|
Phenylephrine JW Waste Charge per 1 ml
|
Facility
|
IP
|
$11.00
|
|
|
Service Code
|
HCPCS J2370 JW
|
| Hospital Charge Code |
5266688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$6.60
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Phenylephrine JW Waste Charge per 1 ml
|
Professional
|
Both
|
$11.00
|
|
|
Service Code
|
HCPCS J2370 JW
|
| Hospital Charge Code |
5266688
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| Max. Negotiated Rate |
$10.45 |
| Rate for Payer: Aetna Commercial |
$10.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.60
|
| Rate for Payer: Health EOS Commercial |
$10.01
|
| Rate for Payer: HFN Commercial |
$10.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10.45
|
| Rate for Payer: Quartz Beloit One Network |
$4.84
|
| Rate for Payer: Quartz Commercial |
$6.27
|
| Rate for Payer: The Alliance Commercial |
$5.50
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Phenytoin JW Waste Charge per 50 mg
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
HCPCS J1165 JW
|
| Hospital Charge Code |
5266720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$4.75 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.64
|
| Rate for Payer: Health EOS Commercial |
$4.55
|
| Rate for Payer: HFN Commercial |
$4.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.61
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.75
|
| Rate for Payer: Quartz Beloit One Network |
$2.20
|
| Rate for Payer: Quartz Commercial |
$2.85
|
| Rate for Payer: The Alliance Commercial |
$2.50
|
| Rate for Payer: United Healthcare Medicaid |
$0.64
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$1.60
|
|
|
Phenytoin JW Waste Charge per 50 mg
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS J1165 JW
|
| Hospital Charge Code |
5266720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Phenytoin JW Waste Charge per 50 mg
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS J1165 JW
|
| Hospital Charge Code |
5266720
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.85
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$1.60
|
|
|
Phenytoin Level Free
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
633802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.57 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$199.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.00
|
| Rate for Payer: Health EOS Commercial |
$191.10
|
| Rate for Payer: HFN Commercial |
$199.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.57
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$199.50
|
| Rate for Payer: Quartz Beloit One Network |
$92.40
|
| Rate for Payer: Quartz Commercial |
$119.70
|
| Rate for Payer: The Alliance Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Phenytoin Level Free
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
633802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$13.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.84
|
| Rate for Payer: Anthem Medicaid |
$14.22
|
| Rate for Payer: Anthem Medicare Advantage |
$13.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.76
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Dean Health Medicaid |
$14.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.76
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.76
|
| Rate for Payer: Managed Health Services Medicaid |
$14.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.76
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$20.64
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.22
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$13.76
|
| Rate for Payer: The Alliance Commercial |
$55.04
|
| Rate for Payer: United Healthcare Medicaid |
$14.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.76
|
| Rate for Payer: United Healthcare PPO |
$157.50
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: Wellcare Medicare |
$13.76
|
| Rate for Payer: WMAP Medicaid |
$14.22
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Phenytoin Level Free
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 80186
|
| Hospital Charge Code |
633802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Phenytoin Level Total
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
633801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$221.72 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$144.60
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
Phenytoin Level Total
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
633801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$221.72 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Aetna Managed Medicare |
$13.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.00
|
| Rate for Payer: Anthem Medicaid |
$13.69
|
| Rate for Payer: Anthem Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.25
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.86
|
| Rate for Payer: Dean Health Medicaid |
$13.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.25
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.25
|
| Rate for Payer: Managed Health Services Medicaid |
$14.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.88
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.69
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$156.65
|
| Rate for Payer: Quartz Medicare Advantage |
$13.25
|
| Rate for Payer: The Alliance Commercial |
$53.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare PPO |
$180.75
