|
Njx aa&/strd brach plex nfs 64416
|
Professional
|
Both
|
$1,643.00
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
6178528
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.81 |
| Max. Negotiated Rate |
$1,560.85 |
| Rate for Payer: Aetna Commercial |
$1,560.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.98
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cigna Commercial |
$1,560.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$985.80
|
| Rate for Payer: Health EOS Commercial |
$1,495.13
|
| Rate for Payer: HFN Commercial |
$1,560.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$218.37
|
| Rate for Payer: Multiplan Commercial |
$1,314.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,560.85
|
| Rate for Payer: Quartz Beloit One Network |
$722.92
|
| Rate for Payer: Quartz Commercial |
$936.51
|
| Rate for Payer: The Alliance Commercial |
$821.50
|
| Rate for Payer: United Healthcare Medicaid |
$81.81
|
| Rate for Payer: WEA Trust Commercial |
$903.65
|
| Rate for Payer: WPS Commercial |
$1,216.97
|
|
|
Njx aa&/strd tfrm epi c/t ea 64480
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
6178529
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.49 |
| Max. Negotiated Rate |
$592.80 |
| Rate for Payer: Aetna Commercial |
$592.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$592.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$196.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$374.40
|
| Rate for Payer: Health EOS Commercial |
$567.84
|
| Rate for Payer: HFN Commercial |
$592.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$209.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.40
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$592.80
|
| Rate for Payer: Quartz Beloit One Network |
$274.56
|
| Rate for Payer: Quartz Commercial |
$355.68
|
| Rate for Payer: The Alliance Commercial |
$312.00
|
| Rate for Payer: United Healthcare Medicaid |
$196.49
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.20
|
|
|
NJX Ans&/Steroid Plantar Common Digital Nerve 64455
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
4163758
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.65 |
| Max. Negotiated Rate |
$115.08 |
| Rate for Payer: Aetna Commercial |
$107.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$107.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.80
|
| Rate for Payer: Health EOS Commercial |
$102.83
|
| Rate for Payer: HFN Commercial |
$107.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.08
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Preferred Network Access Commercial |
$107.35
|
| Rate for Payer: Quartz Beloit One Network |
$49.72
|
| Rate for Payer: Quartz Commercial |
$64.41
|
| Rate for Payer: The Alliance Commercial |
$56.50
|
| Rate for Payer: United Healthcare Medicaid |
$45.65
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Njx px discography lumbar 62290
|
Professional
|
Both
|
$1,960.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
6178532
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$179.57 |
| Max. Negotiated Rate |
$1,862.00 |
| Rate for Payer: Aetna Commercial |
$1,862.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,685.60
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$1,862.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.00
|
| Rate for Payer: Health EOS Commercial |
$1,783.60
|
| Rate for Payer: HFN Commercial |
$1,862.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$554.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$554.56
|
| Rate for Payer: Multiplan Commercial |
$1,568.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.00
|
| Rate for Payer: Quartz Beloit One Network |
$862.40
|
| Rate for Payer: Quartz Commercial |
$1,117.20
|
| Rate for Payer: The Alliance Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicaid |
$179.57
|
| Rate for Payer: WEA Trust Commercial |
$1,078.00
|
| Rate for Payer: WPS Commercial |
$1,451.77
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Professional
|
Both
|
$2,121.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586799
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$871.10 |
| Max. Negotiated Rate |
$2,014.95 |
| Rate for Payer: Aetna Commercial |
$2,014.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,014.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,060.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,272.60
|
| Rate for Payer: Health EOS Commercial |
$1,930.11
|
| Rate for Payer: HFN Commercial |
$2,014.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$871.10
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.95
|
| Rate for Payer: Quartz Beloit One Network |
$933.24
|
| Rate for Payer: Quartz Commercial |
$1,208.97
|
| Rate for Payer: The Alliance Commercial |
$1,060.50
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Facility
|
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586799
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675699
|
| Min. Negotiated Rate |
$962.85 |
| Max. Negotiated Rate |
$1,807.80 |
| Rate for Payer: Aetna Commercial |
$1,768.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.45
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,807.80
|
| Rate for Payer: Health EOS Commercial |
$1,748.85
|
| Rate for Payer: HFN Commercial |
$1,807.80
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,179.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.80
|
| Rate for Payer: Quartz Beloit One Network |
$962.85
|
| Rate for Payer: Quartz Commercial |
$1,179.00
|
| Rate for Payer: WEA Trust Commercial |
$1,080.75
|
| Rate for Payer: WPS Commercial |
$1,455.48
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Facility
|
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586799
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675699
|
| Min. Negotiated Rate |
$864.60 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Aetna Commercial |
$1,866.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.90
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,866.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,179.00
|
| Rate for Payer: Health EOS Commercial |
$1,788.15
|
| Rate for Payer: HFN Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$871.10
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,866.75
|
| Rate for Payer: Quartz Beloit One Network |
$864.60
|
| Rate for Payer: Quartz Commercial |
$1,120.05
|
| Rate for Payer: The Alliance Commercial |
$982.50
|
