|
Parsabiv 7.5 mg dose
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.61 |
| Max. Negotiated Rate |
$10.44 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$2.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.32
|
| Rate for Payer: Anthem Medicare Advantage |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.61
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.61
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.61
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$3.92
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2.61
|
| Rate for Payer: The Alliance Commercial |
$10.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.61
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: Wellcare Medicare |
$2.61
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
PARTIAL AMPUTATION OF TOE 28825
|
Professional
|
Both
|
$1,504.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
3014286
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$1,428.80 |
| Rate for Payer: Aetna Commercial |
$1,428.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,293.44
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cigna Commercial |
$1,428.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.40
|
| Rate for Payer: Health EOS Commercial |
$1,368.64
|
| Rate for Payer: HFN Commercial |
$1,428.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$586.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$586.16
|
| Rate for Payer: Multiplan Commercial |
$1,203.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.80
|
| Rate for Payer: Quartz Beloit One Network |
$661.76
|
| Rate for Payer: Quartz Commercial |
$857.28
|
| Rate for Payer: The Alliance Commercial |
$752.00
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$827.20
|
| Rate for Payer: WPS Commercial |
$1,114.01
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL PHALANX OF FINGER
|
Facility
|
OP
|
$6,546.14
|
|
|
Service Code
|
CPT 26236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,588.57 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,588.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,588.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,588.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,588.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,588.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,909.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,588.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,588.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,588.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,588.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,382.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,588.57
|
| Rate for Payer: The Alliance Commercial |
$2,700.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,588.57
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,588.57
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE, FEMUR, PROXIMAL TIBIA AND/OR FIBULA (EG, OSTEOMYELITIS OR BONE ABSCESS)
|
Facility
|
OP
|
$11,901.43
|
|
|
Service Code
|
CPT 27360
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$11,901.43 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$5,438.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); PHALANX OF TOE
|
Facility
|
OP
|
$11,901.43
|
|
|
Service Code
|
CPT 28124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$11,901.43 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$5,438.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TALUS OR CALCANEUS
|
Facility
|
OP
|
$11,901.43
|
|
|
Service Code
|
CPT 28120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$11,901.43 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,639.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$5,438.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR CALCANEUS
|
Facility
|
OP
|
$11,901.43
|
|
|
Service Code
|
CPT 28122
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$11,901.43 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$5,438.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PARTIAL EXCISION OF LIP 40510
|
Professional
|
Both
|
$3,338.00
|
|
|
Service Code
|
CPT 40510
|
| Hospital Charge Code |
3014601
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$439.62 |
| Max. Negotiated Rate |
$3,171.10 |
| Rate for Payer: Aetna Commercial |
$3,171.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,870.68
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,171.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$439.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,002.80
|
| Rate for Payer: Health EOS Commercial |
$3,037.58
|
| Rate for Payer: HFN Commercial |
$3,171.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,167.02
|
| Rate for Payer: Multiplan Commercial |
$2,670.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,171.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,468.72
|
| Rate for Payer: Quartz Commercial |
$1,902.66
|
| Rate for Payer: The Alliance Commercial |
$1,669.00
|
| Rate for Payer: United Healthcare Medicaid |
$439.62
|
| Rate for Payer: WEA Trust Commercial |
$1,835.90
|
| Rate for Payer: WPS Commercial |
$2,472.46
|
|
|
