|
Skin Substitute Apligraft 1 Sq Cm Q4101
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
3542168
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.84 |
| Max. Negotiated Rate |
$348.66 |
| Rate for Payer: Aetna Commercial |
$170.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$126.79
|
| Rate for Payer: Anthem Medicare Advantage |
$126.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.79
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$170.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.84
|
| Rate for Payer: Health EOS Commercial |
$163.73
|
| Rate for Payer: HFN Commercial |
$170.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.79
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$190.18
|
| Rate for Payer: Preferred Network Access Commercial |
$170.92
|
| Rate for Payer: Quartz Beloit One Network |
$79.16
|
| Rate for Payer: Quartz Commercial |
$102.55
|
| Rate for Payer: Quartz Medicare Advantage |
$126.79
|
| Rate for Payer: The Alliance Commercial |
$348.66
|
| Rate for Payer: United Healthcare Medicaid |
$32.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.79
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$79.61
|
|
|
SKIN TISSUE REARRANGEMENT 14000
|
Professional
|
Both
|
$2,167.00
|
|
|
Service Code
|
CPT 14000
|
| Hospital Charge Code |
3013619
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.56 |
| Max. Negotiated Rate |
$2,141.00 |
| Rate for Payer: Aetna Commercial |
$2,141.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,938.16
|
| Rate for Payer: Aetna Managed Medicare |
$448.01
|
| Rate for Payer: Anthem Medicare Advantage |
$448.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$448.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$448.01
|
| Rate for Payer: Cash Price |
$650.10
|
| Rate for Payer: Cash Price |
$650.10
|
| Rate for Payer: Cash Price |
$650.10
|
| Rate for Payer: Cigna Commercial |
$2,141.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$448.01
|
| Rate for Payer: Health EOS Commercial |
$2,050.85
|
| Rate for Payer: HFN Commercial |
$2,141.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,719.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,719.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$448.01
|
| Rate for Payer: Multiplan Commercial |
$1,802.94
|
| Rate for Payer: NAPHCARE Commercial |
$672.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,141.00
|
| Rate for Payer: Quartz Beloit One Network |
$991.62
|
| Rate for Payer: Quartz Commercial |
$1,284.60
|
| Rate for Payer: Quartz Medicare Advantage |
$448.01
|
| Rate for Payer: The Alliance Commercial |
$1,904.05
|
| Rate for Payer: United Healthcare Medicaid |
$203.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$448.01
|
| Rate for Payer: WEA Trust Commercial |
$1,239.52
|
| Rate for Payer: WPS Commercial |
$2,016.05
|
|
|
SKIN TISSUE REARRANGEMENT 14001
|
Professional
|
Both
|
$1,966.00
|
|
|
Service Code
|
CPT 14001
|
| Hospital Charge Code |
3013620
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$335.46 |
| Max. Negotiated Rate |
$2,589.12 |
| Rate for Payer: Aetna Commercial |
$1,942.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,758.39
|
| Rate for Payer: Aetna Managed Medicare |
$575.36
|
| Rate for Payer: Anthem Medicare Advantage |
$575.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.36
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cash Price |
$589.80
|
| Rate for Payer: Cigna Commercial |
$1,942.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$335.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.36
|
| Rate for Payer: Health EOS Commercial |
$1,860.62
|
| Rate for Payer: HFN Commercial |
$1,942.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,228.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,228.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.36
|
| Rate for Payer: Multiplan Commercial |
$1,635.71
|
| Rate for Payer: NAPHCARE Commercial |
$863.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,942.41
|
| Rate for Payer: Quartz Beloit One Network |
$899.64
|
| Rate for Payer: Quartz Commercial |
$1,165.44
|
| Rate for Payer: Quartz Medicare Advantage |
$575.36
|
| Rate for Payer: The Alliance Commercial |
$2,445.28
|
| Rate for Payer: United Healthcare Medicaid |
$335.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.36
|
| Rate for Payer: WEA Trust Commercial |
$1,124.55
|
| Rate for Payer: WPS Commercial |
$2,589.12
|
|
|
SKIN TISSUE REARRANGEMENT 14020
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
CPT 14020
|
| Hospital Charge Code |
3013621
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$378.41 |
| Max. Negotiated Rate |
