|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$140,765.04
|
|
|
Service Code
|
MSDRG 326
|
| Min. Negotiated Rate |
$38,701.27 |
| Max. Negotiated Rate |
$140,765.04 |
| Rate for Payer: Aetna Managed Medicare |
$38,701.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108,821.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83,410.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79,245.40
|
| Rate for Payer: Anthem Medicare Advantage |
$38,701.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38,701.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38,701.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38,701.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87,969.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38,701.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103,002.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38,701.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38,701.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38,701.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38,701.27
|
| Rate for Payer: NAPHCARE Commercial |
$58,051.91
|
| Rate for Payer: Quartz Medicare Advantage |
$38,701.27
|
| Rate for Payer: The Alliance Commercial |
$140,765.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,701.27
|
| Rate for Payer: United Healthcare PPO |
$80,188.47
|
| Rate for Payer: Wellcare Medicare |
$38,701.27
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$44,497.44
|
|
|
Service Code
|
MSDRG 328
|
| Min. Negotiated Rate |
$12,777.51 |
| Max. Negotiated Rate |
$44,497.44 |
| Rate for Payer: Aetna Managed Medicare |
$12,777.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,960.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,797.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,459.14
|
| Rate for Payer: Anthem Medicare Advantage |
$12,777.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,777.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,777.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,777.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,261.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,777.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,393.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,777.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,777.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,777.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,777.51
|
| Rate for Payer: NAPHCARE Commercial |
$19,166.27
|
| Rate for Payer: Quartz Medicare Advantage |
$12,777.51
|
| Rate for Payer: The Alliance Commercial |
$44,497.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,777.51
|
| Rate for Payer: United Healthcare PPO |
$25,218.55
|
| Rate for Payer: Wellcare Medicare |
$12,777.51
|
|
|
STOMAHESIVE WAFER 4X4
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
2963916
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
STOMAHESIVE WAFER 4X4
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
2963916
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$24.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$53.04
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$53.04
|
| Rate for Payer: The Alliance Commercial |
$44.20
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
STOMAHESIVE WAFER 8X8
|
Facility
|
IP
|
$216.00
|
|
| Hospital Charge Code |
2963712
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$134.78
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
STOMAHESIVE WAFER 8X8
|
Facility
|
OP
|
$216.00
|
|
| Hospital Charge Code |
2963712
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Aetna Managed Medicare |
$62.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.71
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.48
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: NAPHCARE Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: Quartz Medicare Advantage |
$134.78
|
| Rate for Payer: The Alliance Commercial |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
STOMAL URETERAL STENT CHANGE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960391
|
|
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
|
|
|
STOMAL URETERAL STENT CHANGE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960391
|
|
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
|
|
|
Stone Analysis
|
Facility
|
OP
|
$222.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
3241498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$212.41 |
| Rate for Payer: Aetna Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.04
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$212.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.04
|
| Rate for Payer: Health EOS Commercial |
$205.48
|
| Rate for Payer: HFN Commercial |
$212.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.04
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: NAPHCARE Commercial |
$18.06
|
| Rate for Payer: Preferred Network Access Commercial |
$212.41
|
| Rate for Payer: Quartz Beloit One Network |
$113.13
|
| Rate for Payer: Quartz Commercial |
$150.07
|
| Rate for Payer: Quartz Medicare Advantage |
$12.04
|
| Rate for Payer: The Alliance Commercial |
$48.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.04
|
| Rate for Payer: United Healthcare PPO |
$173.16
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: Wellcare Medicare |
$12.04
|
| Rate for Payer: WPS Commercial |
$171.01
|
|
|
Stone Analysis
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
3241498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna Commercial |
$219.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.04
|
| Rate for Payer: Anthem Medicare Advantage |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.04
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$219.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.04
|
| Rate for Payer: Health EOS Commercial |
$210.10
|
| Rate for Payer: HFN Commercial |
$219.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.04
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: NAPHCARE Commercial |
$18.06
|
| Rate for Payer: Preferred Network Access Commercial |
$219.34
|
| Rate for Payer: Quartz Beloit One Network |
$101.59
|
| Rate for Payer: Quartz Commercial |
$131.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.04
|
| Rate for Payer: The Alliance Commercial |
$47.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.04
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: WPS Commercial |
$52.99
|
|
|
Stone Analysis
|
Facility
|
IP
|
$222.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
3241498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.13 |
| Max. Negotiated Rate |
$212.41 |
| Rate for Payer: Aetna Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.37
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$212.41
|
| Rate for Payer: Health EOS Commercial |
$205.48
|
| Rate for Payer: HFN Commercial |
$212.41
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: Preferred Network Access Commercial |
$212.41
|
| Rate for Payer: Quartz Beloit One Network |
$113.13
|
| Rate for Payer: Quartz Commercial |
$138.53
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: WPS Commercial |
$171.01
|
|
|
Stone Analysis Charge
|
Facility
|
OP
|
$206.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
4063449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna Commercial |
$192.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.25
|
| Rate for Payer: Aetna Managed Medicare |
$12.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.04
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$197.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.04
|
| Rate for Payer: Health EOS Commercial |
$190.67
|
| Rate for Payer: HFN Commercial |
