|
Testosterone pellet 75 mg S0189
|
Facility
|
OP
|
$142.00
|
|
| Hospital Charge Code |
3382853
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$41.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.76
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$88.61
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$95.99
|
| Rate for Payer: Quartz Medicare Advantage |
$88.61
|
| Rate for Payer: The Alliance Commercial |
$73.84
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
Testosterone pellet 75 mg S0189
|
Facility
|
IP
|
$142.00
|
|
| Hospital Charge Code |
3382853
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$88.61
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
Testosterone, Total Males
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
4004575
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$311.92 |
| Rate for Payer: Aetna Commercial |
$305.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Aetna Managed Medicare |
$26.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.56
|
| Rate for Payer: Anthem Medicare Advantage |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.84
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$311.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.84
|
| Rate for Payer: Health EOS Commercial |
$301.75
|
| Rate for Payer: HFN Commercial |
$311.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.84
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: NAPHCARE Commercial |
$40.26
|
| Rate for Payer: Preferred Network Access Commercial |
$311.92
|
| Rate for Payer: Quartz Beloit One Network |
$166.13
|
| Rate for Payer: Quartz Commercial |
$220.38
|
| Rate for Payer: Quartz Medicare Advantage |
$26.84
|
| Rate for Payer: The Alliance Commercial |
$107.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.84
|
| Rate for Payer: United Healthcare PPO |
$254.28
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: Wellcare Medicare |
$26.84
|
| Rate for Payer: WPS Commercial |
$251.12
|
|
|
Testosterone, Total Males
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
4004575
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.13 |
| Max. Negotiated Rate |
$311.92 |
| Rate for Payer: Aetna Commercial |
$305.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.69
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$311.92
|
| Rate for Payer: Health EOS Commercial |
$301.75
|
| Rate for Payer: HFN Commercial |
$311.92
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: Preferred Network Access Commercial |
$311.92
|
| Rate for Payer: Quartz Beloit One Network |
$166.13
|
| Rate for Payer: Quartz Commercial |
$203.42
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: WPS Commercial |
$251.12
|
|
|
Testosterone, Total Males
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
CPT 84403
|
| Hospital Charge Code |
4004575
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$322.09 |
| Rate for Payer: Aetna Commercial |
$322.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Aetna Managed Medicare |
$26.84
|
| Rate for Payer: Anthem Medicare Advantage |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.84
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$322.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$169.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.84
|
| Rate for Payer: Health EOS Commercial |
$308.53
|
| Rate for Payer: HFN Commercial |
$322.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.84
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: NAPHCARE Commercial |
$40.26
|
| Rate for Payer: Preferred Network Access Commercial |
$322.09
|
| Rate for Payer: Quartz Beloit One Network |
$149.18
|
| Rate for Payer: Quartz Commercial |
$193.25
|
| Rate for Payer: Quartz Medicare Advantage |
$26.84
|
| Rate for Payer: The Alliance Commercial |
$106.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.84
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: WPS Commercial |
$118.11
|
|
|
Tetanus AB
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
4510783
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$15.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.39
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.39
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.39
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$23.09
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| Rate for Payer: Quartz Medicare Advantage |
$15.39
|
| Rate for Payer: The Alliance Commercial |
$61.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.39
|
| Rate for Payer: United Healthcare PPO |
$102.18
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: Wellcare Medicare |
$15.39
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Tetanus AB
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
4510783
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$129.43 |
| Rate for Payer: Aetna Commercial |
$129.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$15.39
|
| Rate for Payer: Anthem Medicare Advantage |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.39
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$129.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.39
|