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: Wellcare Medicare |
$13.25
|
| Rate for Payer: WMAP Medicaid |
$13.69
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
Phenytoin Level Total
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
CPT 80185
|
| Hospital Charge Code |
633801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Aetna Commercial |
$228.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$228.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.60
|
| Rate for Payer: Health EOS Commercial |
$219.31
|
| Rate for Payer: HFN Commercial |
$228.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.77
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.95
|
| Rate for Payer: Quartz Beloit One Network |
$106.04
|
| Rate for Payer: Quartz Commercial |
$137.37
|
| Rate for Payer: The Alliance Commercial |
$120.50
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
pH, Feces
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3167486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
pH, Feces
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3167486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.00
|
| Rate for Payer: Health EOS Commercial |
$50.05
|
| Rate for Payer: HFN Commercial |
$52.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.64
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Preferred Network Access Commercial |
$52.25
|
| Rate for Payer: Quartz Beloit One Network |
$24.20
|
| Rate for Payer: Quartz Commercial |
$31.35
|
| Rate for Payer: The Alliance Commercial |
$27.50
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
pH, Feces
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3167486
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$3.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.94
|
| Rate for Payer: Anthem Medicaid |
$3.70
|
| Rate for Payer: Anthem Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.58
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Dean Health Medicaid |
$3.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.58
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.58
|
| Rate for Payer: Managed Health Services Medicaid |
$3.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$5.37
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.70
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3.58
|
| Rate for Payer: The Alliance Commercial |
$14.32
|
| Rate for Payer: United Healthcare Medicaid |
$3.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: United Healthcare PPO |
$41.25
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
| Rate for Payer: WMAP Medicaid |
$3.70
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
pH, Fluid
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3154876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.64 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.00
|
| Rate for Payer: Health EOS Commercial |
$50.05
|
| Rate for Payer: HFN Commercial |
$52.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.64
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Preferred Network Access Commercial |
$52.25
|
| Rate for Payer: Quartz Beloit One Network |
$24.20
|
| Rate for Payer: Quartz Commercial |
$31.35
|
| Rate for Payer: The Alliance Commercial |
$27.50
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
pH, Fluid
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3154876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$3.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.94
|
| Rate for Payer: Anthem Medicaid |
$3.70
|
| Rate for Payer: Anthem Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.58
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Dean Health Medicaid |
$3.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.58
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.58
|
| Rate for Payer: Managed Health Services Medicaid |
$3.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$5.37
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.70
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3.58
|
| Rate for Payer: The Alliance Commercial |
$14.32
|
| Rate for Payer: United Healthcare Medicaid |
$3.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: United Healthcare PPO |
$41.25
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
| Rate for Payer: WMAP Medicaid |
$3.70
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
pH, Fluid
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3154876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
PHLEBECTOMY/VARICOSE VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
PHLEBECTOMY/VARICOSE VEIN LIGATION AND STRIPPING
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960315
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
PHLEB VEINS EXTREM 10-20 37765
|
Professional
|
Both
|
$3,869.00
|
|
|
Service Code
|
CPT 37765
|
| Hospital Charge Code |
3014576
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$451.85 |
| Max. Negotiated Rate |
$3,675.55 |
| Rate for Payer: Aetna Commercial |
$3,675.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,327.34
|
| Rate for Payer: Cash Price |
$1,160.70
|
| Rate for Payer: Cash Price |
$1,160.70
|
| Rate for Payer: Cash Price |
$1,160.70
|
| Rate for Payer: Cigna Commercial |
$3,675.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$451.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,321.40
|
| Rate for Payer: Health EOS Commercial |
$3,520.79
|
| Rate for Payer: HFN Commercial |