$197.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.04
|
| Rate for Payer: Multiplan Commercial |
$171.39
|
| Rate for Payer: NAPHCARE Commercial |
$18.06
|
| Rate for Payer: Preferred Network Access Commercial |
$197.10
|
| Rate for Payer: Quartz Beloit One Network |
$104.98
|
| Rate for Payer: Quartz Commercial |
$139.26
|
| Rate for Payer: Quartz Medicare Advantage |
$12.04
|
| Rate for Payer: The Alliance Commercial |
$48.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.04
|
| Rate for Payer: United Healthcare PPO |
$160.68
|
| Rate for Payer: WEA Trust Commercial |
$117.83
|
| Rate for Payer: Wellcare Medicare |
$12.04
|
| Rate for Payer: WPS Commercial |
$158.68
|
|
|
Stone Analysis Charge
|
Facility
|
IP
|
$206.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
4063449
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.98 |
| Max. Negotiated Rate |
$197.10 |
| Rate for Payer: Aetna Commercial |
$192.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.55
|
| Rate for Payer: Cash Price |
$61.80
|
| Rate for Payer: Cigna Commercial |
$197.10
|
| Rate for Payer: Health EOS Commercial |
$190.67
|
| Rate for Payer: HFN Commercial |
$197.10
|
| Rate for Payer: Multiplan Commercial |
$171.39
|
| Rate for Payer: Preferred Network Access Commercial |
$197.10
|
| Rate for Payer: Quartz Beloit One Network |
$104.98
|
| Rate for Payer: Quartz Commercial |
$128.54
|
| Rate for Payer: WEA Trust Commercial |
$117.83
|
| Rate for Payer: WPS Commercial |
$158.68
|
|
|
STONE CATCHER WITH TUBING LITHOCLAST M0068407501
|
Facility
|
OP
|
$1,179.00
|
|
| Hospital Charge Code |
5415202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.32 |
| Max. Negotiated Rate |
$1,128.07 |
| Rate for Payer: Aetna Commercial |
$1,103.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.50
|
| Rate for Payer: Aetna Managed Medicare |
$343.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.86
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,128.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.18
|
| Rate for Payer: Health EOS Commercial |
$1,091.28
|
| Rate for Payer: HFN Commercial |
$1,128.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$919.62
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: NAPHCARE Commercial |
$735.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.07
|
| Rate for Payer: Quartz Beloit One Network |
$600.82
|
| Rate for Payer: Quartz Commercial |
$797.00
|
| Rate for Payer: Quartz Medicare Advantage |
$735.70
|
| Rate for Payer: The Alliance Commercial |
$613.08
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$908.18
|
|
|
STONE CATCHER WITH TUBING LITHOCLAST M0068407501
|
Facility
|
IP
|
$1,179.00
|
|
| Hospital Charge Code |
5415202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$600.82 |
| Max. Negotiated Rate |
$1,128.07 |
| Rate for Payer: Aetna Commercial |
$1,103.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.86
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,128.07
|
| Rate for Payer: Health EOS Commercial |
$1,091.28
|
| Rate for Payer: HFN Commercial |
$1,128.07
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.07
|
| Rate for Payer: Quartz Beloit One Network |
$600.82
|
| Rate for Payer: Quartz Commercial |
$735.70
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$908.18
|
|
|
STONE MANIPULATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960392
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
STONE MANIPULATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960392
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Stone Risk Diagnostic Profile
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
Stone Risk Diagnostic Profile
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$6.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.41
|
| Rate for Payer: Anthem Medicare Advantage |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.27
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.27
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.27
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$9.41
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$6.27
|
| Rate for Payer: The Alliance Commercial |
$25.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.27
|
| Rate for Payer: United Healthcare PPO |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: Wellcare Medicare |
$6.27
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
Stone Risk Diagnostic Profile
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983409
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$86.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$6.27
|
| Rate for Payer: Anthem Medicare Advantage |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.27
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$86.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.27
|
| Rate for Payer: Health EOS Commercial |
$83.28
|
| Rate for Payer: HFN Commercial |
$86.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.27
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$9.41
|
| Rate for Payer: Preferred Network Access Commercial |
$86.94
|
| Rate for Payer: Quartz Beloit One Network |
$40.27
|
| Rate for Payer: Quartz Commercial |
$52.17
|
| Rate for Payer: Quartz Medicare Advantage |
$6.27
|
| Rate for Payer: The Alliance Commercial |
$24.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.27
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$27.59
|
|
|
Stone Track Diagnostic Monitoring Test
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$74.26
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
Stone Track Diagnostic Monitoring Test
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$117.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$6.27
|
| Rate for Payer: Anthem Medicare Advantage |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.27
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$117.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.27
|
| Rate for Payer: Health EOS Commercial |
$112.62
|
| Rate for Payer: HFN Commercial |
$117.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.27
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$9.41
|
| Rate for Payer: Preferred Network Access Commercial |
$117.57
|
| Rate for Payer: Quartz Beloit One Network |
$54.45
|
| Rate for Payer: Quartz Commercial |
$70.54
|
| Rate for Payer: Quartz Medicare Advantage |
$6.27
|
| Rate for Payer: The Alliance Commercial |
$24.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.27
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$27.59
|
|
|
Stone Track Diagnostic Monitoring Test
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
983410
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.27 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$6.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.41
|
| Rate for Payer: Anthem Medicare Advantage |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.27
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.27
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.27
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$9.41
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$80.44
|
| Rate for Payer: Quartz Medicare Advantage |
$6.27
|
| Rate for Payer: The Alliance Commercial |
$25.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.27
|
| Rate for Payer: United Healthcare PPO |
$92.82
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: Wellcare Medicare |
$6.27
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
Stool Culture to Quest
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5472907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
Stool Culture to Quest
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87427
|
| Hospital Charge Code |
5472907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