| Rate for Payer: Health EOS Commercial |
$123.98
|
| Rate for Payer: HFN Commercial |
$129.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.39
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$23.09
|
| Rate for Payer: Preferred Network Access Commercial |
$129.43
|
| Rate for Payer: Quartz Beloit One Network |
$59.95
|
| Rate for Payer: Quartz Commercial |
$77.66
|
| Rate for Payer: Quartz Medicare Advantage |
$15.39
|
| Rate for Payer: The Alliance Commercial |
$60.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.39
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$67.72
|
|
|
Tetanus AB
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
4510783
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Tetanus Antibody
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
978076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$257.87 |
| Rate for Payer: Aetna Commercial |
$257.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$15.39
|
| Rate for Payer: Anthem Medicare Advantage |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.39
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$257.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.39
|
| Rate for Payer: Health EOS Commercial |
$247.01
|
| Rate for Payer: HFN Commercial |
$257.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.39
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$23.09
|
| Rate for Payer: Preferred Network Access Commercial |
$257.87
|
| Rate for Payer: Quartz Beloit One Network |
$119.43
|
| Rate for Payer: Quartz Commercial |
$154.72
|
| Rate for Payer: Quartz Medicare Advantage |
$15.39
|
| Rate for Payer: The Alliance Commercial |
$60.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.39
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$67.72
|
|
|
Tetanus Antibody
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
978076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
Tetanus Antibody
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 86774
|
| Hospital Charge Code |
978076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.39 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$15.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.39
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.39
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.39
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$23.09
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$15.39
|
| Rate for Payer: The Alliance Commercial |
$61.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.39
|
| Rate for Payer: United Healthcare PPO |
$203.58
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: Wellcare Medicare |
$15.39
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
Tetracaine 0.5% Ophth Solution 1ml [Med]
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
2974986
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
Tetracaine 0.5% Ophth Solution 1ml [Med]
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
2974986
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.37
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$21.84
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$23.66
|
| Rate for Payer: Quartz Medicare Advantage |
$21.84
|
| Rate for Payer: The Alliance Commercial |
$18.20
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
TE voice prosthesis indwelling - Equipment/Device Used
|
Facility
|
IP
|
$818.00
|
|
|
Service Code
|
HCPCS L8509
|
| Hospital Charge Code |
3008017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$416.85 |
| Max. Negotiated Rate |
$782.66 |
| Rate for Payer: Aetna Commercial |
$765.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.88
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$782.66
|
| Rate for Payer: Health EOS Commercial |
$757.14
|
| Rate for Payer: HFN Commercial |
$782.66
|
| Rate for Payer: Multiplan Commercial |
$680.58
|
| Rate for Payer: Preferred Network Access Commercial |
$782.66
|
| Rate for Payer: Quartz Beloit One Network |
$416.85
|
| Rate for Payer: Quartz Commercial |
$510.43
|
| Rate for Payer: WEA Trust Commercial |
$467.90
|
| Rate for Payer: WPS Commercial |
$630.11
|
|
|
TE voice prosthesis indwelling - Equipment/Device Used
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
HCPCS L8509
|
| Hospital Charge Code |
3008017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$782.66 |
| Rate for Payer: Aetna Commercial |
$765.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.62
|
| Rate for Payer: Aetna Managed Medicare |
$238.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.88
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$782.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.08
|
| Rate for Payer: Health EOS Commercial |
$757.14
|
| Rate for Payer: HFN Commercial |
$782.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$638.04
|
| Rate for Payer: Multiplan Commercial |
$680.58
|
| Rate for Payer: NAPHCARE Commercial |
$510.43
|
| Rate for Payer: Preferred Network Access Commercial |
$782.66
|
| Rate for Payer: Quartz Beloit One Network |
$416.85
|
| Rate for Payer: Quartz Commercial |
$552.97
|
| Rate for Payer: Quartz Medicare Advantage |
$510.43
|