| Rate for Payer: WEA Trust Commercial |
$1,080.75
|
| Rate for Payer: WPS Commercial |
$1,455.48
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675699
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$1,807.80 |
| Rate for Payer: Aetna Commercial |
$1,768.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.90
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,277.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$943.20
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,807.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,748.85
|
| Rate for Payer: HFN Commercial |
$1,807.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.80
|
| Rate for Payer: Quartz Beloit One Network |
$962.85
|
| Rate for Payer: Quartz Commercial |
$1,277.25
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: WEA Trust Commercial |
$1,080.75
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,455.48
|
|
|
NM Abscess Loc/Limited - Gallium
|
Facility
|
IP
|
$2,044.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,001.56 |
| Max. Negotiated Rate |
$1,880.48 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.32
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,880.48
|
| Rate for Payer: Health EOS Commercial |
$1,819.16
|
| Rate for Payer: HFN Commercial |
$1,880.48
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.56
|
| Rate for Payer: Quartz Commercial |
$1,226.40
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
NM Abscess Loc/Limited - Gallium
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$899.36 |
| Max. Negotiated Rate |
$1,941.80 |
| Rate for Payer: Aetna Commercial |
$1,941.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,941.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,022.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,226.40
|
| Rate for Payer: Health EOS Commercial |
$1,860.04
|
| Rate for Payer: HFN Commercial |
$1,941.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$962.24
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.80
|
| Rate for Payer: Quartz Beloit One Network |
$899.36
|
| Rate for Payer: Quartz Commercial |
$1,165.08
|
| Rate for Payer: The Alliance Commercial |
$1,022.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
NM Abscess Loc/Limited - Gallium
|
Facility
|
OP
|
$2,044.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,839.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.84
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,880.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,143.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,819.16
|
| Rate for Payer: HFN Commercial |
$1,880.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,635.20
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.56
|
| Rate for Payer: Quartz Commercial |
$1,328.60
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.20
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,513.99
|
|
|
NM Abscess Loc/Limited - Gallium
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675697
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$1,807.80 |
| Rate for Payer: Aetna Commercial |
$1,768.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.90
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,277.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$943.20
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,807.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,748.85
|
| Rate for Payer: HFN Commercial |
$1,807.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.80
|
| Rate for Payer: Quartz Beloit One Network |
$962.85
|
| Rate for Payer: Quartz Commercial |
$1,277.25
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: WEA Trust Commercial |
$1,080.75
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,455.48
|
|
|
NM Abscess Loc/Limited - Gallium
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675697
|
| Min. Negotiated Rate |
$962.85 |
| Max. Negotiated Rate |
$1,807.80 |
| Rate for Payer: Aetna Commercial |
$1,768.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.45
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,807.80
|
| Rate for Payer: Health EOS Commercial |
$1,748.85
|
| Rate for Payer: HFN Commercial |
$1,807.80
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,179.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.80
|
| Rate for Payer: Quartz Beloit One Network |
$962.85
|
| Rate for Payer: Quartz Commercial |
$1,179.00
|
| Rate for Payer: WEA Trust Commercial |
$1,080.75
|
| Rate for Payer: WPS Commercial |
$1,455.48
|
|
|
NM Abscess Loc/Limited - Gallium
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675697
|
| Min. Negotiated Rate |
$864.60 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Aetna Commercial |
$1,866.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.90
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,866.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,179.00
|
| Rate for Payer: Health EOS Commercial |
$1,788.15
|
| Rate for Payer: HFN Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$962.24
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,866.75
|
| Rate for Payer: Quartz Beloit One Network |
$864.60
|
| Rate for Payer: Quartz Commercial |
$1,120.05
|
| Rate for Payer: The Alliance Commercial |
$982.50
|
| Rate for Payer: WEA Trust Commercial |
$1,080.75
|
| Rate for Payer: WPS Commercial |
$1,455.48
|
|
|
NM Abscess Loc/Limited - Indium
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675695
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$1,807.80 |
| Rate for Payer: Aetna Commercial |
$1,768.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.90
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,277.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$982.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$943.20
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,807.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,748.85
|
| Rate for Payer: HFN Commercial |
$1,807.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.80
|
| Rate for Payer: Quartz Beloit One Network |
$962.85
|
| Rate for Payer: Quartz Commercial |
$1,277.25
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: WEA Trust Commercial |
$1,080.75
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,455.48
|
|
|
NM Abscess Loc/Limited - Indium
|
Facility
|
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$1,951.32 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,272.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,272.60