$2,207.37 |
| Rate for Payer: Aetna Commercial |
$1,019.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Aetna Managed Medicare |
$490.53
|
| Rate for Payer: Anthem Medicare Advantage |
$490.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$490.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$490.53
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$1,019.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$378.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.53
|
| Rate for Payer: Health EOS Commercial |
$976.68
|
| Rate for Payer: HFN Commercial |
$1,019.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,946.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,946.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$490.53
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: NAPHCARE Commercial |
$735.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,019.62
|
| Rate for Payer: Quartz Beloit One Network |
$472.24
|
| Rate for Payer: Quartz Commercial |
$611.77
|
| Rate for Payer: Quartz Medicare Advantage |
$490.53
|
| Rate for Payer: The Alliance Commercial |
$2,084.74
|
| Rate for Payer: United Healthcare Medicaid |
$378.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$490.53
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$2,207.37
|
|
|
SKIN TISSUE REARRANGEMENT 14021
|
Professional
|
Both
|
$3,831.00
|
|
|
Service Code
|
CPT 14021
|
| Hospital Charge Code |
3013622
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$602.22 |
| Max. Negotiated Rate |
$3,785.03 |
| Rate for Payer: Aetna Commercial |
$3,785.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,426.45
|
| Rate for Payer: Aetna Managed Medicare |
$602.22
|
| Rate for Payer: Anthem Medicare Advantage |
$602.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$602.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$602.22
|
| Rate for Payer: Cash Price |
$1,149.30
|
| Rate for Payer: Cash Price |
$1,149.30
|
| Rate for Payer: Cash Price |
$1,149.30
|
| Rate for Payer: Cigna Commercial |
$3,785.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$653.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$602.22
|
| Rate for Payer: Health EOS Commercial |
$3,625.66
|
| Rate for Payer: HFN Commercial |
$3,785.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,443.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,443.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$602.22
|
| Rate for Payer: Multiplan Commercial |
$3,187.39
|
| Rate for Payer: NAPHCARE Commercial |
$903.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3,785.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,753.07
|
| Rate for Payer: Quartz Commercial |
$2,271.02
|
| Rate for Payer: Quartz Medicare Advantage |
$602.22
|
| Rate for Payer: The Alliance Commercial |
$2,559.45
|
| Rate for Payer: United Healthcare Medicaid |
$653.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$602.22
|
| Rate for Payer: WEA Trust Commercial |
$2,191.33
|
| Rate for Payer: WPS Commercial |
$2,710.00
|
|
|
SKIN TISSUE REARRANGEMENT 14040
|
Professional
|
Both
|
$3,302.00
|
|
|
Service Code
|
CPT 14040
|
| Hospital Charge Code |
3013623
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$405.36 |
| Max. Negotiated Rate |
$3,262.38 |
| Rate for Payer: Aetna Commercial |
$3,262.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,953.31
|
| Rate for Payer: Aetna Managed Medicare |
$532.18
|
| Rate for Payer: Anthem Medicare Advantage |
$532.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$532.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$532.18
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Cash Price |
$990.60
|
| Rate for Payer: Cigna Commercial |
$3,262.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$405.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.18
|
| Rate for Payer: Health EOS Commercial |
$3,125.01
|
| Rate for Payer: HFN Commercial |
$3,262.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,156.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,156.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$532.18
|
| Rate for Payer: Multiplan Commercial |
$2,747.26
|
| Rate for Payer: NAPHCARE Commercial |
$798.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,262.38
|
| Rate for Payer: Quartz Beloit One Network |
$1,511.00
|
| Rate for Payer: Quartz Commercial |
$1,957.43
|
| Rate for Payer: Quartz Medicare Advantage |
$532.18
|
| Rate for Payer: The Alliance Commercial |
$2,261.76
|
| Rate for Payer: United Healthcare Medicaid |
$405.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$532.18
|
| Rate for Payer: WEA Trust Commercial |
$1,888.74
|
