|
Myoglobin
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
633786
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.45
|
| Rate for Payer: Anthem Medicaid |
$13.35
|
| Rate for Payer: Anthem Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.92
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.73
|
| Rate for Payer: Dean Health Medicaid |
$13.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.92
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.92
|
| Rate for Payer: Managed Health Services Medicaid |
$13.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.92
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.38
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.35
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.92
|
| Rate for Payer: The Alliance Commercial |
$51.68
|
| Rate for Payer: United Healthcare Medicaid |
$13.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.92
|
| Rate for Payer: United Healthcare PPO |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: Wellcare Medicare |
$12.92
|
| Rate for Payer: WMAP Medicaid |
$13.35
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
Myoglobin
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
633786
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.92
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$158.40
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
Myoglobin Urine
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
978024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.61 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna Commercial |
$305.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$305.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$293.02
|
| Rate for Payer: HFN Commercial |
$305.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.61
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Preferred Network Access Commercial |
$305.90
|
| Rate for Payer: Quartz Beloit One Network |
$141.68
|
| Rate for Payer: Quartz Commercial |
$183.54
|
| Rate for Payer: The Alliance Commercial |
$161.00
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Myoglobin Urine
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
978024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.92 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$12.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.45
|
| Rate for Payer: Anthem Medicaid |
$13.35
|
| Rate for Payer: Anthem Medicare Advantage |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.92
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Dean Health Medicaid |
$13.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.92
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.92
|
| Rate for Payer: Managed Health Services Medicaid |
$13.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.92
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.38
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.35
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12.92
|
| Rate for Payer: The Alliance Commercial |
$51.68
|
| Rate for Payer: United Healthcare Medicaid |
$13.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.92
|
| Rate for Payer: United Healthcare PPO |
$241.50
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: Wellcare Medicare |
$12.92
|
| Rate for Payer: WMAP Medicaid |
$13.35
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Myoglobin Urine
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 83874
|
| Hospital Charge Code |
978024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
MYOMECTOMY, EXCISION OF FIBROID TUMOR(S) OF UTERUS, 1 TO 4 INTRAMURAL MYOMA(S) WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS; VAGINAL APPROACH
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 58145
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
Myositis AssessR
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4586653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.96 |
| Max. Negotiated Rate |
$127.30 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$127.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.40
|
| Rate for Payer: Health EOS Commercial |
$121.94
|
| Rate for Payer: HFN Commercial |
$127.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Preferred Network Access Commercial |
$127.30
|
| Rate for Payer: Quartz Beloit One Network |
$58.96
|
| Rate for Payer: Quartz Commercial |
$76.38
|
| Rate for Payer: The Alliance Commercial |
$67.00
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
Myositis AssessR
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4586653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.40
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$80.40
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
Myositis AssessR
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4586653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.99
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$87.10
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$100.50
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
MYO Spect Ex/Rest 7845226
|
Professional
|
Both
|
$1,331.00
|
|
|
Service Code
|
CPT 78452 26
|
| Hospital Charge Code |
3133503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$266.34 |
| Max. Negotiated Rate |
$1,264.45 |
| Rate for Payer: Aetna Commercial |
$1,264.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.66
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,264.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$665.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$798.60
|
| Rate for Payer: Health EOS Commercial |
$1,211.21
|
| Rate for Payer: HFN Commercial |
$1,264.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$266.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$266.34
|
| Rate for Payer: Multiplan Commercial |
$1,064.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.45
|
| Rate for Payer: Quartz Beloit One Network |
$585.64
|
| Rate for Payer: Quartz Commercial |
$758.67
|
| Rate for Payer: The Alliance Commercial |
$665.50
|
| Rate for Payer: WEA Trust Commercial |
$732.05
|
| Rate for Payer: WPS Commercial |
$985.87
|
|
|
MYOtherm XP 4;1 Bridge Coated
|
Facility
|
IP
|
$1,983.00
|
|
| Hospital Charge Code |
2975047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.67 |
| Max. Negotiated Rate |
$1,824.36 |
| Rate for Payer: Aetna Commercial |
$1,784.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,050.99
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,824.36
|
| Rate for Payer: Health EOS Commercial |
$1,764.87
|
| Rate for Payer: HFN Commercial |
$1,824.36
|
| Rate for Payer: Multiplan Commercial |
$1,586.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.36
|
| Rate for Payer: Quartz Beloit One Network |
$971.67
|
| Rate for Payer: Quartz Commercial |
$1,189.80
|
| Rate for Payer: WEA Trust Commercial |
$1,090.65
|
| Rate for Payer: WPS Commercial |
$1,468.81
|
|
|
MYOtherm XP 4;1 Bridge Coated
|
Facility
|
OP
|
$1,983.00
|
|
| Hospital Charge Code |
2975047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.24 |
| Max. Negotiated Rate |
$7,932.00 |
| Rate for Payer: Aetna Commercial |
$1,784.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.38
|
| Rate for Payer: Aetna Managed Medicare |
$555.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,288.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$991.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$951.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,050.99
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,824.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,109.69
|
| Rate for Payer: Health EOS Commercial |
$1,764.87
|
| Rate for Payer: HFN Commercial |
$1,824.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,487.25
|
| Rate for Payer: Multiplan Commercial |
$1,586.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.36
|
| Rate for Payer: Quartz Beloit One Network |
$971.67
|
| Rate for Payer: Quartz Commercial |
$1,288.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,189.80
|
| Rate for Payer: The Alliance Commercial |
$7,932.00
|