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
NM Abscess Loc/Limited - Indium
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675695
|
| Min. Negotiated Rate |
$864.60 |
| Max. Negotiated Rate |
$1,866.75 |
| Rate for Payer: Aetna Commercial |
$1,866.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.90
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,866.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,179.00
|
| Rate for Payer: Health EOS Commercial |
$1,788.15
|
| Rate for Payer: HFN Commercial |
$1,866.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$962.24
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,866.75
|
| Rate for Payer: Quartz Beloit One Network |
$864.60
|
| Rate for Payer: Quartz Commercial |
$1,120.05
|
| Rate for Payer: The Alliance Commercial |
$982.50
|
| Rate for Payer: WEA Trust Commercial |
$1,080.75
|
| Rate for Payer: WPS Commercial |
$1,455.48
|
|
|
NM Abscess Loc/Limited - Indium
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675695
|
| Min. Negotiated Rate |
$962.85 |
| Max. Negotiated Rate |
$1,807.80 |
| Rate for Payer: Aetna Commercial |
$1,768.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,041.45
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,807.80
|
| Rate for Payer: Health EOS Commercial |
$1,748.85
|
| Rate for Payer: HFN Commercial |
$1,807.80
|
| Rate for Payer: Multiplan Commercial |
$1,572.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,179.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,807.80
|
| Rate for Payer: Quartz Beloit One Network |
$962.85
|
| Rate for Payer: Quartz Commercial |
$1,179.00
|
| Rate for Payer: WEA Trust Commercial |
$1,080.75
|
| Rate for Payer: WPS Commercial |
$1,455.48
|
|
|
NM Abscess Loc/Limited - Indium
|
Facility
|
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,908.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$1,951.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,186.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,887.69
|
| Rate for Payer: HFN Commercial |
$1,951.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,951.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.29
|
| Rate for Payer: Quartz Commercial |
$1,378.65
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
NM Abscess Loc/Limited - Indium
|
Professional
|
Both
|
$2,121.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$933.24 |
| Max. Negotiated Rate |
$2,014.95 |
| Rate for Payer: Aetna Commercial |
$2,014.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.06
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,014.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,060.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,272.60
|
| Rate for Payer: Health EOS Commercial |
$1,930.11
|
| Rate for Payer: HFN Commercial |
$2,014.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$962.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$962.24
|
| Rate for Payer: Multiplan Commercial |
$1,696.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,014.95
|
| Rate for Payer: Quartz Beloit One Network |
$933.24
|
| Rate for Payer: Quartz Commercial |
$1,208.97
|
| Rate for Payer: The Alliance Commercial |
$1,060.50
|
| Rate for Payer: WEA Trust Commercial |
$1,166.55
|
| Rate for Payer: WPS Commercial |
$1,571.02
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Facility
|
IP
|
$4,294.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
2586805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,104.06 |
| Max. Negotiated Rate |
$3,950.48 |
| Rate for Payer: Aetna Commercial |
$3,864.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,692.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,275.82
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cigna Commercial |
$3,950.48
|
| Rate for Payer: Health EOS Commercial |
$3,821.66
|
| Rate for Payer: HFN Commercial |
$3,950.48
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,576.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,950.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,104.06
|
| Rate for Payer: Quartz Commercial |
$2,576.40
|
| Rate for Payer: WEA Trust Commercial |
$2,361.70
|
| Rate for Payer: WPS Commercial |
$3,180.57
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Professional
|
Both
|
$4,294.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
2586805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,067.97 |
| Max. Negotiated Rate |
$4,079.30 |
| Rate for Payer: Aetna Commercial |
$4,079.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,692.84
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cigna Commercial |
$4,079.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,147.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,576.40
|
| Rate for Payer: Health EOS Commercial |
$3,907.54
|
| Rate for Payer: HFN Commercial |
$4,079.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,067.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,067.97
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,079.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,889.36
|
| Rate for Payer: Quartz Commercial |
$2,447.58
|
| Rate for Payer: The Alliance Commercial |
$2,147.00
|
| Rate for Payer: WEA Trust Commercial |
$2,361.70
|
| Rate for Payer: WPS Commercial |
$3,180.57
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Facility
|
OP
|
$4,294.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
2586805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$5,614.00 |
| Rate for Payer: Aetna Commercial |
$3,864.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,692.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,263.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.98
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,275.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cigna Commercial |
$3,950.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,402.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$3,821.66
|
| Rate for Payer: HFN Commercial |
$3,950.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$3,435.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,950.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,104.06
|
| Rate for Payer: Quartz Commercial |
$2,791.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$5,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$2,361.70
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$3,180.57
|
|
