|
Phase II Non-COPD - Pulmonary Rehab
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS G0239
|
| Hospital Charge Code |
2990160
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare PPO |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
Phencyclidine Meconium
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2942890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Phencyclidine Meconium
|
Professional
|
Both
|
$38.00
|
|
| Hospital Charge Code |
2942890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$37.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.71
|
| Rate for Payer: Health EOS Commercial |
$35.96
|
| Rate for Payer: HFN Commercial |
$37.54
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$37.54
|
| Rate for Payer: Quartz Beloit One Network |
$17.39
|
| Rate for Payer: Quartz Commercial |
$22.53
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Phencyclidine Meconium
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2942890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.64
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$23.71
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$23.71
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: United Healthcare PPO |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Phencyclidine, Quant, GC/MS, Urine
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
983359
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.10 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$149.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.22
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.58
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$149.19
|
| Rate for Payer: Quartz Beloit One Network |
$69.10
|
| Rate for Payer: Quartz Commercial |
$89.51
|
| Rate for Payer: The Alliance Commercial |
$78.52
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Phencyclidine, Quant, GC/MS, Urine
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
983359
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.97 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$43.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.78
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$94.22
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$94.22
|
| Rate for Payer: The Alliance Commercial |
$78.52
|
| Rate for Payer: United Healthcare PPO |
$117.78
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Phencyclidine, Quant, GC/MS, Urine
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 83992
|
| Hospital Charge Code |
983359
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Phenergan 50 mg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
2958938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$11.35 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$4.13
|
| Rate for Payer: Anthem Medicare Advantage |
$4.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.13
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.22
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.13
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$6.19
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4.13
|
| Rate for Payer: The Alliance Commercial |
$11.35
|
| Rate for Payer: United Healthcare Medicaid |
$4.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.13
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$8.06
|
|
|
Phenergan 50 mg Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
2958938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$16.52 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.26
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$16.52
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$8.06
|
|
|
Phenergan 50 mg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J2550
|
| Hospital Charge Code |
2958938
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Phenobarbital
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
1037307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$70.01 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$29.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$28.39
|
| Rate for Payer: HFN Commercial |
$29.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$23.87
|
| Rate for Payer: Preferred Network Access Commercial |
$29.64
|
| Rate for Payer: Quartz Beloit One Network |
$13.73
|
| Rate for Payer: Quartz Commercial |
$17.78
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$62.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$70.01
|
|
|
Phenobarbital
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
2942975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.41
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$23.87
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$63.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$15.91
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Phenobarbital
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
1037307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.41
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$23.87
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$63.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: United Healthcare PPO |
$23.40
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: Wellcare Medicare |
$15.91
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Phenobarbital
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
2942975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$70.01 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$23.87
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$62.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$70.01
|
|
|
Phenobarbital
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
2942975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Phenobarbital
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
1037307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Phenobarbital JW Waste Charge per 120 mg
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
HCPCS J2560 JW
|
| Hospital Charge Code |
5266679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
Phenobarbital JW Waste Charge per 120 mg
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
HCPCS J2560 JW
|
| Hospital Charge Code |
5266679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$45.13 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$107.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.13
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$229.63
|
| Rate for Payer: The Alliance Commercial |
$191.36
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$85.28
|
|
|
Phenobarbital JW Waste Charge per 120 mg
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
HCPCS J2560 JW
|
| Hospital Charge Code |
5266679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.24 |
| Max. Negotiated Rate |
$363.58 |
| Rate for Payer: Aetna Commercial |
$363.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$363.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.11
|
| Rate for Payer: Health EOS Commercial |
$348.28
|
| Rate for Payer: HFN Commercial |
$363.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$363.58
|
