|
Nasogastric - Tube Type
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
3025913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$168.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$172.22
|
| Rate for Payer: Health EOS Commercial |
$166.61
|
| Rate for Payer: HFN Commercial |
$172.22
|
| Rate for Payer: Multiplan Commercial |
$149.76
|
| Rate for Payer: Preferred Network Access Commercial |
$172.22
|
| Rate for Payer: Quartz Beloit One Network |
$91.73
|
| Rate for Payer: Quartz Commercial |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$102.96
|
| Rate for Payer: WPS Commercial |
$138.65
|
|
|
Nasopharyngeal Airway
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
3040316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Nasopharyngeal Airway
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
3040316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
NASOPHARYNGEAL TUMOR RESECTION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
NASOPHARYNGEAL TUMOR RESECTION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Nasopharyngoscopy With Endoscope
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
1152808
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.57 |
| Max. Negotiated Rate |
$189.70 |
| Rate for Payer: Aetna Commercial |
$189.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$32.57
|
| Rate for Payer: Anthem Medicare Advantage |
$32.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.57
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$189.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.57
|
| Rate for Payer: Health EOS Commercial |
$181.71
|
| Rate for Payer: HFN Commercial |
$189.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.57
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$48.86
|
| Rate for Payer: Preferred Network Access Commercial |
$189.70
|
| Rate for Payer: Quartz Beloit One Network |
$87.86
|
| Rate for Payer: Quartz Commercial |
$113.82
|
| Rate for Payer: Quartz Medicare Advantage |
$32.57
|
| Rate for Payer: The Alliance Commercial |
$81.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.57
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$130.29
|
|
|
Navantrone 5 mg Charge
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
2958926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$718.54 |
| Max. Negotiated Rate |
$1,349.09 |
| Rate for Payer: Aetna Commercial |
$1,319.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.19
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,349.09
|
| Rate for Payer: Health EOS Commercial |
$1,305.10
|
| Rate for Payer: HFN Commercial |
$1,349.09
|
| Rate for Payer: Multiplan Commercial |
$1,173.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.09
|
| Rate for Payer: Quartz Beloit One Network |
$718.54
|
| Rate for Payer: Quartz Commercial |
$879.84
|
| Rate for Payer: WEA Trust Commercial |
$806.52
|
| Rate for Payer: WPS Commercial |
$1,086.12
|
|
|
Navantrone 5 mg Charge
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
2958926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$1,393.08 |
| Rate for Payer: Aetna Commercial |
$1,393.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.10
|
| Rate for Payer: Aetna Managed Medicare |
$32.12
|
| Rate for Payer: Anthem Medicare Advantage |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.12
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,393.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.38
|
| Rate for Payer: Health EOS Commercial |
$1,334.42
|
| Rate for Payer: HFN Commercial |
$1,393.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.12
|
| Rate for Payer: Multiplan Commercial |
$1,173.12
|
| Rate for Payer: NAPHCARE Commercial |
$48.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.08
|
| Rate for Payer: Quartz Beloit One Network |
$645.22
|
| Rate for Payer: Quartz Commercial |
$835.85
|
| Rate for Payer: Quartz Medicare Advantage |
$32.12
|
| Rate for Payer: The Alliance Commercial |
$88.32
|
| Rate for Payer: United Healthcare Medicaid |
$32.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.12
|
| Rate for Payer: WEA Trust Commercial |
$806.52
|
| Rate for Payer: WPS Commercial |
$110.94
|
|
|
Navantrone 5 mg Charge
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
2958926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$1,349.09 |
| Rate for Payer: Aetna Commercial |
$1,319.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.10
|
| Rate for Payer: Aetna Managed Medicare |
$32.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$953.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$733.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$703.87
|
| Rate for Payer: Anthem Medicare Advantage |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.12
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,349.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32.12
|
| Rate for Payer: Health EOS Commercial |
$1,305.10
|
| Rate for Payer: HFN Commercial |
$1,349.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32.12
|
| Rate for Payer: Multiplan Commercial |
$1,173.12
|
| Rate for Payer: NAPHCARE Commercial |
$48.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.09
|
| Rate for Payer: Quartz Beloit One Network |
$718.54
|
| Rate for Payer: Quartz Commercial |
$953.16
|
| Rate for Payer: Quartz Medicare Advantage |
$32.12
|
| Rate for Payer: The Alliance Commercial |