| Rate for Payer: WPS Commercial |
$2,394.80
|
|
|
SKIN TISSUE REARRANGEMENT 14041
|
Professional
|
Both
|
$3,998.00
|
|
|
Service Code
|
CPT 14041
|
| Hospital Charge Code |
3013624
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$636.76 |
| Max. Negotiated Rate |
$3,950.02 |
| Rate for Payer: Aetna Commercial |
$3,950.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,575.81
|
| Rate for Payer: Aetna Managed Medicare |
$636.76
|
| Rate for Payer: Anthem Medicare Advantage |
$636.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$636.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$636.76
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cash Price |
$1,199.40
|
| Rate for Payer: Cigna Commercial |
$3,950.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$783.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.76
|
| Rate for Payer: Health EOS Commercial |
$3,783.71
|
| Rate for Payer: HFN Commercial |
$3,950.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,639.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,639.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$636.76
|
| Rate for Payer: Multiplan Commercial |
$3,326.34
|
| Rate for Payer: NAPHCARE Commercial |
$955.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,950.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,829.48
|
| Rate for Payer: Quartz Commercial |
$2,370.01
|
| Rate for Payer: Quartz Medicare Advantage |
$636.76
|
| Rate for Payer: The Alliance Commercial |
$2,706.23
|
| Rate for Payer: United Healthcare Medicaid |
$783.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$636.76
|
| Rate for Payer: WEA Trust Commercial |
$2,286.86
|
| Rate for Payer: WPS Commercial |
$2,865.42
|
|
|
SKIN TISSUE REARRANGEMENT 14060
|
Professional
|
Both
|
$4,193.00
|
|
|
Service Code
|
CPT 14060
|
| Hospital Charge Code |
3013625
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$406.44 |
| Max. Negotiated Rate |
$4,142.68 |
| Rate for Payer: Aetna Commercial |
$4,142.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,750.22
|
| Rate for Payer: Aetna Managed Medicare |
$560.35
|
| Rate for Payer: Anthem Medicare Advantage |
$560.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$560.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$560.35
|
| Rate for Payer: Cash Price |
$1,257.90
|
| Rate for Payer: Cash Price |
$1,257.90
|
| Rate for Payer: Cash Price |
$1,257.90
|
| Rate for Payer: Cigna Commercial |
$4,142.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$406.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$560.35
|
| Rate for Payer: Health EOS Commercial |
$3,968.26
|
| Rate for Payer: HFN Commercial |
$4,142.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,299.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,299.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$560.35
|
| Rate for Payer: Multiplan Commercial |
$3,488.58
|
| Rate for Payer: NAPHCARE Commercial |
$840.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,142.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,918.72
|
| Rate for Payer: Quartz Commercial |
$2,485.61
|
| Rate for Payer: Quartz Medicare Advantage |
$560.35
|
| Rate for Payer: The Alliance Commercial |
$2,381.50
|
| Rate for Payer: United Healthcare Medicaid |
$406.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$560.35
|
| Rate for Payer: WEA Trust Commercial |
$2,398.40
|
| Rate for Payer: WPS Commercial |
$2,521.58
|
|
|
SKIN TISSUE REARRANGEMENT 14061
|
Professional
|
Both
|
$5,111.00
|
|
|
Service Code
|
CPT 14061
|
| Hospital Charge Code |
3013626
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$544.28 |
| Max. Negotiated Rate |
$5,049.67 |
| Rate for Payer: Aetna Commercial |
$5,049.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,571.28
|
| Rate for Payer: Aetna Managed Medicare |
$682.47
|
| Rate for Payer: Anthem Medicare Advantage |
$682.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$682.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$682.47
|
| Rate for Payer: Cash Price |
$1,533.30
|
| Rate for Payer: Cash Price |
$1,533.30
|
| Rate for Payer: Cash Price |
$1,533.30
|
| Rate for Payer: Cigna Commercial |
$5,049.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$544.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$682.47
|
| Rate for Payer: Health EOS Commercial |
$4,837.05
|
| Rate for Payer: HFN Commercial |
$5,049.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,831.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,831.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$682.47
|
| Rate for Payer: Multiplan Commercial |
