|
Vectibix 5 mg Charge
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
2958964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$190.44 |
| Rate for Payer: Aetna Commercial |
$186.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.71
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$190.44
|
| Rate for Payer: Health EOS Commercial |
$184.23
|
| Rate for Payer: HFN Commercial |
$190.44
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: NAPHCARE Commercial |
$124.20
|
| Rate for Payer: Preferred Network Access Commercial |
$190.44
|
| Rate for Payer: Quartz Beloit One Network |
$101.43
|
| Rate for Payer: Quartz Commercial |
$124.20
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
Vectibix 5 mg Charge
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
2958964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.08 |
| Max. Negotiated Rate |
$378.10 |
| Rate for Payer: Aetna Commercial |
$196.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$196.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.24
|
| Rate for Payer: Health EOS Commercial |
$188.37
|
| Rate for Payer: HFN Commercial |
$196.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.85
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$196.65
|
| Rate for Payer: Quartz Beloit One Network |
$91.08
|
| Rate for Payer: Quartz Commercial |
$117.99
|
| Rate for Payer: The Alliance Commercial |
$103.50
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$378.10
|
|
|
Vedolizumab Antibody Quantitation
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
5619661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$38.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.03
|
| Rate for Payer: Anthem Medicaid |
$30.85
|
| Rate for Payer: Anthem Medicare Advantage |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.57
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$644.66
|
| Rate for Payer: Dean Health Medicaid |
$30.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.57
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.57
|
| Rate for Payer: Managed Health Services Medicaid |
$32.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.57
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$57.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.85
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: Quartz Medicare Advantage |
$38.57
|
| Rate for Payer: The Alliance Commercial |
$154.28
|
| Rate for Payer: United Healthcare Medicaid |
$30.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare PPO |
$864.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: Wellcare Medicare |
$38.57
|
| Rate for Payer: WMAP Medicaid |
$30.85
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
Vedolizumab Antibody Quantitation
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
5619661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.15 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,094.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$576.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.20
|
| Rate for Payer: Health EOS Commercial |
$1,048.32
|
| Rate for Payer: HFN Commercial |
$1,094.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.15
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.40
|
| Rate for Payer: Quartz Beloit One Network |
$506.88
|
| Rate for Payer: Quartz Commercial |
$656.64
|
| Rate for Payer: The Alliance Commercial |
$576.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
Vedolizumab Antibody Quantitation
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
5619661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
VEGA TOTAL KNEE IMPLANTS (FEMUR,TIBIA PLATEAU,PATELLA,GLIDING SURFACE- CONSTRUCT)
|
Facility
|
IP
|
$29,506.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,457.94 |
| Max. Negotiated Rate |
$27,145.52 |
| Rate for Payer: Aetna Commercial |
$26,555.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,375.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,638.18
|
| Rate for Payer: Cash Price |
$8,851.80
|
| Rate for Payer: Cigna Commercial |
$27,145.52
|
| Rate for Payer: Health EOS Commercial |
$26,260.34
|
| Rate for Payer: HFN Commercial |
$27,145.52
|
| Rate for Payer: Multiplan Commercial |
$23,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$17,703.60
|
| Rate for Payer: Preferred Network Access Commercial |
$27,145.52
|
| Rate for Payer: Quartz Beloit One Network |
$14,457.94
|
| Rate for Payer: Quartz Commercial |
$17,703.60
|
| Rate for Payer: WEA Trust Commercial |
$16,228.30
|
| Rate for Payer: WPS Commercial |
$21,855.09
|
|
|
VEGA TOTAL KNEE IMPLANTS (FEMUR,TIBIA PLATEAU,PATELLA,GLIDING SURFACE- CONSTRUCT)
|
Facility
|
OP
|
$29,506.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,261.68 |
| Max. Negotiated Rate |
$118,024.00 |
| Rate for Payer: Aetna Commercial |
$26,555.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,375.16
|
| Rate for Payer: Aetna Managed Medicare |
$8,261.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,178.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,753.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,162.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,638.18
|
| Rate for Payer: Cash Price |
$8,851.80
|
| Rate for Payer: Cigna Commercial |
$27,145.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,511.56
|
| Rate for Payer: Health EOS Commercial |
$26,260.34
|
| Rate for Payer: HFN Commercial |
$27,145.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,129.50
|
| Rate for Payer: Multiplan Commercial |
$23,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$17,703.60
|
| Rate for Payer: Preferred Network Access Commercial |
$27,145.52
|
| Rate for Payer: Quartz Beloit One Network |
$14,457.94
|
| Rate for Payer: Quartz Commercial |
$19,178.90
|
| Rate for Payer: Quartz Medicare Advantage |
$17,703.60
|
| Rate for Payer: The Alliance Commercial |
$118,024.00
|
| Rate for Payer: WEA Trust Commercial |
$16,228.30
|