| Rate for Payer: The Alliance Commercial |
$559.44
|
| Rate for Payer: WEA Trust Commercial |
$467.90
|
| Rate for Payer: WPS Commercial |
$630.11
|
|
|
TE voice prosthesis PT insert - Equipment/Device Used
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS L8507
|
| Hospital Charge Code |
3008018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$296.61 |
| Rate for Payer: Aetna Commercial |
$290.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.26
|
| Rate for Payer: Aetna Managed Medicare |
$90.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$296.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.42
|
| Rate for Payer: Health EOS Commercial |
$286.94
|
| Rate for Payer: HFN Commercial |
$296.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.80
|
| Rate for Payer: Multiplan Commercial |
$257.92
|
| Rate for Payer: NAPHCARE Commercial |
$193.44
|
| Rate for Payer: Preferred Network Access Commercial |
$296.61
|
| Rate for Payer: Quartz Beloit One Network |
$157.98
|
| Rate for Payer: Quartz Commercial |
$209.56
|
| Rate for Payer: Quartz Medicare Advantage |
$193.44
|
| Rate for Payer: The Alliance Commercial |
$214.45
|
| Rate for Payer: WEA Trust Commercial |
$177.32
|
| Rate for Payer: WPS Commercial |
$238.79
|
|
|
TE voice prosthesis PT insert - Equipment/Device Used
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS L8507
|
| Hospital Charge Code |
3008018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$296.61 |
| Rate for Payer: Aetna Commercial |
$290.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$296.61
|
| Rate for Payer: Health EOS Commercial |
$286.94
|
| Rate for Payer: HFN Commercial |
$296.61
|
| Rate for Payer: Multiplan Commercial |
$257.92
|
| Rate for Payer: Preferred Network Access Commercial |
$296.61
|
| Rate for Payer: Quartz Beloit One Network |
$157.98
|
| Rate for Payer: Quartz Commercial |
$193.44
|
| Rate for Payer: WEA Trust Commercial |
$177.32
|
| Rate for Payer: WPS Commercial |
$238.79
|
|
|
tezepelumab (Tezspire) 210 mg/1.9 mL J2356
|
Facility
|
OP
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6180528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$7,657.27 |
| Rate for Payer: Aetna Commercial |
$7,490.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,410.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,161.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,995.10
|
| Rate for Payer: Anthem Medicare Advantage |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,411.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.53
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,657.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.53
|
| Rate for Payer: Health EOS Commercial |
$7,407.58
|
| Rate for Payer: HFN Commercial |
$7,657.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.53
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: NAPHCARE Commercial |
$27.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,657.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,078.33
|
| Rate for Payer: Quartz Commercial |
$5,410.03
|
| Rate for Payer: Quartz Medicare Advantage |
$18.53
|
| Rate for Payer: The Alliance Commercial |
$74.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.53
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: Wellcare Medicare |
$18.53
|
| Rate for Payer: WPS Commercial |
$46.28
|
|
|
tezepelumab (Tezspire) 210 mg/1.9 mL J2356
|
Professional
|
Both
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6180528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$7,906.96 |
| Rate for Payer: Aetna Commercial |
$7,906.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.53
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,906.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.51
|
| Rate for Payer: Health EOS Commercial |
$7,574.04
|
| Rate for Payer: HFN Commercial |
$7,906.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.53
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: NAPHCARE Commercial |
$27.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,906.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,662.17
|
| Rate for Payer: Quartz Commercial |
$4,744.18
|
| Rate for Payer: Quartz Medicare Advantage |
$18.53
|
| Rate for Payer: The Alliance Commercial |
$50.97
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.53
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: WPS Commercial |
$46.28
|
|
|
tezepelumab (Tezspire) 210 mg/1.9 mL J2356
|
Facility
|
IP
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6180528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,078.33 |
| Max. Negotiated Rate |
$7,657.27 |
| Rate for Payer: Aetna Commercial |
$7,490.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,411.25
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,657.27
|
| Rate for Payer: Health EOS Commercial |
$7,407.58
|
| Rate for Payer: HFN Commercial |
$7,657.27
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,657.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,078.33
|
| Rate for Payer: Quartz Commercial |
$4,993.87
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: WPS Commercial |
$6,164.71
|
|
|
Tezspire Charge
|
Facility
|
OP
