|
UNDERWEAR DISP PULL UP XL #1625
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
2974518
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
UNDERWEAR DISP PULL UP XL #1625
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
2974518
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.11
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
UNI COMPARTMENTAL KNEE ARTHROPLASTY
|
Facility
IP
|
$13,291.00
|
|
| Hospital Charge Code |
4524686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,512.59 |
| Max. Negotiated Rate |
$12,227.72 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$7,974.60
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
UNI COMPARTMENTAL KNEE ARTHROPLASTY
|
Facility
OP
|
$13,291.00
|
|
| Hospital Charge Code |
4524686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,721.48 |
| Max. Negotiated Rate |
$53,164.00 |
| Rate for Payer: Aetna Commercial |
$11,961.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,430.26
|
| Rate for Payer: Aetna Managed Medicare |
$3,721.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,639.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,645.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,379.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,044.23
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,227.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,437.64
|
| Rate for Payer: Health EOS Commercial |
$11,828.99
|
| Rate for Payer: HFN Commercial |
$12,227.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,968.25
|
| Rate for Payer: Multiplan Commercial |
$10,632.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,974.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,227.72
|
| Rate for Payer: Quartz Beloit One Network |
$6,512.59
|
| Rate for Payer: Quartz Commercial |
$8,639.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,974.60
|
| Rate for Payer: The Alliance Commercial |
$53,164.00
|
| Rate for Payer: WEA Trust Commercial |
$7,310.05
|
| Rate for Payer: WPS Commercial |
$9,844.64
|
|
|
UNIVERSAL JOINT FOR TWO TUBES 393.71
|
Facility
OP
|
$4,057.00
|
|
| Hospital Charge Code |
5811628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,135.96 |
| Max. Negotiated Rate |
$16,228.00 |
| Rate for Payer: Aetna Commercial |
$3,651.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,489.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,135.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,637.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,028.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,947.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,150.21
|
| Rate for Payer: Cash Price |
$1,217.10
|
| Rate for Payer: Cigna Commercial |
$3,732.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,270.30
|
| Rate for Payer: Health EOS Commercial |
$3,610.73
|
| Rate for Payer: HFN Commercial |
$3,732.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,042.75
|
| Rate for Payer: Multiplan Commercial |
$3,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,732.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,987.93
|
| Rate for Payer: Quartz Commercial |
$2,637.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,434.20
|
| Rate for Payer: The Alliance Commercial |
$16,228.00
|
| Rate for Payer: WEA Trust Commercial |
$2,231.35
|
| Rate for Payer: WPS Commercial |
$3,005.02
|
|
|
UNIVERSAL JOINT FOR TWO TUBES 393.71
|
Facility
IP
|
$4,057.00
|
|
| Hospital Charge Code |
5811628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,987.93 |
| Max. Negotiated Rate |
$3,732.44 |
| Rate for Payer: Aetna Commercial |
$3,651.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,150.21
|
| Rate for Payer: Cash Price |
$1,217.10
|
| Rate for Payer: Cigna Commercial |
$3,732.44
|
| Rate for Payer: Health EOS Commercial |
$3,610.73
|
| Rate for Payer: HFN Commercial |
$3,732.44
|
| Rate for Payer: Multiplan Commercial |
$3,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,434.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,732.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,987.93
|
| Rate for Payer: Quartz Commercial |
$2,434.20
|
| Rate for Payer: WEA Trust Commercial |
$2,231.35
|
| Rate for Payer: WPS Commercial |
$3,005.02
|
|
|
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
|
Facility
OP
|
$21,215.49
|
|
|
Service Code
|
CPT 47379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,603.44 |
| Max. Negotiated Rate |
$21,215.49 |
| Rate for Payer: Aetna Managed Medicare |
$5,703.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,003.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,703.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,703.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,009.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,703.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,215.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,703.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,703.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,703.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,703.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,554.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,703.09
|
| Rate for Payer: The Alliance Commercial |
$2,603.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,703.09
|
| Rate for Payer: United Healthcare PPO |