$3,675.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$870.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$870.11
|
| Rate for Payer: Multiplan Commercial |
$3,095.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,675.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,702.36
|
| Rate for Payer: Quartz Commercial |
$2,205.33
|
| Rate for Payer: The Alliance Commercial |
$1,934.50
|
| Rate for Payer: United Healthcare Medicaid |
$451.85
|
| Rate for Payer: WEA Trust Commercial |
$2,127.95
|
| Rate for Payer: WPS Commercial |
$2,865.77
|
|
|
PHLEB VEINS EXTREM 10-20 (Less than) 3779937765
|
Professional
|
Both
|
$4,702.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
6167698
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,068.88 |
| Max. Negotiated Rate |
$4,466.90 |
| Rate for Payer: Aetna Commercial |
$4,466.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,043.72
|
| Rate for Payer: Cash Price |
$1,410.60
|
| Rate for Payer: Cash Price |
$1,410.60
|
| Rate for Payer: Cigna Commercial |
$4,466.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,351.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,821.20
|
| Rate for Payer: Health EOS Commercial |
$4,278.82
|
| Rate for Payer: HFN Commercial |
$4,466.90
|
| Rate for Payer: Multiplan Commercial |
$3,761.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,466.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,068.88
|
| Rate for Payer: Quartz Commercial |
$2,680.14
|
| Rate for Payer: The Alliance Commercial |
$2,351.00
|
| Rate for Payer: WEA Trust Commercial |
$2,586.10
|
| Rate for Payer: WPS Commercial |
$3,482.77
|
|
|
PHLEB VEINS EXTREM 20+ 37766
|
Professional
|
Both
|
$4,925.00
|
|
|
Service Code
|
CPT 37766
|
| Hospital Charge Code |
3014577
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$550.27 |
| Max. Negotiated Rate |
$4,678.75 |
| Rate for Payer: Aetna Commercial |
$4,678.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,235.50
|
| Rate for Payer: Cash Price |
$1,477.50
|
| Rate for Payer: Cash Price |
$1,477.50
|
| Rate for Payer: Cash Price |
$1,477.50
|
| Rate for Payer: Cigna Commercial |
$4,678.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$550.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,955.00
|
| Rate for Payer: Health EOS Commercial |
$4,481.75
|
| Rate for Payer: HFN Commercial |
$4,678.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,065.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,065.39
|
| Rate for Payer: Multiplan Commercial |
$3,940.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,678.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,167.00
|
| Rate for Payer: Quartz Commercial |
$2,807.25
|
| Rate for Payer: The Alliance Commercial |
$2,462.50
|
| Rate for Payer: United Healthcare Medicaid |
$550.27
|
| Rate for Payer: WEA Trust Commercial |
$2,708.75
|
| Rate for Payer: WPS Commercial |
$3,647.95
|
|
|
Phosphate, Urine
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
5024609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$20.40 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13.76
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.60
|
| Rate for Payer: Health EOS Commercial |
$14.56
|
| Rate for Payer: HFN Commercial |
$15.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15.20
|
| Rate for Payer: Quartz Beloit One Network |
$7.04
|
| Rate for Payer: Quartz Commercial |
$9.12
|
| Rate for Payer: The Alliance Commercial |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$8.80
|
| Rate for Payer: WPS Commercial |
$11.85
|
|
|
Phosphate, Urine
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
5024609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$14.72 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.48
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$14.72
|
| Rate for Payer: Health EOS Commercial |
$14.24
|
| Rate for Payer: HFN Commercial |
$14.72
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: NAPHCARE Commercial |
$9.60
|
| Rate for Payer: Preferred Network Access Commercial |
$14.72
|
| Rate for Payer: Quartz Beloit One Network |
$7.84
|
| Rate for Payer: Quartz Commercial |
$9.60
|
| Rate for Payer: WEA Trust Commercial |
$8.80
|
| Rate for Payer: WPS Commercial |
$11.85
|
|
|
Phosphate, Urine
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
5024609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$23.12 |
| Rate for Payer: Aetna Commercial |
$14.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13.76
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.59
|
| Rate for Payer: Anthem Medicaid |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$14.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.95
|
| Rate for Payer: Dean Health Medicaid |
$5.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$14.24
|
| Rate for Payer: HFN Commercial |
$14.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Managed Health Services Medicaid |
$6.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$14.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.97
|
| Rate for Payer: Quartz Beloit One Network |
$7.84
|
| Rate for Payer: Quartz Commercial |
$10.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$23.12
|
| Rate for Payer: United Healthcare Medicaid |
$5.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$8.80
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WMAP Medicaid |
$5.97
|
| Rate for Payer: WPS Commercial |
$11.85
|
|