$4,252.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,023.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,049.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,338.79
|
| Rate for Payer: Quartz Commercial |
$3,029.80
|
| Rate for Payer: Quartz Medicare Advantage |
$682.47
|
| Rate for Payer: The Alliance Commercial |
$2,900.49
|
| Rate for Payer: United Healthcare Medicaid |
$544.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$682.47
|
| Rate for Payer: WEA Trust Commercial |
$2,923.49
|
| Rate for Payer: WPS Commercial |
$3,071.11
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$6,576.23
|
|
|
Service Code
|
APR-DRG 3802
|
| Min. Negotiated Rate |
$5,841.42 |
| Max. Negotiated Rate |
$6,576.23 |
| Rate for Payer: Anthem Medicaid |
$6,297.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,297.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,297.10
|
| Rate for Payer: Dean Health Medicaid |
$6,297.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,841.42
|
| Rate for Payer: Managed Health Services Medicaid |
$6,576.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,297.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,297.10
|
| Rate for Payer: United Healthcare Medicaid |
$6,297.10
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$5,085.62
|
|
|
Service Code
|
APR-DRG 3801
|
| Min. Negotiated Rate |
$4,517.36 |
| Max. Negotiated Rate |
$5,085.62 |
| Rate for Payer: Anthem Medicaid |
$4,869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,869.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,869.76
|
| Rate for Payer: Dean Health Medicaid |
$4,869.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,517.36
|
| Rate for Payer: Managed Health Services Medicaid |
$5,085.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,869.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,869.76
|
| Rate for Payer: United Healthcare Medicaid |
$4,869.76
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$10,083.56
|
|
|
Service Code
|
APR-DRG 3803
|
| Min. Negotiated Rate |
$8,956.84 |
| Max. Negotiated Rate |
$10,083.56 |
| Rate for Payer: Anthem Medicaid |
$9,655.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,655.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,655.56
|
| Rate for Payer: Dean Health Medicaid |
$9,655.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,956.84
|
| Rate for Payer: Managed Health Services Medicaid |
$10,083.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,655.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,655.56
|
| Rate for Payer: United Healthcare Medicaid |
$9,655.56
|
|
|
SKIN ULCERS
|
Facility
|
IP
|
$17,536.62
|
|
|
Service Code
|
APR-DRG 3804
|
| Min. Negotiated Rate |
$15,577.12 |
| Max. Negotiated Rate |
$17,536.62 |
| Rate for Payer: Anthem Medicaid |
$16,792.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,792.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,792.28
|
| Rate for Payer: Dean Health Medicaid |
$16,792.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,577.12
|
| Rate for Payer: Managed Health Services Medicaid |
$17,536.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,792.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,792.28
|
| Rate for Payer: United Healthcare Medicaid |
$16,792.28
|
|
|
SKIN ULCERS WITH CC
|
Facility
|
IP
|
$33,786.48
|
|
|
Service Code
|
MSDRG 593
|
| Min. Negotiated Rate |
$9,591.70 |
| Max. Negotiated Rate |
$33,786.48 |
| Rate for Payer: Aetna Managed Medicare |
$9,591.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,884.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,839.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,849.26
|
| Rate for Payer: Anthem Medicare Advantage |
$9,591.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,591.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,591.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,591.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,924.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,591.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,536.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,591.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,591.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,591.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,591.70
|
| Rate for Payer: NAPHCARE Commercial |
$14,387.55
|
| Rate for Payer: Quartz Medicare Advantage |
$9,591.70
|
| Rate for Payer: The Alliance Commercial |
$33,786.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,591.70
|
| Rate for Payer: United Healthcare PPO |
$19,102.19
|
| Rate for Payer: Wellcare Medicare |
$9,591.70
|
|
|
SKIN ULCERS WITH MCC
|
Facility
|
IP
|
$58,123.52
|
|
|