$5,266.00
|
| Rate for Payer: Wellcare Medicare |
$5,703.09
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
OP
|
$21,215.49
|
|
|
Service Code
|
CPT 49329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,266.00 |
| Max. Negotiated Rate |
$21,215.49 |
| Rate for Payer: Aetna Managed Medicare |
$5,703.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,003.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,703.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,703.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,009.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,703.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,215.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,703.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,703.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,703.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,703.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,554.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,703.09
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,703.09
|
| Rate for Payer: United Healthcare PPO |
$5,266.00
|
| Rate for Payer: Wellcare Medicare |
$5,703.09
|
|
|
Unlisted Magnetic Resonance 7649872195
|
Facility
OP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
5518689
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$7.36 |
| Max. Negotiated Rate |
$4,651.52 |
| Rate for Payer: Aetna Commercial |
$4,550.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,348.16
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,679.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,651.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$4,499.84
|
| Rate for Payer: HFN Commercial |
$4,651.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$4,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,651.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,477.44
|
| Rate for Payer: Quartz Commercial |
$3,286.40
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$7.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,780.80
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$3,744.98
|
|
|
Unlisted Magnetic Resonance 7649872195
|
Facility
IP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
5518689
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,477.44 |
| Max. Negotiated Rate |
$4,651.52 |
| Rate for Payer: Aetna Commercial |
$4,550.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,679.68
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,651.52
|
| Rate for Payer: Health EOS Commercial |
$4,499.84
|
| Rate for Payer: HFN Commercial |
$4,651.52
|
| Rate for Payer: Multiplan Commercial |
$4,044.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,033.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,651.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,477.44
|
| Rate for Payer: Quartz Commercial |
$3,033.60
|
| Rate for Payer: WEA Trust Commercial |
$2,780.80
|
| Rate for Payer: WPS Commercial |
$3,744.98
|
|
|
UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM
|
Facility
OP
|
$27,974.00
|
|
|
Service Code
|
CPT 22999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$27,974.00 |
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,974.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,008.00
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$15,495.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$13,676.00
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
|
|
UNLISTED PROCEDURE, ANUS
|
Facility
OP
|
$27,974.00
|
|
|
Service Code
|
CPT 46999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$903.36 |
| Max. Negotiated Rate |
$27,974.00 |
| Rate for Payer: Aetna Managed Medicare |
$903.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,974.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,008.00
|
| Rate for Payer: Anthem Medicare Advantage |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,360.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.04
|
| Rate for Payer: Quartz Medicare Advantage |
$903.36
|
| Rate for Payer: The Alliance Commercial |
$21,990.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.36
|
| Rate for Payer: United Healthcare PPO |
$13,676.00
|
| Rate for Payer: Wellcare Medicare |
$903.36
|
|
|
UNLISTED PROCEDURE, ARTHROSCOPY
|
Facility
OP
|
$27,974.00
|
|
|
Service Code
|
CPT 29999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$27,974.00 |
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,974.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,008.00
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$7,358.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$13,676.00
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
|
|
UNLISTED PROCEDURE, LEG OR ANKLE
|
Facility
OP
|
$27,974.00
|
|
|
Service Code
|
CPT 27899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$233.09 |
| Max. Negotiated Rate |
$27,974.00 |
| Rate for Payer: Aetna Managed Medicare |
$233.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,974.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,008.00
|