PARTIAL EXCISION OF LIP 40520
|
Professional
|
Both
|
$1,964.00
|
|
|
Service Code
|
CPT 40520
|
| Hospital Charge Code |
3014602
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$403.73 |
| Max. Negotiated Rate |
$1,865.80 |
| Rate for Payer: Aetna Commercial |
$1,865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,689.04
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cash Price |
$589.20
|
| Rate for Payer: Cigna Commercial |
$1,865.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$403.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,178.40
|
| Rate for Payer: Health EOS Commercial |
$1,787.24
|
| Rate for Payer: HFN Commercial |
$1,865.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,186.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,186.01
|
| Rate for Payer: Multiplan Commercial |
$1,571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,865.80
|
| Rate for Payer: Quartz Beloit One Network |
$864.16
|
| Rate for Payer: Quartz Commercial |
$1,119.48
|
| Rate for Payer: The Alliance Commercial |
$982.00
|
| Rate for Payer: United Healthcare Medicaid |
$403.73
|
| Rate for Payer: WEA Trust Commercial |
$1,080.20
|
| Rate for Payer: WPS Commercial |
$1,454.73
|
|
|
PARTIAL REMOVAL, FOOT FASCIA 28060
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 28060
|
| Hospital Charge Code |
3014191
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Aetna Commercial |
$1,855.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,855.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,171.80
|
| Rate for Payer: Health EOS Commercial |
$1,777.23
|
| Rate for Payer: HFN Commercial |
$1,855.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,216.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,216.54
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,855.35
|
| Rate for Payer: Quartz Beloit One Network |
$859.32
|
| Rate for Payer: Quartz Commercial |
$1,113.21
|
| Rate for Payer: The Alliance Commercial |
$976.50
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
PARTIAL REMOVAL OF FOOT BONE 28122
|
Professional
|
Both
|
$1,824.00
|
|
|
Service Code
|
CPT 28122
|
| Hospital Charge Code |
3014207
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,732.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,732.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,094.40
|
| Rate for Payer: Health EOS Commercial |
$1,659.84
|
| Rate for Payer: HFN Commercial |
$1,732.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,473.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,473.49
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.80
|
| Rate for Payer: Quartz Beloit One Network |
$802.56
|
| Rate for Payer: Quartz Commercial |
$1,039.68
|
| Rate for Payer: The Alliance Commercial |
$912.00
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
Partial Removal of Foot Bone 2812250
|
Professional
|
Both
|
$3,649.00
|
|
|
Service Code
|
CPT 28122 50
|
| Hospital Charge Code |
5096727
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,605.56 |
| Max. Negotiated Rate |
$3,466.55 |
| Rate for Payer: Aetna Commercial |
$3,466.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,138.14
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cash Price |
$1,094.70
|
| Rate for Payer: Cigna Commercial |
$3,466.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,824.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,189.40
|
| Rate for Payer: Health EOS Commercial |
$3,320.59
|
| Rate for Payer: HFN Commercial |
$3,466.55
|
| Rate for Payer: Multiplan Commercial |
$2,919.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,466.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,605.56
|
| Rate for Payer: Quartz Commercial |
$2,079.93
|
| Rate for Payer: The Alliance Commercial |
$1,824.50
|
| Rate for Payer: WEA Trust Commercial |
$2,006.95
|
| Rate for Payer: WPS Commercial |
$2,702.81
|
|
|
PARTIAL REMOVAL OF FOOT BONE 28288
|
Professional
|
Both
|
$2,261.00
|
|
|
Service Code
|
CPT 28288
|
| Hospital Charge Code |
3014231
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$266.83 |
| Max. Negotiated Rate |
$2,147.95 |
| Rate for Payer: Aetna Commercial |
$2,147.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,944.46
|
| Rate for Payer: Cash Price |
$678.30
|
| Rate for Payer: Cash Price |
$678.30
|
| Rate for Payer: Cigna Commercial |
$2,147.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$266.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,356.60
|
| Rate for Payer: Health EOS Commercial |
$2,057.51
|
| Rate for Payer: HFN Commercial |
$2,147.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,461.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,461.38
|
| Rate for Payer: Multiplan Commercial |
$1,808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,147.95
|
| Rate for Payer: Quartz Beloit One Network |
$994.84
|
| Rate for Payer: Quartz Commercial |
$1,288.77
|
| Rate for Payer: The Alliance Commercial |
$1,130.50
|
| Rate for Payer: United Healthcare Medicaid |
$266.83
|
| Rate for Payer: WEA Trust Commercial |
$1,243.55
|
| Rate for Payer: WPS Commercial |
$1,674.72
|
|
|
Partial Removal of Foot Bone 2828850
|