Service Code
|
MSDRG 592
|
| Min. Negotiated Rate |
$15,327.69 |
| Max. Negotiated Rate |
$58,123.52 |
| Rate for Payer: Aetna Managed Medicare |
$15,327.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,226.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,366.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,750.21
|
| Rate for Payer: Anthem Medicare Advantage |
$15,327.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,327.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,327.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,327.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,135.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,327.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,387.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,327.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,327.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,327.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,327.69
|
| Rate for Payer: NAPHCARE Commercial |
$22,991.53
|
| Rate for Payer: Quartz Medicare Advantage |
$15,327.69
|
| Rate for Payer: The Alliance Commercial |
$58,123.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,327.69
|
| Rate for Payer: United Healthcare PPO |
$32,999.00
|
| Rate for Payer: Wellcare Medicare |
$15,327.69
|
|
|
SKIN ULCERS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,104.16
|
|
|
Service Code
|
MSDRG 594
|
| Min. Negotiated Rate |
$7,144.90 |
| Max. Negotiated Rate |
$22,104.16 |
| Rate for Payer: Aetna Managed Medicare |
$7,144.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,912.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,496.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,772.69
|
| Rate for Payer: Anthem Medicare Advantage |
$7,144.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,144.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,144.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,144.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,288.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,144.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,968.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,144.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,144.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,144.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,144.90
|
| Rate for Payer: NAPHCARE Commercial |
$10,717.36
|
| Rate for Payer: Quartz Medicare Advantage |
$7,144.90
|
| Rate for Payer: The Alliance Commercial |
$22,104.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,144.90
|
| Rate for Payer: United Healthcare PPO |
$12,431.66
|
| Rate for Payer: Wellcare Medicare |
$7,144.90
|
|
|
SKN SPLT A-GRFT FAC/NCK/HF/G 15120
|
Professional
|
Both
|
$3,886.00
|
|
|
Service Code
|
CPT 15120
|
| Hospital Charge Code |
3013636
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$590.28 |
| Max. Negotiated Rate |
$3,839.37 |
| Rate for Payer: Aetna Commercial |
$3,839.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,475.64
|
| Rate for Payer: Aetna Managed Medicare |
$590.28
|
| Rate for Payer: Anthem Medicare Advantage |
$590.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$590.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$590.28
|
| Rate for Payer: Cash Price |
$1,165.80
|
| Rate for Payer: Cash Price |
$1,165.80
|
| Rate for Payer: Cash Price |
$1,165.80
|
| Rate for Payer: Cigna Commercial |
$3,839.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$815.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$590.28
|
| Rate for Payer: Health EOS Commercial |
$3,677.71
|
| Rate for Payer: HFN Commercial |
$3,839.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,376.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,376.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$590.28
|
| Rate for Payer: Multiplan Commercial |
$3,233.15
|
| Rate for Payer: NAPHCARE Commercial |
$885.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,839.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,778.23
|
| Rate for Payer: Quartz Commercial |
$2,303.62
|
| Rate for Payer: Quartz Medicare Advantage |
$590.28
|
| Rate for Payer: The Alliance Commercial |
$2,508.70
|
| Rate for Payer: United Healthcare Medicaid |
$815.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$590.28
|
| Rate for Payer: WEA Trust Commercial |
$2,222.79
|
| Rate for Payer: WPS Commercial |
$2,656.27
|
|
|
SLEEP APNEA CPAP
|
Facility
|
OP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3059529
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,462.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$5,183.57
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$5,981.04