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6181580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.53 |
| Max. Negotiated Rate |
$7,657.27 |
| Rate for Payer: Aetna Commercial |
$7,490.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,410.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,161.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,995.10
|
| Rate for Payer: Anthem Medicare Advantage |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,411.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.53
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,657.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.53
|
| Rate for Payer: Health EOS Commercial |
$7,407.58
|
| Rate for Payer: HFN Commercial |
$7,657.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.53
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: NAPHCARE Commercial |
$27.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,657.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,078.33
|
| Rate for Payer: Quartz Commercial |
$5,410.03
|
| Rate for Payer: Quartz Medicare Advantage |
$18.53
|
| Rate for Payer: The Alliance Commercial |
$74.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.53
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: Wellcare Medicare |
$18.53
|
| Rate for Payer: WPS Commercial |
$46.28
|
|
|
Tezspire Charge
|
Professional
|
Both
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6181580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$7,906.96 |
| Rate for Payer: Aetna Commercial |
$7,906.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.53
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,906.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.51
|
| Rate for Payer: Health EOS Commercial |
$7,574.04
|
| Rate for Payer: HFN Commercial |
$7,906.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.53
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: NAPHCARE Commercial |
$27.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,906.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,662.17
|
| Rate for Payer: Quartz Commercial |
$4,744.18
|
| Rate for Payer: Quartz Medicare Advantage |
$18.53
|
| Rate for Payer: The Alliance Commercial |
$50.97
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.53
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: WPS Commercial |
$46.28
|
|
|
Tezspire Charge
|
Facility
|
IP
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6181580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,078.33 |
| Max. Negotiated Rate |
$7,657.27 |
| Rate for Payer: Aetna Commercial |
$7,490.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,411.25
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,657.27
|
| Rate for Payer: Health EOS Commercial |
$7,407.58
|
| Rate for Payer: HFN Commercial |
$7,657.27
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,657.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,078.33
|
| Rate for Payer: Quartz Commercial |
$4,993.87
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: WPS Commercial |
$6,164.71
|
|
|
Thalassemia & Hemoglobinopathy Comprehensive
|
Facility
|
IP
|
$99.27
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
4254047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.59 |
| Max. Negotiated Rate |
$94.98 |
| Rate for Payer: Aetna Commercial |
$92.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.72
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cigna Commercial |
$94.98
|
| Rate for Payer: Health EOS Commercial |
$91.88
|
| Rate for Payer: HFN Commercial |
$94.98
|
| Rate for Payer: Multiplan Commercial |
$82.59
|
| Rate for Payer: Preferred Network Access Commercial |
$94.98
|
| Rate for Payer: Quartz Beloit One Network |
$50.59
|
| Rate for Payer: Quartz Commercial |
$61.94
|
| Rate for Payer: WEA Trust Commercial |
$56.78
|
| Rate for Payer: WPS Commercial |
$76.47
|
|
|
Thalassemia & Hemoglobinopathy Comprehensive
|
Facility
|
OP
|
$99.27
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
4254047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$94.98 |
| Rate for Payer: Aetna Commercial |
$92.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.79
|
| Rate for Payer: Aetna Managed Medicare |
$14.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.53
|
| Rate for Payer: Anthem Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.18
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cigna Commercial |
$94.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.18
|
| Rate for Payer: Health EOS Commercial |
$91.88
|
| Rate for Payer: HFN Commercial |
$94.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$82.59
|
| Rate for Payer: NAPHCARE Commercial |
$21.26
|
| Rate for Payer: Preferred Network Access Commercial |
$94.98
|
| Rate for Payer: Quartz Beloit One Network |
$50.59
|
| Rate for Payer: Quartz Commercial |
$67.11
|
| Rate for Payer: Quartz Medicare Advantage |
$14.18
|
| Rate for Payer: The Alliance Commercial |
$56.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare PPO |
$77.43
|
| Rate for Payer: WEA Trust Commercial |
$56.78
|
| Rate for Payer: Wellcare Medicare |
$14.18
|
| Rate for Payer: WPS Commercial |
$76.47
|
|