| Rate for Payer: Anthem Medicare Advantage |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$233.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$233.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$233.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$233.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$867.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$233.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$233.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$233.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$233.09
|
| Rate for Payer: NAPHCARE Commercial |
$349.64
|
| Rate for Payer: Quartz Medicare Advantage |
$233.09
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$233.09
|
| Rate for Payer: United Healthcare PPO |
$13,676.00
|
| Rate for Payer: Wellcare Medicare |
$233.09
|
|
|
UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS
|
Facility
OP
|
$27,974.00
|
|
|
Service Code
|
CPT 42999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$241.43 |
| Max. Negotiated Rate |
$27,974.00 |
| Rate for Payer: Aetna Managed Medicare |
$241.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,974.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,008.00
|
| Rate for Payer: Anthem Medicare Advantage |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$241.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$241.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$241.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$241.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$898.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$241.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$241.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$241.43
|
| Rate for Payer: NAPHCARE Commercial |
$362.14
|
| Rate for Payer: Quartz Medicare Advantage |
$241.43
|
| Rate for Payer: The Alliance Commercial |
$7,251.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$241.43
|
| Rate for Payer: United Healthcare PPO |
$13,676.00
|
| Rate for Payer: Wellcare Medicare |
$241.43
|
|
|
UNLISTED PROCEDURE STOMACH 43999-43762
|
Professional
|
$204.00
|
|
|
Service Code
|
CPT 43999
|
| Hospital Charge Code |
5609741
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.76 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.40
|
| Rate for Payer: Health EOS Commercial |
$185.64
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$193.80
|
| Rate for Payer: Quartz Beloit One Network |
$89.76
|
| Rate for Payer: Quartz Commercial |
$116.28
|
| Rate for Payer: The Alliance Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
UNLISTED PROCEDURE, VASCULAR SURGERY
|
Facility
OP
|
$41,927.24
|
|
|
Service Code
|
CPT 37799
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$620.92 |
| Max. Negotiated Rate |
$41,927.24 |
| Rate for Payer: The Alliance Commercial |
$41,927.24
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,974.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,008.00
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$13,676.00
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
|
|
Unna Boot
|
Professional
|
$182.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
2572822
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$24.53
|
| Rate for Payer: Anthem Medicare Advantage |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.53
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.53
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.53
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: Quartz Medicare Advantage |
$24.53
|
| Rate for Payer: The Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Medicaid |
$20.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.53
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$110.38
|
|
|
Unna Boot 29580PP
|
Professional
|
$300.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
3133515
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Aetna Managed Medicare |
$24.53
|
| Rate for Payer: Anthem Medicare Advantage |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.53
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$285.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.53
|
| Rate for Payer: Health EOS Commercial |
$273.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.53
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Preferred Network Access Commercial |
$285.00
|
| Rate for Payer: Quartz Beloit One Network |
$132.00
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: Quartz Medicare Advantage |
$24.53
|
| Rate for Payer: The Alliance Commercial |
$104.25
|
| Rate for Payer: United Healthcare Medicaid |
$20.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.53
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$110.38
|
|
|
Unscheduled dialysis for an ESRD patient
|
Facility
OP
|
$1,331.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
5164612
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$346.32 |
| Max. Negotiated Rate |
$2,569.40 |
| Rate for Payer: Aetna Commercial |
$1,197.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.66
|
| Rate for Payer: Aetna Managed Medicare |
$690.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,281.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,091.00
|
| Rate for Payer: Anthem Medicare Advantage |
$690.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$690.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$690.70
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,224.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$690.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$690.70
|
| Rate for Payer: Health EOS Commercial |
