|
MA Dig Diag Unilateral Right
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 77065 TC,RT
|
| Hospital Charge Code |
5478932
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$306.38
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
MA Dig Diag Unilateral Right
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 77065 TC,RT
|
| Hospital Charge Code |
5478932
|
|
Hospital Revenue Code
|
401
|
| Min. Negotiated Rate |
$142.98 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Aetna Managed Medicare |
$142.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.76
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.98
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: NAPHCARE Commercial |
$306.38
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$331.92
|
| Rate for Payer: Quartz Medicare Advantage |
$306.38
|
| Rate for Payer: The Alliance Commercial |
$255.32
|
| Rate for Payer: United Healthcare PPO |
$382.98
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
MA Dig Screen Bilateral
|
Professional
|
Both
|
$410.00
|
|
|
Service Code
|
CPT 77067 TC
|
| Hospital Charge Code |
5478933
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$90.63 |
| Max. Negotiated Rate |
$453.13 |
| Rate for Payer: Aetna Commercial |
$405.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Aetna Managed Medicare |
$90.63
|
| Rate for Payer: Anthem Medicare Advantage |
$90.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$90.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$90.63
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$405.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$213.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.63
|
| Rate for Payer: Health EOS Commercial |
$388.02
|
| Rate for Payer: HFN Commercial |
$405.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$333.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$90.63
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: NAPHCARE Commercial |
$135.94
|
| Rate for Payer: Preferred Network Access Commercial |
$405.08
|
| Rate for Payer: Quartz Beloit One Network |
$187.62
|
| Rate for Payer: Quartz Commercial |
$243.05
|
| Rate for Payer: Quartz Medicare Advantage |
$90.63
|
| Rate for Payer: The Alliance Commercial |
$344.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.63
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$453.13
|
|
|
MA Dig Screen Bilateral
|
Facility
|
OP
|
$410.00
|
|
|
Service Code
|
CPT 77067 TC
|
| Hospital Charge Code |
5478933
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Aetna Managed Medicare |
$119.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.62
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.80
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: NAPHCARE Commercial |
$255.84
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$277.16
|
| Rate for Payer: Quartz Medicare Advantage |
$255.84
|
| Rate for Payer: The Alliance Commercial |
$362.50
|
| Rate for Payer: United Healthcare PPO |
$319.80
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
MA Dig Screen Bilateral
|
Facility
|
IP
|
$410.00
|
|
|
Service Code
|
CPT 77067 TC
|
| Hospital Charge Code |
5478933
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$208.94 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$255.84
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
MA Dig Screen Unilateral Left
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
CPT 77067 TC,LT
|
| Hospital Charge Code |
5478934
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$473.62 |
| Rate for Payer: Aetna Commercial |
$463.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.73
|
| Rate for Payer: Aetna Managed Medicare |
$144.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.84
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$473.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.09
|
| Rate for Payer: Health EOS Commercial |
$458.17
|
| Rate for Payer: HFN Commercial |
$473.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$386.10
|
| Rate for Payer: Multiplan Commercial |
$411.84
|
| Rate for Payer: NAPHCARE Commercial |
$308.88
|
| Rate for Payer: Preferred Network Access Commercial |
$473.62
|
| Rate for Payer: Quartz Beloit One Network |
$252.25
|
| Rate for Payer: Quartz Commercial |
$334.62
|
| Rate for Payer: Quartz Medicare Advantage |
$308.88
|
| Rate for Payer: The Alliance Commercial |
$257.40
|
| Rate for Payer: United Healthcare PPO |
$386.10
|
| Rate for Payer: WEA Trust Commercial |
$283.14
|
| Rate for Payer: WPS Commercial |
$381.30
|
|
|
MA Dig Screen Unilateral Left
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
CPT 77067 TC,LT
|
| Hospital Charge Code |
5478934
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$473.62 |
| Rate for Payer: Aetna Commercial |
$463.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.84
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$473.62
|
| Rate for Payer: Health EOS Commercial |
$458.17
|
| Rate for Payer: HFN Commercial |
$473.62
|
| Rate for Payer: Multiplan Commercial |
$411.84
|
| Rate for Payer: Preferred Network Access Commercial |
$473.62
|
| Rate for Payer: Quartz Beloit One Network |
$252.25
|
| Rate for Payer: Quartz Commercial |
$308.88
|