| Rate for Payer: WPS Commercial |
$21,855.09
|
|
|
VEIN ACCESS CUTDOWN OVER 1 YR 36425
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
CPT 36425
|
| Hospital Charge Code |
3014524
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Aetna Commercial |
$214.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.36
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$214.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.60
|
| Rate for Payer: Health EOS Commercial |
$205.66
|
| Rate for Payer: HFN Commercial |
$214.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.39
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.70
|
| Rate for Payer: Quartz Beloit One Network |
$99.44
|
| Rate for Payer: Quartz Commercial |
$128.82
|
| Rate for Payer: The Alliance Commercial |
$113.00
|
| Rate for Payer: United Healthcare Medicaid |
$40.42
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: WPS Commercial |
$167.40
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
|
IP
|
$75,431.00
|
|
|
Service Code
|
MSDRG 263
|
| Min. Negotiated Rate |
$27,133.49 |
| Max. Negotiated Rate |
$75,431.00 |
| Rate for Payer: Aetna Managed Medicare |
$27,133.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59,373.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,509.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,236.74
|
| Rate for Payer: Anthem Medicare Advantage |
$27,133.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,133.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,133.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,133.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47,996.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,133.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55,091.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,133.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,133.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,133.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,133.49
|
| Rate for Payer: NAPHCARE Commercial |
$40,700.24
|
| Rate for Payer: Quartz Medicare Advantage |
$27,133.49
|
| Rate for Payer: The Alliance Commercial |
$75,431.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,133.49
|
| Rate for Payer: United Healthcare PPO |
$42,889.36
|
| Rate for Payer: Wellcare Medicare |
$27,133.49
|
|
|
VEIN STRIPPER DORMO-STRIP SYMMETRY DISP STERILE VE-022
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
5178752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
VEIN STRIPPER DORMO-STRIP SYMMETRY DISP STERILE VE-022
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
5178752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
VEIN X-RAY, ARM/LEG 7582026
|
Professional
|
Both
|
$1,144.00
|
|
|
Service Code
|
CPT 75820 26
|
| Hospital Charge Code |
3015293
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$172.05 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna Commercial |
$1,086.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,086.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$572.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.40
|
| Rate for Payer: Health EOS Commercial |
$1,041.04
|
| Rate for Payer: HFN Commercial |
$1,086.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.05
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.80
|
| Rate for Payer: Quartz Beloit One Network |
$503.36
|
| Rate for Payer: Quartz Commercial |
$652.08
|
| Rate for Payer: The Alliance Commercial |
$572.00
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$847.36
|
|
|
Velban 1 mg Charge
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
2958983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.65
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$12.56
|
|
|
Velban 1 mg Charge
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
2958983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Velban 1 mg Charge
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
2958983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.22 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.02
|
| Rate for Payer: Health EOS Commercial |
$9.10
|
| Rate for Payer: HFN Commercial |
$9.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.83
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.50
|
| Rate for Payer: Quartz Beloit One Network |
$4.40
|
| Rate for Payer: Quartz Commercial |
$5.70
|
| Rate for Payer: The Alliance Commercial |
$5.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.22
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$12.56
|
|
|
Velcade 0.1 mg Charge
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2958967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$117.80 |
| Rate for Payer: Aetna Commercial |
$117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$117.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.07
|
| Rate for Payer: Health EOS Commercial |
$112.84
|
| Rate for Payer: HFN Commercial |
$117.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.77
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: Preferred Network Access Commercial |
$117.80
|
| Rate for Payer: Quartz Beloit One Network |
$54.56
|
| Rate for Payer: Quartz Commercial |
$70.68
|
| Rate for Payer: The Alliance Commercial |
$62.00
|
| Rate for Payer: United Healthcare Medicaid |
$1.96
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Velcade 0.1 mg Charge
|
Facility
|
OP
|
$124.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2958967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Anthem Medicare Advantage |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.96
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1.96
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1.96
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.94
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1.96
|
| Rate for Payer: The Alliance Commercial |
$7.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.96
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: Wellcare Medicare |