$1,184.59
|
| Rate for Payer: HFN Commercial |
$1,224.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,569.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$690.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$690.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$690.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$690.70
|
| Rate for Payer: Multiplan Commercial |
$1,064.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,036.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.52
|
| Rate for Payer: Quartz Beloit One Network |
$652.19
|
| Rate for Payer: Quartz Commercial |
$865.15
|
| Rate for Payer: Quartz Medicare Advantage |
$690.70
|
| Rate for Payer: The Alliance Commercial |
$346.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$690.70
|
| Rate for Payer: United Healthcare PPO |
$998.25
|
| Rate for Payer: WEA Trust Commercial |
$732.05
|
| Rate for Payer: Wellcare Medicare |
$690.70
|
| Rate for Payer: WPS Commercial |
$985.87
|
|
|
Unscheduled dialysis for an ESRD patient
|
Facility
IP
|
$1,331.00
|
|
|
Service Code
|
HCPCS G0257
|
| Hospital Charge Code |
5164612
|
|
Hospital Revenue Code
|
821
|
| Min. Negotiated Rate |
$652.19 |
| Max. Negotiated Rate |
$1,224.52 |
| Rate for Payer: Aetna Commercial |
$1,197.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.43
|
| Rate for Payer: Cash Price |
$399.30
|
| Rate for Payer: Cigna Commercial |
$1,224.52
|
| Rate for Payer: Health EOS Commercial |
$1,184.59
|
| Rate for Payer: HFN Commercial |
$1,224.52
|
| Rate for Payer: Multiplan Commercial |
$1,064.80
|
| Rate for Payer: NAPHCARE Commercial |
$798.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.52
|
| Rate for Payer: Quartz Beloit One Network |
$652.19
|
| Rate for Payer: Quartz Commercial |
$798.60
|
| Rate for Payer: WEA Trust Commercial |
$732.05
|
| Rate for Payer: WPS Commercial |
$985.87
|
|
|
UPEP Interpretation
|
Facility
OP
|
$237.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
2942979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$948.00 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.82
|
| Rate for Payer: Aetna Managed Medicare |
$17.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.60
|
| Rate for Payer: Anthem Medicaid |
$18.42
|
| Rate for Payer: Anthem Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.83
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$218.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.42
|
| Rate for Payer: Dean Health Medicaid |
$18.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.83
|
| Rate for Payer: Health EOS Commercial |
$210.93
|
| Rate for Payer: HFN Commercial |
$218.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.83
|
| Rate for Payer: Managed Health Services Medicaid |
$19.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.83
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.74
|
| Rate for Payer: Preferred Network Access Commercial |
$218.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.42
|
| Rate for Payer: Quartz Beloit One Network |
$116.13
|
| Rate for Payer: Quartz Commercial |
$154.05
|
| Rate for Payer: Quartz Medicare Advantage |
$17.83
|
| Rate for Payer: The Alliance Commercial |
$948.00
|
| Rate for Payer: United Healthcare Medicaid |
$18.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare PPO |
$177.75
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: Wellcare Medicare |
$17.83
|
| Rate for Payer: WMAP Medicaid |
$18.42
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
UPEP Interpretation
|
Professional
|
$237.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
2942979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$225.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.82
|
| Rate for Payer: Aetna Managed Medicare |
$17.83
|
| Rate for Payer: Anthem Commercial |
$19.41
|
| Rate for Payer: Anthem Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.83
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$225.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.83
|
| Rate for Payer: Health EOS Commercial |
$215.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.83
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$225.15
|
| Rate for Payer: Quartz Beloit One Network |
$104.28
|
| Rate for Payer: Quartz Commercial |
$135.09
|
| Rate for Payer: Quartz Medicare Advantage |
$17.83
|
| Rate for Payer: The Alliance Commercial |
$70.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: WPS Commercial |
$78.45
|
|
|
UPEP Interpretation
|
Facility
IP
|
$237.00
|
|
|
Service Code
|
CPT 84166
|
| Hospital Charge Code |
2942979
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.61
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$218.04
|
| Rate for Payer: Health EOS Commercial |
$210.93
|
| Rate for Payer: HFN Commercial |
$218.04
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: NAPHCARE Commercial |
$142.20
|
| Rate for Payer: Preferred Network Access Commercial |
$218.04
|
| Rate for Payer: Quartz Beloit One Network |
$116.13
|
| Rate for Payer: Quartz Commercial |
$142.20
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
U Porphyrins, Fract, Qnt / 36592
|
Facility
IP
|
$119.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3423526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$71.40
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