Professional
|
Both
|
$4,523.00
|
|
|
Service Code
|
CPT 28288 50
|
| Hospital Charge Code |
5220624
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,990.12 |
| Max. Negotiated Rate |
$4,296.85 |
| Rate for Payer: Aetna Commercial |
$4,296.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,889.78
|
| Rate for Payer: Cash Price |
$1,356.90
|
| Rate for Payer: Cash Price |
$1,356.90
|
| Rate for Payer: Cigna Commercial |
$4,296.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,261.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,713.80
|
| Rate for Payer: Health EOS Commercial |
$4,115.93
|
| Rate for Payer: HFN Commercial |
$4,296.85
|
| Rate for Payer: Multiplan Commercial |
$3,618.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,296.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,990.12
|
| Rate for Payer: Quartz Commercial |
$2,578.11
|
| Rate for Payer: The Alliance Commercial |
$2,261.50
|
| Rate for Payer: WEA Trust Commercial |
$2,487.65
|
| Rate for Payer: WPS Commercial |
$3,350.19
|
|
|
PARTIAL REMOVAL OF TOE 28124
|
Professional
|
Both
|
$1,927.00
|
|
|
Service Code
|
CPT 28124
|
| Hospital Charge Code |
3014208
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,830.65 |
| Rate for Payer: Aetna Commercial |
$1,830.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.22
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cash Price |
$578.10
|
| Rate for Payer: Cigna Commercial |
$1,830.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,156.20
|
| Rate for Payer: Health EOS Commercial |
$1,753.57
|
| Rate for Payer: HFN Commercial |
$1,830.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,125.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,125.40
|
| Rate for Payer: Multiplan Commercial |
$1,541.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,830.65
|
| Rate for Payer: Quartz Beloit One Network |
$847.88
|
| Rate for Payer: Quartz Commercial |
$1,098.39
|
| Rate for Payer: The Alliance Commercial |
$963.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$1,059.85
|
| Rate for Payer: WPS Commercial |
$1,427.33
|
|
|
PARTIAL REMOVAL OF TOE 28126
|
Professional
|
Both
|
$1,349.00
|
|
|
Service Code
|
CPT 28126
|
| Hospital Charge Code |
3014209
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$269.52 |
| Max. Negotiated Rate |
$1,281.55 |
| Rate for Payer: Aetna Commercial |
$1,281.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.14
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cigna Commercial |
$1,281.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$809.40
|
| Rate for Payer: Health EOS Commercial |
$1,227.59
|
| Rate for Payer: HFN Commercial |
$1,281.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$832.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$832.02
|
| Rate for Payer: Multiplan Commercial |
$1,079.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,281.55
|
| Rate for Payer: Quartz Beloit One Network |
$593.56
|
| Rate for Payer: Quartz Commercial |
$768.93
|
| Rate for Payer: The Alliance Commercial |
$674.50
|
| Rate for Payer: United Healthcare Medicaid |
$269.52
|
| Rate for Payer: WEA Trust Commercial |
$741.95
|
| Rate for Payer: WPS Commercial |
$999.20
|
|
|
PARTIAL REMOVAL OF TOE 28153
|
Professional
|
Both
|
$1,643.00
|
|
|
Service Code
|
CPT 28153
|
| Hospital Charge Code |
3014211
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.57 |
| 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: Cigna Commercial |
$1,560.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.57
|
| 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 |
$891.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$891.93
|
| 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 |
$103.57
|
| Rate for Payer: WEA Trust Commercial |
$903.65
|
| Rate for Payer: WPS Commercial |
$1,216.97
|
|
|
Partial Thromboplastin Time
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$144.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.20
|
| Rate for Payer: Health EOS Commercial |
$138.32
|
| Rate for Payer: HFN Commercial |
$144.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Preferred Network Access Commercial |
$144.40
|
| Rate for Payer: Quartz Beloit One Network |
$66.88
|
| Rate for Payer: Quartz Commercial |
$86.64
|
| Rate for Payer: The Alliance Commercial |
$76.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Partial Thromboplastin Time
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicaid |
$6.21
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Dean Health Medicaid |
$6.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicaid |
$6.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.21
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WMAP Medicaid |
$6.21
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Partial Thromboplastin Time
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
PART REMOVAL OF ANKLE/HEEL 28120
|
Professional
|
Both
|
$2,714.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
3014206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$2,578.30 |
| Rate for Payer: Aetna Commercial |
$2,578.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.04