| Rate for Payer: WEA Trust Commercial |
$283.14
|
| Rate for Payer: WPS Commercial |
$381.30
|
|
|
MA Dig Screen Unilateral Left
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
CPT 77067 TC,LT
|
| Hospital Charge Code |
5478934
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$226.51 |
| Max. Negotiated Rate |
$489.06 |
| Rate for Payer: Aetna Commercial |
$489.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.73
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$489.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$257.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.88
|
| Rate for Payer: Health EOS Commercial |
$468.47
|
| Rate for Payer: HFN Commercial |
$489.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$466.10
|
| Rate for Payer: Multiplan Commercial |
$411.84
|
| Rate for Payer: Preferred Network Access Commercial |
$489.06
|
| Rate for Payer: Quartz Beloit One Network |
$226.51
|
| Rate for Payer: Quartz Commercial |
$293.44
|
| Rate for Payer: The Alliance Commercial |
$257.40
|
| Rate for Payer: WEA Trust Commercial |
$283.14
|
| Rate for Payer: WPS Commercial |
$381.30
|
|
|
MA Dig Screen Unilateral Right
|
Professional
|
Both
|
$495.00
|
|
|
Service Code
|
CPT 77067 TC,RT
|
| Hospital Charge Code |
5478935
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$226.51 |
| Max. Negotiated Rate |
$489.06 |
| Rate for Payer: Aetna Commercial |
$489.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.73
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$489.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$257.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.88
|
| Rate for Payer: Health EOS Commercial |
$468.47
|
| Rate for Payer: HFN Commercial |
$489.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$466.10
|
| Rate for Payer: Multiplan Commercial |
$411.84
|
| Rate for Payer: Preferred Network Access Commercial |
$489.06
|
| Rate for Payer: Quartz Beloit One Network |
$226.51
|
| Rate for Payer: Quartz Commercial |
$293.44
|
| Rate for Payer: The Alliance Commercial |
$257.40
|
| Rate for Payer: WEA Trust Commercial |
$283.14
|
| Rate for Payer: WPS Commercial |
$381.30
|
|
|
MA Dig Screen Unilateral Right
|
Facility
|
IP
|
$495.00
|
|
|
Service Code
|
CPT 77067 TC,RT
|
| Hospital Charge Code |
5478935
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$252.25 |
| Max. Negotiated Rate |
$473.62 |
| Rate for Payer: Aetna Commercial |
$463.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.84
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$473.62
|
| Rate for Payer: Health EOS Commercial |
$458.17
|
| Rate for Payer: HFN Commercial |
$473.62
|
| Rate for Payer: Multiplan Commercial |
$411.84
|
| Rate for Payer: Preferred Network Access Commercial |
$473.62
|
| Rate for Payer: Quartz Beloit One Network |
$252.25
|
| Rate for Payer: Quartz Commercial |
$308.88
|
| Rate for Payer: WEA Trust Commercial |
$283.14
|
| Rate for Payer: WPS Commercial |
$381.30
|
|
|
MA Dig Screen Unilateral Right
|
Facility
|
OP
|
$495.00
|
|
|
Service Code
|
CPT 77067 TC,RT
|
| Hospital Charge Code |
5478935
|
|
Hospital Revenue Code
|
403
|
| Min. Negotiated Rate |
$144.14 |
| Max. Negotiated Rate |
$473.62 |
| Rate for Payer: Aetna Commercial |
$463.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.73
|
| Rate for Payer: Aetna Managed Medicare |
$144.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.84
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cash Price |
$148.50
|
| Rate for Payer: Cigna Commercial |
$473.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.09
|
| Rate for Payer: Health EOS Commercial |
$458.17
|
| Rate for Payer: HFN Commercial |
$473.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$386.10
|
| Rate for Payer: Multiplan Commercial |
$411.84
|
| Rate for Payer: NAPHCARE Commercial |
$308.88
|
| Rate for Payer: Preferred Network Access Commercial |
$473.62
|
| Rate for Payer: Quartz Beloit One Network |
$252.25
|
| Rate for Payer: Quartz Commercial |
$334.62
|
| Rate for Payer: Quartz Medicare Advantage |
$308.88
|
| Rate for Payer: The Alliance Commercial |
$257.40
|
| Rate for Payer: United Healthcare PPO |
$386.10
|
| Rate for Payer: WEA Trust Commercial |
$283.14
|
| Rate for Payer: WPS Commercial |
$381.30
|
|
|
MA Ductogram Or Galactogram Multi Left
|
Facility
|
IP
|
$1,910.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
3072687
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$973.34 |
| Max. Negotiated Rate |
$1,827.49 |
| Rate for Payer: Aetna Commercial |
$1,787.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,708.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.79
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$1,827.49
|
| Rate for Payer: Health EOS Commercial |
$1,767.90
|
| Rate for Payer: HFN Commercial |
$1,827.49
|
| Rate for Payer: Multiplan Commercial |
$1,589.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.49
|
| Rate for Payer: Quartz Beloit One Network |
$973.34
|
| Rate for Payer: Quartz Commercial |
$1,191.84
|
| Rate for Payer: WEA Trust Commercial |
$1,092.52
|
| Rate for Payer: WPS Commercial |
$1,471.27
|
|
|
MA Ductogram Or Galactogram Multi Left
|
Facility
|
OP
|
$1,910.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