$128.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.12
|
| Rate for Payer: WEA Trust Commercial |
$806.52
|
| Rate for Payer: Wellcare Medicare |
$32.12
|
| Rate for Payer: WPS Commercial |
$110.94
|
|
|
NAVG Protection Filter
|
Facility
|
IP
|
$6,635.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
5460725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,381.20 |
| Max. Negotiated Rate |
$6,348.37 |
| Rate for Payer: Aetna Commercial |
$6,210.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,934.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,657.21
|
| Rate for Payer: Cash Price |
$1,990.50
|
| Rate for Payer: Cigna Commercial |
$6,348.37
|
| Rate for Payer: Health EOS Commercial |
$6,141.36
|
| Rate for Payer: HFN Commercial |
$6,348.37
|
| Rate for Payer: Multiplan Commercial |
$5,520.32
|
| Rate for Payer: Preferred Network Access Commercial |
$6,348.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.20
|
| Rate for Payer: Quartz Commercial |
$4,140.24
|
| Rate for Payer: WEA Trust Commercial |
$3,795.22
|
| Rate for Payer: WPS Commercial |
$5,110.94
|
|
|
NAVG Protection Filter
|
Facility
|
OP
|
$6,635.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
5460725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,932.11 |
| Max. Negotiated Rate |
$6,348.37 |
| Rate for Payer: Aetna Commercial |
$6,210.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,934.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,932.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,485.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,450.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,312.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,657.21
|
| Rate for Payer: Cash Price |
$1,990.50
|
| Rate for Payer: Cigna Commercial |
$6,348.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,861.57
|
| Rate for Payer: Health EOS Commercial |
$6,141.36
|
| Rate for Payer: HFN Commercial |
$6,348.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,175.30
|
| Rate for Payer: Multiplan Commercial |
$5,520.32
|
| Rate for Payer: NAPHCARE Commercial |
$4,140.24
|
| Rate for Payer: Preferred Network Access Commercial |
$6,348.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,381.20
|
| Rate for Payer: Quartz Commercial |
$4,485.26
|
| Rate for Payer: Quartz Medicare Advantage |
$4,140.24
|
| Rate for Payer: The Alliance Commercial |
$3,450.20
|
| Rate for Payer: WEA Trust Commercial |
$3,795.22
|
| Rate for Payer: WPS Commercial |
$5,110.94
|
|
|
Navircross Support Catheter
|
Facility
|
IP
|
$2,640.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4534606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,345.34 |
| Max. Negotiated Rate |
$2,525.95 |
| Rate for Payer: Aetna Commercial |
$2,471.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,361.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.17
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$2,525.95
|
| Rate for Payer: Health EOS Commercial |
$2,443.58
|
| Rate for Payer: HFN Commercial |
$2,525.95
|
| Rate for Payer: Multiplan Commercial |
$2,196.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,525.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,345.34
|
| Rate for Payer: Quartz Commercial |
$1,647.36
|
| Rate for Payer: WEA Trust Commercial |
$1,510.08
|
| Rate for Payer: WPS Commercial |
$2,033.59
|
|
|
Navircross Support Catheter
|
Facility
|
OP
|
$2,640.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4534606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$768.77 |
| Max. Negotiated Rate |
$2,525.95 |
| Rate for Payer: Aetna Commercial |
$2,471.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,361.22
|
| Rate for Payer: Aetna Managed Medicare |
$768.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,784.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,372.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,317.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.17
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$2,525.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,536.48
|
| Rate for Payer: Health EOS Commercial |
$2,443.58
|
| Rate for Payer: HFN Commercial |
$2,525.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,059.20
|
| Rate for Payer: Multiplan Commercial |
$2,196.48
|
| Rate for Payer: NAPHCARE Commercial |
$1,647.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,525.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,345.34
|
| Rate for Payer: Quartz Commercial |
$1,784.64
|
| Rate for Payer: Quartz Medicare Advantage |
$1,647.36
|
| Rate for Payer: The Alliance Commercial |
$1,372.80
|
| Rate for Payer: WEA Trust Commercial |
$1,510.08
|
| Rate for Payer: WPS Commercial |
$2,033.59
|
|
|
N BLOCK INJ, ILIO-ING/HYPOGI 64425
|
Professional
|
Both
|
$974.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
3015187
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.98 |
| Max. Negotiated Rate |
$962.31 |
| Rate for Payer: Aetna Commercial |
$962.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$871.15
|
| Rate for Payer: Aetna Managed Medicare |
$48.98
|
| Rate for Payer: Anthem Medicare Advantage |
$48.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.98
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$962.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.98
|
| Rate for Payer: Health EOS Commercial |
$921.79
|
| Rate for Payer: HFN Commercial |
