|
Urine Mercury Level
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$316.46 |
| Max. Negotiated Rate |
$594.17 |
| Rate for Payer: Aetna Commercial |
$581.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$594.17
|
| Rate for Payer: Health EOS Commercial |
$574.80
|
| Rate for Payer: HFN Commercial |
$594.17
|
| Rate for Payer: Multiplan Commercial |
$516.67
|
| Rate for Payer: Preferred Network Access Commercial |
$594.17
|
| Rate for Payer: Quartz Beloit One Network |
$316.46
|
| Rate for Payer: Quartz Commercial |
$387.50
|
| Rate for Payer: WEA Trust Commercial |
$355.21
|
| Rate for Payer: WPS Commercial |
$478.36
|
|
|
Urine Mercury Level
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$613.55 |
| Rate for Payer: Aetna Commercial |
$613.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Aetna Managed Medicare |
$16.91
|
| Rate for Payer: Anthem Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.91
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$613.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$322.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.91
|
| Rate for Payer: Health EOS Commercial |
$587.71
|
| Rate for Payer: HFN Commercial |
$613.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$516.67
|
| Rate for Payer: NAPHCARE Commercial |
$25.37
|
| Rate for Payer: Preferred Network Access Commercial |
$613.55
|
| Rate for Payer: Quartz Beloit One Network |
$284.17
|
| Rate for Payer: Quartz Commercial |
$368.13
|
| Rate for Payer: Quartz Medicare Advantage |
$16.91
|
| Rate for Payer: The Alliance Commercial |
$66.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: WEA Trust Commercial |
$355.21
|
| Rate for Payer: WPS Commercial |
$74.41
|
|
|
Urine Mercury Level
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3986165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.91 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$16.91
|
| Rate for Payer: Anthem Medicare Advantage |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.91
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.91
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.91
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$25.37
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.91
|
| Rate for Payer: The Alliance Commercial |
$66.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.91
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$74.41
|
|
|
URINEMETER LF SURESTEP WO FOLEY A304400A
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
5384736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.33 |
| Max. Negotiated Rate |
$381.76 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.93
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$381.76
|
| Rate for Payer: Health EOS Commercial |
$369.31
|
| Rate for Payer: HFN Commercial |
$381.76
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: Preferred Network Access Commercial |
$381.76
|
| Rate for Payer: Quartz Beloit One Network |
$203.33
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$307.35
|
|
|
URINEMETER LF SURESTEP WO FOLEY A304400A
|
Facility
|
OP
|
$399.00
|
|
| Hospital Charge Code |
5384736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.19 |
| Max. Negotiated Rate |
$381.76 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.87
|
| Rate for Payer: Aetna Managed Medicare |
$116.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.93
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$381.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.22
|
| Rate for Payer: Health EOS Commercial |
$369.31
|
| Rate for Payer: HFN Commercial |
$381.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.22
|
| Rate for Payer: Multiplan Commercial |
$331.97
|
| Rate for Payer: NAPHCARE Commercial |
$248.98
|
| Rate for Payer: Preferred Network Access Commercial |
$381.76
|
| Rate for Payer: Quartz Beloit One Network |
$203.33
|
| Rate for Payer: Quartz Commercial |
$269.72
|
| Rate for Payer: Quartz Medicare Advantage |
$248.98
|
| Rate for Payer: The Alliance Commercial |
$207.48
|
| Rate for Payer: WEA Trust Commercial |
$228.23
|
| Rate for Payer: WPS Commercial |
$307.35
|
|
|
URINEMETER SSTEP W TEMP LF A119216M
|
Facility
|
OP
|
$816.00
|
|
| Hospital Charge Code |
5384738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.62 |
| Max. Negotiated Rate |
$780.75 |
| Rate for Payer: Aetna Commercial |
$763.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.83
|
| Rate for Payer: Aetna Managed Medicare |
$237.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$551.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.78
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$780.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$474.91
|
| Rate for Payer: Health EOS Commercial |
$755.29
|
| Rate for Payer: HFN Commercial |
$780.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.48
|
| Rate for Payer: Multiplan Commercial |
$678.91
|
| Rate for Payer: NAPHCARE Commercial |
$509.18
|
| Rate for Payer: Preferred Network Access Commercial |
$780.75
|
| Rate for Payer: Quartz Beloit One Network |
$415.83
|
| Rate for Payer: Quartz Commercial |
$551.62
|
| Rate for Payer: Quartz Medicare Advantage |
$509.18
|
| Rate for Payer: The Alliance Commercial |
$424.32
|
| Rate for Payer: WEA Trust Commercial |
$466.75
|
| Rate for Payer: WPS Commercial |
$628.56
|
|
|
URINEMETER SSTEP W TEMP LF A119216M
|
Facility
|
IP
|
$816.00
|
|
| Hospital Charge Code |
5384738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.83 |
| Max. Negotiated Rate |
$780.75 |
| Rate for Payer: Aetna Commercial |
$763.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.78
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$780.75
|
| Rate for Payer: Health EOS Commercial |
$755.29
|
| Rate for Payer: HFN Commercial |
$780.75
|
| Rate for Payer: Multiplan Commercial |
$678.91
|
| Rate for Payer: Preferred Network Access Commercial |
$780.75
|
| Rate for Payer: Quartz Beloit One Network |
