|
Upper limb orthosis NOS L3999
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
3165660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$278.32 |
| Max. Negotiated Rate |
$522.56 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$340.80
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
Upp ext fx orthosis humeral L3980
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Aetna Managed Medicare |
$69.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$200.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.78
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$161.20
|
| Rate for Payer: Quartz Medicare Advantage |
$148.80
|
| Rate for Payer: The Alliance Commercial |
$992.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Upp ext fx orthosis humeral L3980
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.12 |
| Max. Negotiated Rate |
$1,247.61 |
| Rate for Payer: Aetna Commercial |
$235.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$235.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.80
|
| Rate for Payer: Health EOS Commercial |
$225.68
|
| Rate for Payer: HFN Commercial |
$235.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,247.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,247.61
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Preferred Network Access Commercial |
$235.60
|
| Rate for Payer: Quartz Beloit One Network |
$109.12
|
| Rate for Payer: Quartz Commercial |
$141.36
|
| Rate for Payer: The Alliance Commercial |
$124.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Upp ext fx orthosis humeral L3980
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$148.80
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
UPPR GI ENDOSCOPY, DIAGNOSIS 43235
|
Professional
|
Both
|
$1,581.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
3014654
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$260.40 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: Aetna Commercial |
$1,501.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,359.66
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cigna Commercial |
$1,501.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.60
|
| Rate for Payer: Health EOS Commercial |
$1,438.71
|
| Rate for Payer: HFN Commercial |
$1,501.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$409.27
|
| Rate for Payer: Multiplan Commercial |
$1,264.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.95
|
| Rate for Payer: Quartz Beloit One Network |
$695.64
|
| Rate for Payer: Quartz Commercial |
$901.17
|
| Rate for Payer: The Alliance Commercial |
$790.50
|
| Rate for Payer: United Healthcare Medicaid |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$869.55
|
| Rate for Payer: WPS Commercial |
$1,171.05
|
|
|
UPPR GI ENDOSCOPY, DIAGNOSIS, EXTENDED 4323522
|
Professional
|
Both
|
$1,897.00
|
|
|
Service Code
|
CPT 43235 22
|
| Hospital Charge Code |
6175703
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$834.68 |
| Max. Negotiated Rate |
$1,802.15 |
| Rate for Payer: Aetna Commercial |
$1,802.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.42
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cash Price |
$569.10
|
| Rate for Payer: Cigna Commercial |
$1,802.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$948.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,138.20
|
| Rate for Payer: Health EOS Commercial |
$1,726.27
|
| Rate for Payer: HFN Commercial |
$1,802.15
|
| Rate for Payer: Multiplan Commercial |
$1,517.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,802.15
|
| Rate for Payer: Quartz Beloit One Network |
$834.68
|
| Rate for Payer: Quartz Commercial |
$1,081.29
|
| Rate for Payer: The Alliance Commercial |
$948.50
|
| Rate for Payer: WEA Trust Commercial |
$1,043.35
|
| Rate for Payer: WPS Commercial |
$1,405.11
|
|
|
Urea Nitrogen 24 Hour Urine
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$107.38
|
| Rate for Payer: HFN Commercial |
$112.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.63
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Preferred Network Access Commercial |
$112.10
|
| Rate for Payer: Quartz Beloit One Network |
$51.92
|
| Rate for Payer: Quartz Commercial |
$67.26
|
| Rate for Payer: The Alliance Commercial |
$59.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Urea Nitrogen 24 Hour Urine
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Urea Nitrogen 24 Hour Urine
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.23
|
| Rate for Payer: Anthem Medicaid |
$5.75
|
| Rate for Payer: Anthem Medicare Advantage |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.56
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Dean Health Medicaid |
$5.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$8.34
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.75
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5.56
|
| Rate for Payer: The Alliance Commercial |
$22.24
|
| Rate for Payer: United Healthcare Medicaid |
$5.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: United Healthcare PPO |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: Wellcare Medicare |
$5.56
|
| Rate for Payer: WMAP Medicaid |
$5.75
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Urea Nitrogen, PDI Fluid
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna Commercial |
$62.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$62.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.60
|
| Rate for Payer: Health EOS Commercial |
$60.06
|
| Rate for Payer: HFN Commercial |
$62.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.94
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$62.70
|
| Rate for Payer: Quartz Beloit One Network |
$29.04
|
| Rate for Payer: Quartz Commercial |
$37.62
|
| Rate for Payer: The Alliance Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Urea Nitrogen, PDI Fluid
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.56
|
| Rate for Payer: Anthem Medicaid |
$4.08
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Dean Health Medicaid |
$4.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.95
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Managed Health Services Medicaid |
$4.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$5.92
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.08
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$15.80
|
| Rate for Payer: United Healthcare Medicaid |
$4.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: United Healthcare PPO |
$49.50
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: Wellcare Medicare |
$3.95
|
| Rate for Payer: WMAP Medicaid |
$4.08
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Urea Nitrogen, PDI Fluid
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Urea Nitrogen Urine
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.56
|
| Rate for Payer: Anthem Medicaid |
$4.08
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.53
|
| Rate for Payer: Dean Health Medicaid |
$4.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.95
