial |
$695.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$183.13
|
| Rate for Payer: WEA Trust Commercial |
$2,221.08
|
| Rate for Payer: WPS Commercial |
$915.67
|
|