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
|
SLEEP APNEA CPAP
|
Facility
|
IP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3059529
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,907.61 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$4,784.83
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
|
SLEEP APNEA PROCEDURE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960378
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
SLEEP APNEA PROCEDURE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960378
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
SLEEP STD AIRFLOW HRT RATE&O2 SAT EFFORT UNATT 9580626
|
Professional
|
Both
|
$1,023.00
|
|
|
Service Code
|
CPT 95806 26
|
| Hospital Charge Code |
6172223
|
|
Hospital Revenue Code
|
511
|
| Min. Negotiated Rate |
$45.02 |
| Max. Negotiated Rate |
$1,010.72 |
| Rate for Payer: Aetna Commercial |
$1,010.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.97
|
| Rate for Payer: Aetna Managed Medicare |
$45.02
|
| Rate for Payer: Anthem Medicare Advantage |
$45.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.02
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$1,010.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.02
|
| Rate for Payer: Health EOS Commercial |
$968.17
|
| Rate for Payer: HFN Commercial |
$1,010.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$160.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.02
|
| Rate for Payer: Multiplan Commercial |
$851.14
|
| Rate for Payer: NAPHCARE Commercial |
$67.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,010.72
|
| Rate for Payer: Quartz Beloit One Network |
$468.12
|
| Rate for Payer: Quartz Commercial |
$606.43
|
| Rate for Payer: Quartz Medicare Advantage |
$45.02
|
| Rate for Payer: The Alliance Commercial |
$112.55
|
| Rate for Payer: United Healthcare Medicaid |
$62.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.02
|
| Rate for Payer: WEA Trust Commercial |
$585.16
|
| Rate for Payer: WPS Commercial |
$180.09
|
|
|
SLEEP STUDIES ATTENDED
|
Facility
|
OP
|
$613.22
|
|
|
Service Code
|
EAPG 00222
|
| Min. Negotiated Rate |
$589.63 |
| Max. Negotiated Rate |
$613.22 |
| Rate for Payer: Anthem Medicaid |
$589.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$589.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$589.63
|
| Rate for Payer: Dean Health Medicaid |
$589.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$589.63
|
| Rate for Payer: Managed Health Services Medicaid |
$613.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$589.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$589.63
|
| Rate for Payer: United Healthcare Medicaid |
$589.63
|
|
|
SLEEP STUDIES UNATTENDED
|
Facility
|
OP
|
$345.92
|
|
|
Service Code
|
EAPG 00226
|
| Min. Negotiated Rate |
$332.61 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Anthem Medicaid |
$332.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$332.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$332.61
|
| Rate for Payer: Dean Health Medicaid |
$332.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$332.61
|
| Rate for Payer: Managed Health Services Medicaid |
$345.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$332.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$332.61
|
| Rate for Payer: United Healthcare Medicaid |
$332.61
|
|
|
SLEEVE COMPRESSION LARGE
|
Facility
|
OP
|
$465.00
|
|
| Hospital Charge Code |
2963056
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.41 |
| Max. Negotiated Rate |
$444.91 |
| Rate for Payer: Aetna Commercial |
$435.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$415.90
|
| Rate for Payer: Aetna Managed Medicare |
$135.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$314.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$241.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.31
|
| Rate for Payer: Cash Price |
$139.50
|
| Rate for Payer: Cigna Commercial |
$444.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.63
|
| Rate for Payer: Health EOS Commercial |
$430.40
|
| Rate for Payer: HFN Commercial |
$444.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$362.70
|
| Rate for Payer: Multiplan Commercial |
$386.88
|
| Rate for Payer: NAPHCARE Commercial |
$290.16
|
| Rate for Payer: Preferred Network Access Commercial |
$444.91
|
| Rate for Payer: Quartz Beloit One Network |
$236.96
|
| Rate for Payer: Quartz Commercial |
$314.34
|
| Rate for Payer: Quartz Medicare Advantage |
$290.16
|
| Rate for Payer: The Alliance Commercial |
$241.80
|
| Rate for Payer: WEA Trust Commercial |
$265.98
|
| Rate for Payer: WPS Commercial |
$358.19
|
|