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Managed Health Services Medicaid |
$4.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$5.92
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.08
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$15.80
|
| Rate for Payer: United Healthcare Medicaid |
$4.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: United Healthcare PPO |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: Wellcare Medicare |
$3.95
|
| Rate for Payer: WMAP Medicaid |
$4.08
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Urea Nitrogen Urine
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Urea Nitrogen Urine
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.94 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.60
|
| Rate for Payer: Health EOS Commercial |
$69.16
|
| Rate for Payer: HFN Commercial |
$72.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.94
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Preferred Network Access Commercial |
$72.20
|
| Rate for Payer: Quartz Beloit One Network |
$33.44
|
| Rate for Payer: Quartz Commercial |
$43.32
|
| Rate for Payer: The Alliance Commercial |
$38.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Urea Nitrogen, Urine
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
5474701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.23
|
| Rate for Payer: Anthem Medicaid |
$5.75
|
| Rate for Payer: Anthem Medicare Advantage |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.56
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Dean Health Medicaid |
$5.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.56
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.56
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$8.34
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5.56
|
| Rate for Payer: The Alliance Commercial |
$22.24
|
| Rate for Payer: United Healthcare Medicaid |
$5.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: United Healthcare PPO |
$22.50
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: Wellcare Medicare |
$5.56
|
| Rate for Payer: WMAP Medicaid |
$5.75
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Urea Nitrogen, Urine
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
5474701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Urea Nitrogen, Urine
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
5474701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.00
|
| Rate for Payer: Health EOS Commercial |
$27.30
|
| Rate for Payer: HFN Commercial |
$28.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.63
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$28.50
|
| Rate for Payer: Quartz Beloit One Network |
$13.20
|
| Rate for Payer: Quartz Commercial |
$17.10
|
| Rate for Payer: The Alliance Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Urea Nitrogen, Urine, PDI
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
979883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Urea Nitrogen, Urine, PDI
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
979883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.63 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.63
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Urea Nitrogen, Urine, PDI
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
979883
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$5.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.23
|
| Rate for Payer: Anthem Medicaid |
$5.75
|
| Rate for Payer: Anthem Medicare Advantage |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.56
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Dean Health Medicaid |
$5.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.56
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.56
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$8.34
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.75
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.56
|
| Rate for Payer: The Alliance Commercial |
$22.24
|
| Rate for Payer: United Healthcare Medicaid |
$5.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: United Healthcare PPO |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$5.56
|
| Rate for Payer: WMAP Medicaid |
$5.75
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR 11/13FR X 28MM M0062502000
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5307023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$787.92 |
| Max. Negotiated Rate |
$1,479.36 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$964.80
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR 11/13FR X 28MM M0062502000
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5307023
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$6,432.00 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Aetna Managed Medicare |
$450.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,045.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$804.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$771.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.84
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$1,045.20
|
| Rate for Payer: Quartz Medicare Advantage |
$964.80
|
| Rate for Payer: The Alliance Commercial |
$6,432.00
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR 11/13FR X 46MM M0062502040
|
Facility
|
IP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5307024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$787.92 |
| Max. Negotiated Rate |
$1,479.36 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$964.80
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
|
URETERAL ACCESS SHEATH SET NAVIGATOR 11/13FR X 46MM M0062502040
|
Facility
|
OP
|
$1,608.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5307024
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$450.24 |
| Max. Negotiated Rate |
$6,432.00 |
| Rate for Payer: Aetna Commercial |
$1,447.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.88
|
| Rate for Payer: Aetna Managed Medicare |
$450.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,045.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$804.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$771.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.24
|
| Rate for Payer: Cash Price |
$482.40
|
| Rate for Payer: Cigna Commercial |
$1,479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.84
|
| Rate for Payer: Health EOS Commercial |
$1,431.12
|
| Rate for Payer: HFN Commercial |
$1,479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,206.00
|
| Rate for Payer: Multiplan Commercial |
$1,286.40
|
| Rate for Payer: NAPHCARE Commercial |
$964.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.36
|
| Rate for Payer: Quartz Beloit One Network |
$787.92
|
| Rate for Payer: Quartz Commercial |
$1,045.20
|
| Rate for Payer: Quartz Medicare Advantage |
$964.80
|
| Rate for Payer: The Alliance Commercial |
$6,432.00
|
| Rate for Payer: WEA Trust Commercial |
$884.40
|
| Rate for Payer: WPS Commercial |
$1,191.05
|
|