|
| Rate for Payer: Cash Price |
$814.20
|
| Rate for Payer: Cash Price |
$814.20
|
| Rate for Payer: Cigna Commercial |
$2,578.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,628.40
|
| Rate for Payer: Health EOS Commercial |
$2,469.74
|
| Rate for Payer: HFN Commercial |
$2,578.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,666.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,666.37
|
| Rate for Payer: Multiplan Commercial |
$2,171.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,578.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,194.16
|
| Rate for Payer: Quartz Commercial |
$1,546.98
|
| Rate for Payer: The Alliance Commercial |
$1,357.00
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$1,492.70
|
| Rate for Payer: WPS Commercial |
$2,010.26
|
|
|
Part Removal of Ankle/Heel 2812050
|
Professional
|
Both
|
$5,428.00
|
|
|
Service Code
|
CPT 28120 50
|
| Hospital Charge Code |
5222855
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,388.32 |
| Max. Negotiated Rate |
$5,156.60 |
| Rate for Payer: Aetna Commercial |
$5,156.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,668.08
|
| Rate for Payer: Cash Price |
$1,628.40
|
| Rate for Payer: Cash Price |
$1,628.40
|
| Rate for Payer: Cigna Commercial |
$5,156.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,714.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,256.80
|
| Rate for Payer: Health EOS Commercial |
$4,939.48
|
| Rate for Payer: HFN Commercial |
$5,156.60
|
| Rate for Payer: Multiplan Commercial |
$4,342.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,156.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,388.32
|
| Rate for Payer: Quartz Commercial |
$3,093.96
|
| Rate for Payer: The Alliance Commercial |
$2,714.00
|
| Rate for Payer: WEA Trust Commercial |
$2,985.40
|
| Rate for Payer: WPS Commercial |
$4,020.52
|
|
|
PART REMOVAL OF METATARSAL 28110
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
3014200
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$274.92 |
| Max. Negotiated Rate |
$1,949.40 |
| Rate for Payer: Aetna Commercial |
$1,949.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,764.72
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$1,949.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$274.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,231.20
|
| Rate for Payer: Health EOS Commercial |
$1,867.32
|
| Rate for Payer: HFN Commercial |
$1,949.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$977.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$977.53
|
| Rate for Payer: Multiplan Commercial |
$1,641.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,949.40
|
| Rate for Payer: Quartz Beloit One Network |
$902.88
|
| Rate for Payer: Quartz Commercial |
$1,169.64
|
| Rate for Payer: The Alliance Commercial |
$1,026.00
|
| Rate for Payer: United Healthcare Medicaid |
$274.92
|
| Rate for Payer: WEA Trust Commercial |
$1,128.60
|
| Rate for Payer: WPS Commercial |
$1,519.92
|
|
|
PART REMOVAL OF METATARSAL 28112
|
Professional
|
Both
|
$2,316.00
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
3014202
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$271.17 |
| Max. Negotiated Rate |
$2,200.20 |
| Rate for Payer: Aetna Commercial |
$2,200.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.76
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cigna Commercial |
$2,200.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,389.60
|
| Rate for Payer: Health EOS Commercial |
$2,107.56
|
| Rate for Payer: HFN Commercial |
$2,200.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,049.57
|
| Rate for Payer: Multiplan Commercial |
$1,852.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,200.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,019.04
|
| Rate for Payer: Quartz Commercial |
$1,320.12
|
| Rate for Payer: The Alliance Commercial |
$1,158.00
|
| Rate for Payer: United Healthcare Medicaid |
$271.17
|
| Rate for Payer: WEA Trust Commercial |
$1,273.80
|
| Rate for Payer: WPS Commercial |
$1,715.46
|
|
|
PART REMOVAL OF METATARSAL 28113
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
3014203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$2,336.05 |
| Rate for Payer: Aetna Commercial |
$2,336.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,114.74
|
| Rate for Payer: Cash Price |
$737.70
|
| Rate for Payer: Cash Price |
$737.70
|
| Rate for Payer: Cigna Commercial |
$2,336.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,475.40
|
| Rate for Payer: Health EOS Commercial |
$2,237.69
|
| Rate for Payer: HFN Commercial |
$2,336.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,432.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,432.72
|
| Rate for Payer: Multiplan Commercial |
$1,967.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,336.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,081.96
|
| Rate for Payer: Quartz Commercial |
$1,401.63
|
| Rate for Payer: The Alliance Commercial |
$1,229.50
|
| Rate for Payer: United Healthcare Medicaid |
$90.38
|
| Rate for Payer: WEA Trust Commercial |
$1,352.45
|
| Rate for Payer: WPS Commercial |
$1,821.38
|
|