3072687
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,827.49 |
| Rate for Payer: Aetna Commercial |
$1,787.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,708.30
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$1,827.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,111.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$1,767.90
|
| Rate for Payer: HFN Commercial |
$1,827.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$1,589.12
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.49
|
| Rate for Payer: Quartz Beloit One Network |
$973.34
|
| Rate for Payer: Quartz Commercial |
$1,291.16
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,092.52
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,471.27
|
|
|
MA Ductogram Or Galactogram Multi Left
|
Professional
|
Both
|
$1,910.00
|
|
|
Service Code
|
CPT 77054
|
| Hospital Charge Code |
3072687
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$67.95 |
| Max. Negotiated Rate |
$1,887.08 |
| Rate for Payer: Aetna Commercial |
$1,887.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,708.30
|
| Rate for Payer: Aetna Managed Medicare |
$67.95
|
| Rate for Payer: Anthem Medicare Advantage |
$67.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.95
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cash Price |
$573.00
|
| Rate for Payer: Cigna Commercial |
$1,887.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$993.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.95
|
| Rate for Payer: Health EOS Commercial |
$1,807.62
|
| Rate for Payer: HFN Commercial |
$1,887.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$254.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.95
|
| Rate for Payer: Multiplan Commercial |
$1,589.12
|
| Rate for Payer: NAPHCARE Commercial |
$101.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,887.08
|
| Rate for Payer: Quartz Beloit One Network |
$874.02
|
| Rate for Payer: Quartz Commercial |
$1,132.25
|
| Rate for Payer: Quartz Medicare Advantage |
$67.95
|
| Rate for Payer: The Alliance Commercial |
$258.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.95
|
| Rate for Payer: WEA Trust Commercial |
$1,092.52
|
| Rate for Payer: WPS Commercial |
$339.77
|
|
|
MA Ductogram Or Galactogram Single Left
|
Facility
|
IP
|
$1,619.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
3072688
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$825.04 |
| Max. Negotiated Rate |
$1,549.06 |
| Rate for Payer: Aetna Commercial |
$1,515.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.39
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,549.06
|
| Rate for Payer: Health EOS Commercial |
$1,498.55
|
| Rate for Payer: HFN Commercial |
$1,549.06
|
| Rate for Payer: Multiplan Commercial |
$1,347.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.06
|
| Rate for Payer: Quartz Beloit One Network |
$825.04
|
| Rate for Payer: Quartz Commercial |
$1,010.26
|
| Rate for Payer: WEA Trust Commercial |
$926.07
|
| Rate for Payer: WPS Commercial |
$1,247.12
|
|
|
MA Ductogram Or Galactogram Single Left
|
Professional
|
Both
|
$1,619.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
3072688
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$1,599.57 |
| Rate for Payer: Aetna Commercial |
$1,599.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.03
|
| Rate for Payer: Aetna Managed Medicare |
$52.75
|
| Rate for Payer: Anthem Medicare Advantage |
$52.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.75
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,599.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$841.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.75
|
| Rate for Payer: Health EOS Commercial |
$1,532.22
|
| Rate for Payer: HFN Commercial |
$1,599.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$195.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.75
|
| Rate for Payer: Multiplan Commercial |
$1,347.01
|
| Rate for Payer: NAPHCARE Commercial |
$79.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.57
|
| Rate for Payer: Quartz Beloit One Network |
$740.85
|
| Rate for Payer: Quartz Commercial |
$959.74
|
| Rate for Payer: Quartz Medicare Advantage |
$52.75
|
| Rate for Payer: The Alliance Commercial |
$200.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.75
|
| Rate for Payer: WEA Trust Commercial |
$926.07
|
| Rate for Payer: WPS Commercial |
$263.74
|
|
|
MA Ductogram Or Galactogram Single Left
|
Facility
|
OP
|
$1,619.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
3072688
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,549.06 |
| Rate for Payer: Aetna Commercial |
$1,515.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.03
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,549.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$1,498.55
|
| Rate for Payer: HFN Commercial |
$1,549.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$1,347.01
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.06
|
| Rate for Payer: Quartz Beloit One Network |
$825.04
|
| Rate for Payer: Quartz Commercial |
$1,094.44
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$926.07
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,247.12
|
|
|