$415.83
|
| Rate for Payer: Quartz Commercial |
$509.18
|
| Rate for Payer: WEA Trust Commercial |
$466.75
|
| Rate for Payer: WPS Commercial |
$628.56
|
|
|
Urine Microalbumin
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3705510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Urine Microalbumin
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
982628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$98.59
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Urine Microalbumin
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
982628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$156.10 |
| Rate for Payer: Aetna Commercial |
$156.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$156.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$149.53
|
| Rate for Payer: HFN Commercial |
$156.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$156.10
|
| Rate for Payer: Quartz Beloit One Network |
$72.30
|
| Rate for Payer: Quartz Commercial |
$93.66
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$23.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$26.45
|
|
|
Urine Microalbumin
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
982628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$106.81
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$123.24
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Urine Microalbumin
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3705510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Urine Microalbumin
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3705510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$23.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$26.45
|
|
|
.Urine Microscopic
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1172799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
.Urine Microscopic
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1172799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$129.43 |
| Rate for Payer: Aetna Commercial |
$129.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$3.30
|
| Rate for Payer: Anthem Medicare Advantage |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$129.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.30
|
| Rate for Payer: Health EOS Commercial |
$123.98
|
| Rate for Payer: HFN Commercial |
$129.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$4.95
|
| Rate for Payer: Preferred Network Access Commercial |
$129.43
|
| Rate for Payer: Quartz Beloit One Network |
$59.95
|
| Rate for Payer: Quartz Commercial |
$77.66
|
| Rate for Payer: Quartz Medicare Advantage |
$3.30
|
| Rate for Payer: The Alliance Commercial |
$13.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.30
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$14.51
|
|
|
.Urine Microscopic
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1172799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$3.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.47
|
| Rate for Payer: Anthem Medicare Advantage |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.30
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$4.95
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| Rate for Payer: Quartz Medicare Advantage |
$3.30
|
| Rate for Payer: The Alliance Commercial |
$13.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.30
|
| Rate for Payer: United Healthcare PPO |
$102.18
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Urine Nortriptyline
|
Facility
|
IP
|
$212.00
|
|
| Hospital Charge Code |
2943022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$132.29
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Urine Nortriptyline
|
Facility
|
OP
|
$212.00
|
|
| Hospital Charge Code |
2943022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$61.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.36
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$132.29
|
| Rate for Payer: The Alliance Commercial |
$110.24
|
| Rate for Payer: United Healthcare PPO |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Urine Nortriptyline
|
Professional
|
Both
|
$212.00
|
|
| Hospital Charge Code |
2943022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$209.46 |
| Rate for Payer: Aetna Commercial |
$209.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$209.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.29
|
| Rate for Payer: Health EOS Commercial |
$200.64
|
| Rate for Payer: HFN Commercial |
$209.46
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$209.46
|
| Rate for Payer: Quartz Beloit One Network |
$97.01
|
| Rate for Payer: Quartz Commercial |
$125.67
|
| Rate for Payer: The Alliance Commercial |
$110.24
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Urine Oxalate
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
2942990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$60.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$15.03
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Urine Oxalate
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
2942990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Urine Oxalate
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3813058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Urine Oxalate
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
2942990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$59.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$66.12
|
|
|
Urine Oxalate
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3813058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$66.12 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$59.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$66.12
|
|
|
Urine Oxalate
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3813058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$60.11 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$60.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$15.03
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