| Rate for Payer: Quartz Beloit One Network |
$168.40
|
| Rate for Payer: Quartz Commercial |
$218.15
|
| Rate for Payer: The Alliance Commercial |
$191.36
|
| Rate for Payer: United Healthcare Medicaid |
$30.24
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$85.28
|
|
|
Phenobarbital Level
|
Professional
|
Both
|
$269.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
633800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$265.77 |
| Rate for Payer: Aetna Commercial |
$265.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$265.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$254.58
|
| Rate for Payer: HFN Commercial |
$265.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$23.87
|
| Rate for Payer: Preferred Network Access Commercial |
$265.77
|
| Rate for Payer: Quartz Beloit One Network |
$123.09
|
| Rate for Payer: Quartz Commercial |
$159.46
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$62.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$70.01
|
|
|
Phenobarbital Level
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
633800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.08 |
| Max. Negotiated Rate |
$257.38 |
| Rate for Payer: Aetna Commercial |
$251.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.27
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$257.38
|
| Rate for Payer: Health EOS Commercial |
$248.99
|
| Rate for Payer: HFN Commercial |
$257.38
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: Preferred Network Access Commercial |
$257.38
|
| Rate for Payer: Quartz Beloit One Network |
$137.08
|
| Rate for Payer: Quartz Commercial |
$167.86
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: WPS Commercial |
$207.21
|
|
|
Phenobarbital Level
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
CPT 80184
|
| Hospital Charge Code |
633800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$257.38 |
| Rate for Payer: Aetna Commercial |
$251.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.59
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.41
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$257.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$248.99
|
| Rate for Payer: HFN Commercial |
$257.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$223.81
|
| Rate for Payer: NAPHCARE Commercial |
$23.87
|
| Rate for Payer: Preferred Network Access Commercial |
$257.38
|
| Rate for Payer: Quartz Beloit One Network |
$137.08
|
| Rate for Payer: Quartz Commercial |
$181.84
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$63.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: United Healthcare PPO |
$209.82
|
| Rate for Payer: WEA Trust Commercial |
$153.87
|
| Rate for Payer: Wellcare Medicare |
$15.91
|
| Rate for Payer: WPS Commercial |
$207.21
|
|
|
PhenoSense
|
Facility
|
IP
|
$2,081.00
|
|
|
Service Code
|
CPT 87903
|
| Hospital Charge Code |
5502672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,060.48 |
| Max. Negotiated Rate |
$1,991.10 |
| Rate for Payer: Aetna Commercial |
$1,947.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,147.05
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cigna Commercial |
$1,991.10
|
| Rate for Payer: Health EOS Commercial |
$1,926.17
|
| Rate for Payer: HFN Commercial |
$1,991.10
|
| Rate for Payer: Multiplan Commercial |
$1,731.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,991.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.48
|
| Rate for Payer: Quartz Commercial |
$1,298.54
|
| Rate for Payer: WEA Trust Commercial |
$1,190.33
|
| Rate for Payer: WPS Commercial |
$1,602.99
|
|
|
PhenoSense
|
Facility
|
OP
|
$2,081.00
|
|
|
Service Code
|
CPT 87903
|
| Hospital Charge Code |
5502672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$508.21 |
| Max. Negotiated Rate |
$2,032.83 |
| Rate for Payer: Aetna Commercial |
$1,947.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.25
|
| Rate for Payer: Aetna Managed Medicare |
$508.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,905.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$889.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.62
|
| Rate for Payer: Anthem Medicare Advantage |
$508.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,147.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$508.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$508.21
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cigna Commercial |
$1,991.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$508.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,211.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$508.21
|
| Rate for Payer: Health EOS Commercial |
$1,926.17
|
| Rate for Payer: HFN Commercial |
$1,991.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,890.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$508.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$508.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$508.21
|
| Rate for Payer: Multiplan Commercial |
$1,731.39
|
| Rate for Payer: NAPHCARE Commercial |
$762.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,991.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.48
|
| Rate for Payer: Quartz Commercial |
$1,406.76
|
| Rate for Payer: Quartz Medicare Advantage |
$508.21
|
| Rate for Payer: The Alliance Commercial |
$2,032.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$508.21
|
| Rate for Payer: United Healthcare PPO |
$1,623.18
|
| Rate for Payer: WEA Trust Commercial |
$1,190.33
|
| Rate for Payer: Wellcare Medicare |
$508.21
|
| Rate for Payer: WPS Commercial |
$1,602.99
|
|
|
PhenoSense
|
Professional
|
Both
|
$2,081.00
|
|
|
Service Code
|
CPT 87903
|
| Hospital Charge Code |
5502672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$508.21 |
| Max. Negotiated Rate |
$2,236.11 |
| Rate for Payer: Aetna Commercial |
$2,056.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.25
|
| Rate for Payer: Aetna Managed Medicare |
$508.21
|
| Rate for Payer: Anthem Medicare Advantage |
$508.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$508.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$508.21
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cigna Commercial |
$2,056.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,082.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$508.21
|
| Rate for Payer: Health EOS Commercial |
$1,969.46
|
| Rate for Payer: HFN Commercial |
$2,056.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,793.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,793.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$508.21
|
| Rate for Payer: Multiplan Commercial |
$1,731.39
|
| Rate for Payer: NAPHCARE Commercial |
$762.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,056.03
|
| Rate for Payer: Quartz Beloit One Network |
$952.27
|
| Rate for Payer: Quartz Commercial |
$1,233.62
|
| Rate for Payer: Quartz Medicare Advantage |
$508.21
|
| Rate for Payer: The Alliance Commercial |
$2,007.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$508.21
|
| Rate for Payer: WEA Trust Commercial |
$1,190.33
|
| Rate for Payer: WPS Commercial |
$2,236.11
|
|