MA Ductogram Or Galactogram Single Right
|
Facility
|
IP
|
$1,619.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
3072689
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$825.04 |
| Max. Negotiated Rate |
$1,549.06 |
| Rate for Payer: Aetna Commercial |
$1,515.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.39
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,549.06
|
| Rate for Payer: Health EOS Commercial |
$1,498.55
|
| Rate for Payer: HFN Commercial |
$1,549.06
|
| Rate for Payer: Multiplan Commercial |
$1,347.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.06
|
| Rate for Payer: Quartz Beloit One Network |
$825.04
|
| Rate for Payer: Quartz Commercial |
$1,010.26
|
| Rate for Payer: WEA Trust Commercial |
$926.07
|
| Rate for Payer: WPS Commercial |
$1,247.12
|
|
|
MA Ductogram Or Galactogram Single Right
|
Facility
|
OP
|
$1,619.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
3072689
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.10 |
| Max. Negotiated Rate |
$1,549.06 |
| Rate for Payer: Aetna Commercial |
$1,515.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.03
|
| Rate for Payer: Aetna Managed Medicare |
$251.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$717.88
|
| Rate for Payer: Anthem Medicare Advantage |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$251.10
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,549.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$251.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$251.10
|
| Rate for Payer: Health EOS Commercial |
$1,498.55
|
| Rate for Payer: HFN Commercial |
$1,549.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$251.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$251.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$251.10
|
| Rate for Payer: Multiplan Commercial |
$1,347.01
|
| Rate for Payer: NAPHCARE Commercial |
$376.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.06
|
| Rate for Payer: Quartz Beloit One Network |
$825.04
|
| Rate for Payer: Quartz Commercial |
$1,094.44
|
| Rate for Payer: Quartz Medicare Advantage |
$251.10
|
| Rate for Payer: The Alliance Commercial |
$1,004.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$251.10
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$926.07
|
| Rate for Payer: Wellcare Medicare |
$251.10
|
| Rate for Payer: WPS Commercial |
$1,247.12
|
|
|
MA Ductogram Or Galactogram Single Right
|
Professional
|
Both
|
$1,619.00
|
|
|
Service Code
|
CPT 77053
|
| Hospital Charge Code |
3072689
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$52.75 |
| Max. Negotiated Rate |
$1,599.57 |
| Rate for Payer: Aetna Commercial |
$1,599.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.03
|
| Rate for Payer: Aetna Managed Medicare |
$52.75
|
| Rate for Payer: Anthem Medicare Advantage |
$52.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.75
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,599.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$841.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.75
|
| Rate for Payer: Health EOS Commercial |
$1,532.22
|
| Rate for Payer: HFN Commercial |
$1,599.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$195.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.75
|
| Rate for Payer: Multiplan Commercial |
$1,347.01
|
| Rate for Payer: NAPHCARE Commercial |
$79.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,599.57
|
| Rate for Payer: Quartz Beloit One Network |
$740.85
|
| Rate for Payer: Quartz Commercial |
$959.74
|
| Rate for Payer: Quartz Medicare Advantage |
$52.75
|
| Rate for Payer: The Alliance Commercial |
$200.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.75
|
| Rate for Payer: WEA Trust Commercial |
$926.07
|
| Rate for Payer: WPS Commercial |
$263.74
|
|
|
Magnesium Level
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.29 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$83.62
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
Magnesium Level
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.57
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$90.58
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: United Healthcare PPO |
$104.52
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: Wellcare Medicare |
$6.97
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
Magnesium Level
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633781
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Aetna Commercial |
$132.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$132.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$126.82
|
| Rate for Payer: HFN Commercial |
$132.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$132.39
|
| Rate for Payer: Quartz Beloit One Network |
$61.32
|
| Rate for Payer: Quartz Commercial |
$79.44
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$30.66
|
|
|
Magnesium Level 24 Hour Urine
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633782
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Magnesium Level 24 Hour Urine
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633782
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$30.66 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$30.66
|
|