$962.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$193.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.98
|
| Rate for Payer: Multiplan Commercial |
$810.37
|
| Rate for Payer: NAPHCARE Commercial |
$73.48
|
| Rate for Payer: Preferred Network Access Commercial |
$962.31
|
| Rate for Payer: Quartz Beloit One Network |
$445.70
|
| Rate for Payer: Quartz Commercial |
$577.39
|
| Rate for Payer: Quartz Medicare Advantage |
$48.98
|
| Rate for Payer: The Alliance Commercial |
$208.18
|
| Rate for Payer: United Healthcare Medicaid |
$78.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.98
|
| Rate for Payer: WEA Trust Commercial |
$557.13
|
| Rate for Payer: WPS Commercial |
$220.43
|
|
|
N Block Inj Intercostal MLT/Regional Block 64421
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
5232633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$1,118.42 |
| Rate for Payer: Aetna Commercial |
$1,118.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,012.46
|
| Rate for Payer: Aetna Managed Medicare |
$21.22
|
| Rate for Payer: Anthem Medicare Advantage |
$21.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.22
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$1,118.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.22
|
| Rate for Payer: Health EOS Commercial |
$1,071.32
|
| Rate for Payer: HFN Commercial |
$1,118.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.22
|
| Rate for Payer: Multiplan Commercial |
$941.82
|
| Rate for Payer: NAPHCARE Commercial |
$31.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.42
|
| Rate for Payer: Quartz Beloit One Network |
$518.00
|
| Rate for Payer: Quartz Commercial |
$671.05
|
| Rate for Payer: Quartz Medicare Advantage |
$21.22
|
| Rate for Payer: The Alliance Commercial |
$90.17
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.22
|
| Rate for Payer: WEA Trust Commercial |
$647.50
|
| Rate for Payer: WPS Commercial |
$95.47
|
|
|
N BLOCK INJ, INTERCOST, SNG 64420
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
3015186
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$1,269.58 |
| Rate for Payer: Aetna Commercial |
$1,269.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.30
|
| Rate for Payer: Aetna Managed Medicare |
$51.75
|
| Rate for Payer: Anthem Medicare Advantage |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.75
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,269.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.75
|
| Rate for Payer: Health EOS Commercial |
$1,216.12
|
| Rate for Payer: HFN Commercial |
$1,269.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$207.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.12
|
| Rate for Payer: NAPHCARE Commercial |
$77.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,269.58
|
| Rate for Payer: Quartz Beloit One Network |
$588.02
|
| Rate for Payer: Quartz Commercial |
$761.75
|
| Rate for Payer: Quartz Medicare Advantage |
$51.75
|
| Rate for Payer: The Alliance Commercial |
$219.94
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.75
|
| Rate for Payer: WEA Trust Commercial |
$735.02
|
| Rate for Payer: WPS Commercial |
$232.88
|
|
|
N BLOCK INJ, PARACERVICAL 64435
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
3015189
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.73 |
| Max. Negotiated Rate |
$521.66 |
| Rate for Payer: Aetna Commercial |
$521.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.24
|
| Rate for Payer: Aetna Managed Medicare |
$36.73
|
| Rate for Payer: Anthem Medicare Advantage |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.73
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$521.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.73
|
| Rate for Payer: Health EOS Commercial |
$499.70
|
| Rate for Payer: HFN Commercial |
$521.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.73
|
| Rate for Payer: Multiplan Commercial |
$439.30
|
| Rate for Payer: NAPHCARE Commercial |
$55.10
|
| Rate for Payer: Preferred Network Access Commercial |
$521.66
|
| Rate for Payer: Quartz Beloit One Network |
$241.61
|
| Rate for Payer: Quartz Commercial |
$313.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.73
|
| Rate for Payer: The Alliance Commercial |
$156.11
|
| Rate for Payer: United Healthcare Medicaid |
$64.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.73
|
| Rate for Payer: WEA Trust Commercial |
$302.02
|
| Rate for Payer: WPS Commercial |
$165.30
|
|
|
N BLOCK INJ, PUDENDAL 64430
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
3015188
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$993.93 |
| Rate for Payer: Aetna Commercial |
$993.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$47.53
|
| Rate for Payer: Anthem Medicare Advantage |
$47.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.53
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$993.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.53
|
| Rate for Payer: Health EOS Commercial |
$952.08
|
| Rate for Payer: HFN Commercial |
$993.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$190.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.53
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$71.29
|
| Rate for Payer: Preferred Network Access Commercial |
$993.93
|
| Rate for Payer: Quartz Beloit One Network |
$460.35
|
| Rate for Payer: Quartz Commercial |
$596.36
|
| Rate for Payer: Quartz Medicare Advantage |