$1.96
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Velcade 0.1 mg Charge
|
Facility
|
IP
|
$124.00
|
|
|
Service Code
|
HCPCS J9041
|
| Hospital Charge Code |
2958967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
Vena Cava Filter Insertion
|
Facility
|
IP
|
$8,784.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
3529588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,304.16 |
| Max. Negotiated Rate |
$8,081.28 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,270.40
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
Vena Cava Filter Insertion
|
Facility
|
OP
|
$8,784.00
|
|
|
Service Code
|
CPT 37191
|
| Hospital Charge Code |
3529588
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$21,726.56 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,709.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$21,726.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
Vena Cava Filter Removal
|
Facility
|
IP
|
$6,795.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3052432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,329.55 |
| Max. Negotiated Rate |
$6,251.40 |
| Rate for Payer: Aetna Commercial |
$6,115.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,843.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,601.35
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,251.40
|
| Rate for Payer: Health EOS Commercial |
$6,047.55
|
| Rate for Payer: HFN Commercial |
$6,251.40
|
| Rate for Payer: Multiplan Commercial |
$5,436.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,077.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,329.55
|
| Rate for Payer: Quartz Commercial |
$4,077.00
|
| Rate for Payer: WEA Trust Commercial |
$3,737.25
|
| Rate for Payer: WPS Commercial |
$5,033.06
|
|
|
Vena Cava Filter Removal
|
Facility
|
OP
|
$6,795.00
|
|
|
Service Code
|
CPT 37193
|
| Hospital Charge Code |
3052432
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$6,115.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,843.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,601.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cash Price |
$2,038.50
|
| Rate for Payer: Cigna Commercial |
$6,251.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$6,047.55
|
| Rate for Payer: HFN Commercial |
$6,251.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$5,436.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,251.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,329.55
|
| Rate for Payer: Quartz Commercial |
$4,416.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$5,355.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$3,737.25
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$5,033.06
|
|
|
Vena Cava Filter Reposition
|
Facility
|
IP
|
$5,685.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
3052431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,785.65 |
| Max. Negotiated Rate |
$5,230.20 |
| Rate for Payer: Aetna Commercial |
$5,116.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,889.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,013.05
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cigna Commercial |
$5,230.20
|
| Rate for Payer: Health EOS Commercial |
$5,059.65
|
| Rate for Payer: HFN Commercial |
$5,230.20
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,411.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,230.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,785.65
|
| Rate for Payer: Quartz Commercial |
$3,411.00
|
| Rate for Payer: WEA Trust Commercial |
$3,126.75
|
| Rate for Payer: WPS Commercial |
$4,210.88
|
|
|
Vena Cava Filter Reposition
|
Facility
|
OP
|
$5,685.00
|
|
|
Service Code
|
CPT 37192
|
| Hospital Charge Code |
3052431
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,785.65 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$5,116.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,889.10
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,013.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cash Price |
$1,705.50
|
| Rate for Payer: Cigna Commercial |
$5,230.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$5,059.65
|
| Rate for Payer: HFN Commercial |
$5,230.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$4,548.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,230.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,785.65
|
| Rate for Payer: Quartz Commercial |
$3,695.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$3,126.75
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$4,210.88
|
|
|
VENACAVAL FILTER
|
Facility
|
OP
|
$16,700.00
|
|
| Hospital Charge Code |
2960499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,676.00 |
| Max. Negotiated Rate |
$66,800.00 |
| Rate for Payer: Aetna Commercial |
$15,030.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,362.00
|
| Rate for Payer: Aetna Managed Medicare |
$4,676.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,855.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,350.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,016.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,851.00
|
| Rate for Payer: Cash Price |
$5,010.00
|
| Rate for Payer: Cigna Commercial |
$15,364.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,345.32
|
| Rate for Payer: Health EOS Commercial |
$14,863.00
|
| Rate for Payer: HFN Commercial |
$15,364.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,525.00
|
| Rate for Payer: Multiplan Commercial |
$13,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$10,020.00
|
| Rate for Payer: Preferred Network Access Commercial |
$15,364.00
|
| Rate for Payer: Quartz Beloit One Network |
$8,183.00
|
| Rate for Payer: Quartz Commercial |
$10,855.00
|
| Rate for Payer: Quartz Medicare Advantage |
$10,020.00
|
| Rate for Payer: The Alliance Commercial |
$66,800.00
|
| Rate for Payer: WEA Trust Commercial |
$9,185.00
|
| Rate for Payer: WPS Commercial |
$12,369.69
|
|