| Rate for Payer: WEA Trust Commercial |
$1,090.65
|
| Rate for Payer: WPS Commercial |
$1,468.81
|
|
|
MYOtherm XP 4:1 Coated
|
Facility
|
IP
|
$1,907.00
|
|
| Hospital Charge Code |
2975046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$934.43 |
| Max. Negotiated Rate |
$1,754.44 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,144.20
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
MYOtherm XP 4:1 Coated
|
Facility
|
OP
|
$1,907.00
|
|
| Hospital Charge Code |
2975046
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.96 |
| Max. Negotiated Rate |
$7,628.00 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.02
|
| Rate for Payer: Aetna Managed Medicare |
$533.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,239.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$953.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$915.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,067.16
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,430.25
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,239.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,144.20
|
| Rate for Payer: The Alliance Commercial |
$7,628.00
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
MYOTHERM XP DELIVERY LINE
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2975048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Aetna Managed Medicare |
$81.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.40
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$189.80
|
| Rate for Payer: Quartz Medicare Advantage |
$175.20
|
| Rate for Payer: The Alliance Commercial |
$1,168.00
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
MYOTHERM XP DELIVERY LINE
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2975048
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$268.64 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$175.20
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
Myotonic Dystrophy DNA Test
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
983340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$244.64 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Health EOS Commercial |
$505.96
|
| Rate for Payer: HFN Commercial |
$528.20
|
| Rate for Payer: Aetna Commercial |
$528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$528.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$483.61
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$528.20
|
| Rate for Payer: Quartz Beloit One Network |
$244.64
|
| Rate for Payer: Quartz Commercial |
$316.92
|
| Rate for Payer: The Alliance Commercial |
$278.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
Myotonic Dystrophy DNA Test
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
983340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.00 |
| Max. Negotiated Rate |
$548.00 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$137.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$513.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$227.42
|
| Rate for Payer: Anthem Medicaid |
$137.00
|
| Rate for Payer: Anthem Medicare Advantage |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.00
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$137.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Dean Health Medicaid |
$137.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$137.00
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$509.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$137.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.00
|
| Rate for Payer: Managed Health Services Medicaid |
$142.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$137.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$137.00
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$205.50
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$137.00
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$137.00
|
| Rate for Payer: The Alliance Commercial |
$548.00
|
| Rate for Payer: United Healthcare Medicaid |
$137.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.00
|
| Rate for Payer: United Healthcare PPO |
$417.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: Wellcare Medicare |
$137.00
|
| Rate for Payer: WMAP Medicaid |
$137.00
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
Myotonic Dystrophy DNA Test
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 81401
|
| Hospital Charge Code |
983340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
Myringotomy Incision With Aspiration Or Inflation
|
Professional
|
Both
|
$385.00
|
|
|
Service Code
|
CPT 69420
|
| Hospital Charge Code |
1152800
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$161.97 |
| Max. Negotiated Rate |
$398.89 |
| Rate for Payer: Aetna Commercial |
$365.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$365.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.00
|
| Rate for Payer: Health EOS Commercial |
$350.35
|
| Rate for Payer: HFN Commercial |
$365.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$398.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$398.89
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: Preferred Network Access Commercial |
$365.75
|
| Rate for Payer: Quartz Beloit One Network |
$169.40
|
| Rate for Payer: Quartz Commercial |
$219.45
|
| Rate for Payer: The Alliance Commercial |
$192.50
|
| Rate for Payer: United Healthcare Medicaid |
$161.97
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
Myringotomy Incision with Aspiration or Inflation 6979969420
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
CPT 69799
|
| Hospital Charge Code |
5322652
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$174.68 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Aetna Commercial |
$377.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.42
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$377.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.20
|
| Rate for Payer: Health EOS Commercial |
$361.27
|
| Rate for Payer: HFN Commercial |
$377.15
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$377.15
|
| Rate for Payer: Quartz Beloit One Network |
$174.68
|
| Rate for Payer: Quartz Commercial |
$226.29
|
| Rate for Payer: The Alliance Commercial |
$198.50
|
| Rate for Payer: WEA Trust Commercial |
$218.35
|
| Rate for Payer: WPS Commercial |
$294.06
|
|
|
MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBE INFLATION REQUIRING GENERAL ANESTHESIA
|
Facility
|
OP
|
$12,729.16
|
|
|
Service Code
|
CPT 69421
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,729.16 |
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,729.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
|
|
MYRINGOTOMY WITHOUT BUTTONS
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
MYRINGOTOMY WITHOUT BUTTONS
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
NAIL 11MM TITANIUM TIBIAL
|
Facility
|
OP
|
$9,692.00
|
|
| Hospital Charge Code |
2966283
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,713.76 |
| Max. Negotiated Rate |
$38,768.00 |
| Rate for Payer: Aetna Commercial |
$8,722.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,335.12
|
| Rate for Payer: Aetna Managed Medicare |
$2,713.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,299.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,652.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,136.76
|
| Rate for Payer: Cash Price |
$2,907.60
|
| Rate for Payer: Cigna Commercial |
$8,916.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,423.64
|
| Rate for Payer: Health EOS Commercial |
$8,625.88
|
| Rate for Payer: HFN Commercial |
$8,916.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,269.00
|
| Rate for Payer: Multiplan Commercial |
$7,753.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,815.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,916.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,749.08
|
| Rate for Payer: Quartz Commercial |
$6,299.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,815.20
|
| Rate for Payer: The Alliance Commercial |
$38,768.00
|
| Rate for Payer: WEA Trust Commercial |
$5,330.60
|
| Rate for Payer: WPS Commercial |
$7,178.86
|
|