$47.53
|
| Rate for Payer: The Alliance Commercial |
$201.99
|
| Rate for Payer: United Healthcare Medicaid |
$63.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.53
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$213.88
|
|
|
N BLOCK INJ, PUDENDAL 6443050
|
Professional
|
Both
|
$2,013.00
|
|
|
Service Code
|
CPT 64430 50
|
| Hospital Charge Code |
5412941
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$1,988.84 |
| Rate for Payer: Aetna Commercial |
$1,988.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,800.43
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cigna Commercial |
$1,988.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,256.11
|
| Rate for Payer: Health EOS Commercial |
$1,905.10
|
| Rate for Payer: HFN Commercial |
$1,988.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$190.94
|
| Rate for Payer: Multiplan Commercial |
$1,674.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,988.84
|
| Rate for Payer: Quartz Beloit One Network |
$921.15
|
| Rate for Payer: Quartz Commercial |
$1,193.31
|
| Rate for Payer: The Alliance Commercial |
$1,046.76
|
| Rate for Payer: United Healthcare Medicaid |
$63.06
|
| Rate for Payer: WEA Trust Commercial |
$1,151.44
|
| Rate for Payer: WPS Commercial |
$1,550.61
|
|
|
N Block Inj Suprascapular Nerve 64418
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
5232627
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$559.21 |
| Rate for Payer: Aetna Commercial |
$559.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.23
|
| Rate for Payer: Aetna Managed Medicare |
$47.00
|
| Rate for Payer: Anthem Medicare Advantage |
$47.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.00
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$559.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.00
|
| Rate for Payer: Health EOS Commercial |
$535.66
|
| Rate for Payer: HFN Commercial |
$559.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$470.91
|
| Rate for Payer: NAPHCARE Commercial |
$70.50
|
| Rate for Payer: Preferred Network Access Commercial |
$559.21
|
| Rate for Payer: Quartz Beloit One Network |
$259.00
|
| Rate for Payer: Quartz Commercial |
$335.52
|
| Rate for Payer: Quartz Medicare Advantage |
$47.00
|
| Rate for Payer: The Alliance Commercial |
$199.74
|
| Rate for Payer: United Healthcare Medicaid |
$120.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.00
|
| Rate for Payer: WEA Trust Commercial |
$323.75
|
| Rate for Payer: WPS Commercial |
$211.49
|
|
|
N BLOCK, OTHER PERIPHERAL 64450
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
3015190
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$722.68
|
| Rate for Payer: Aetna Managed Medicare |
$37.75
|
| Rate for Payer: Anthem Medicare Advantage |
$37.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.75
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$798.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.75
|
| Rate for Payer: Health EOS Commercial |
$764.69
|
| Rate for Payer: HFN Commercial |
$798.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.75
|
| Rate for Payer: Multiplan Commercial |
$672.26
|
| Rate for Payer: NAPHCARE Commercial |
$56.63
|
| Rate for Payer: Preferred Network Access Commercial |
$798.30
|
| Rate for Payer: Quartz Beloit One Network |
$369.74
|
| Rate for Payer: Quartz Commercial |
$478.98
|
| Rate for Payer: Quartz Medicare Advantage |
$37.75
|
| Rate for Payer: The Alliance Commercial |
$160.45
|
| Rate for Payer: United Healthcare Medicaid |
$77.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.75
|
| Rate for Payer: WEA Trust Commercial |
$462.18
|
| Rate for Payer: WPS Commercial |
$169.88
|
|
|
N Block Trigeminal Nerve 64400
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
5232614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$584.90 |
| Rate for Payer: Aetna Commercial |
$584.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.48
|
| Rate for Payer: Aetna Managed Medicare |
$43.58
|
| Rate for Payer: Anthem Medicare Advantage |
$43.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.58
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$584.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.58
|
| Rate for Payer: Health EOS Commercial |
$560.27
|
| Rate for Payer: HFN Commercial |
$584.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$167.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.58
|
| Rate for Payer: Multiplan Commercial |
$492.54
|
| Rate for Payer: NAPHCARE Commercial |
$65.36
|
| Rate for Payer: Preferred Network Access Commercial |
$584.90
|
| Rate for Payer: Quartz Beloit One Network |
$270.90
|
| Rate for Payer: Quartz Commercial |
$350.94
|
| Rate for Payer: Quartz Medicare Advantage |
$43.58
|
| Rate for Payer: The Alliance Commercial |
$185.20
|
| Rate for Payer: United Healthcare Medicaid |
$97.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.58
|
| Rate for Payer: WEA Trust Commercial |
$338.62
|
| Rate for Payer: WPS Commercial |
$196.09
|
|
|
Nebulizer Kit PARI LCD
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3153476
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Nebulizer Kit PARI LCD
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3153476
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
NEBULIZER MINI HEART HI-FLO
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2969759
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
