|
US Head/Neck Soft Tissue
|
Facility
|
OP
|
$1,283.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544891
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$326.56 |
| Max. Negotiated Rate |
$1,227.57 |
| Rate for Payer: Aetna Commercial |
$1,200.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,147.52
|
| Rate for Payer: Aetna Managed Medicare |
$373.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$707.19
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cash Price |
$384.90
|
| Rate for Payer: Cigna Commercial |
$1,227.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$746.71
|
| Rate for Payer: Health EOS Commercial |
$1,187.54
|
| Rate for Payer: HFN Commercial |
$1,227.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,000.74
|
| Rate for Payer: Multiplan Commercial |
$1,067.46
|
| Rate for Payer: NAPHCARE Commercial |
$800.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,227.57
|
| Rate for Payer: Quartz Beloit One Network |
$653.82
|
| Rate for Payer: Quartz Commercial |
$867.31
|
| Rate for Payer: Quartz Medicare Advantage |
$800.59
|
| Rate for Payer: The Alliance Commercial |
$326.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$733.88
|
| Rate for Payer: WPS Commercial |
$988.29
|
|
|
US Head/Neck Soft Tissue
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
631151
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$705.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.67
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$705.07
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
US Hips Infant Dynamic
|
Facility
|
OP
|
$1,249.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
631145
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$1,195.04 |
| Rate for Payer: Aetna Commercial |
$1,169.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.11
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$844.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$649.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$623.50
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,195.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$726.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$1,156.07
|
| Rate for Payer: HFN Commercial |
$1,195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$1,039.17
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.04
|
| Rate for Payer: Quartz Beloit One Network |
$636.49
|
| Rate for Payer: Quartz Commercial |
$844.32
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$714.43
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$962.10
|
|
|
US Hips Infant Dynamic
|
Facility
|
OP
|
$1,350.00
|
|
|
Service Code
|
CPT 76885 TC
|
| Hospital Charge Code |
2544893
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$386.88 |
| Max. Negotiated Rate |
$1,291.68 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Aetna Managed Medicare |
$393.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$744.12
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$785.70
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,053.00
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$842.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$912.60
|
| Rate for Payer: Quartz Medicare Advantage |
$842.40
|
| Rate for Payer: The Alliance Commercial |
$386.88
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
|
US Hips Infant Dynamic
|
Professional
|
Both
|
$1,350.00
|
|
|
Service Code
|
CPT 76885 TC
|
| Hospital Charge Code |
2544893
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$96.72 |
| Max. Negotiated Rate |
$1,333.80 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Aetna Managed Medicare |
$96.72
|
| Rate for Payer: Anthem Medicare Advantage |
$96.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.72
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,333.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$702.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.72
|
| Rate for Payer: Health EOS Commercial |
$1,277.64
|
| Rate for Payer: HFN Commercial |
$1,333.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$145.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,333.80
|
| Rate for Payer: Quartz Beloit One Network |
$617.76
|
| Rate for Payer: Quartz Commercial |
$800.28
|
| Rate for Payer: Quartz Medicare Advantage |
$96.72
|
| Rate for Payer: The Alliance Commercial |
$367.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.72
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$483.60
|
|
|
US Hips Infant Dynamic
|
Facility
|
IP
|
$1,249.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
631145
|
| Min. Negotiated Rate |
$636.49 |
| Max. Negotiated Rate |
$1,195.04 |
| Rate for Payer: Aetna Commercial |
$1,169.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$688.45
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,195.04
|
| Rate for Payer: Health EOS Commercial |
$1,156.07
|
| Rate for Payer: HFN Commercial |
$1,195.04
|
| Rate for Payer: Multiplan Commercial |
$1,039.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,195.04
|
| Rate for Payer: Quartz Beloit One Network |
$636.49
|
| Rate for Payer: Quartz Commercial |
$779.38
|
| Rate for Payer: WEA Trust Commercial |
$714.43
|
| Rate for Payer: WPS Commercial |
$962.10
|
|
|
US Hips Infant Dynamic
|
Facility
|
IP
|
$1,350.00
|
|
|
Service Code
|
CPT 76885 TC
|
| Hospital Charge Code |
2544893
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$687.96 |
| Max. Negotiated Rate |
$1,291.68 |
| Rate for Payer: Aetna Commercial |
$1,263.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,207.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$744.12
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,291.68
|
| Rate for Payer: Health EOS Commercial |
$1,249.56
|
| Rate for Payer: HFN Commercial |
$1,291.68
|
| Rate for Payer: Multiplan Commercial |
$1,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,291.68
|
| Rate for Payer: Quartz Beloit One Network |
$687.96
|
| Rate for Payer: Quartz Commercial |
$842.40
|
| Rate for Payer: WEA Trust Commercial |
$772.20
|
| Rate for Payer: WPS Commercial |
$1,039.90
|
|
|
US Hips Infant Dynamic
|
Professional
|
Both
|
$1,249.00
|
|
|
Service Code
|
CPT 76885
|
| Hospital Charge Code |
631145
|
| Min. Negotiated Rate |
$130.81 |
| Max. Negotiated Rate |
$1,234.01 |
| Rate for Payer: Aetna Commercial |
$1,234.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,117.11
|
| Rate for Payer: Aetna Managed Medicare |
$130.81
|
| Rate for Payer: Anthem Medicare Advantage |
$130.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.81
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cash Price |
$374.70
|
| Rate for Payer: Cigna Commercial |
$1,234.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$649.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.81
|
| Rate for Payer: Health EOS Commercial |
$1,182.05
|
| Rate for Payer: HFN Commercial |
$1,234.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.81
|
| Rate for Payer: Multiplan Commercial |
$1,039.17
|
| Rate for Payer: NAPHCARE Commercial |
$196.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,234.01
|
| Rate for Payer: Quartz Beloit One Network |
$571.54
|
| Rate for Payer: Quartz Commercial |
$740.41
|
| Rate for Payer: Quartz Medicare Advantage |
$130.81
|
| Rate for Payer: The Alliance Commercial |
$497.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.81
|
| Rate for Payer: WEA Trust Commercial |
$714.43
|
| Rate for Payer: WPS Commercial |
$654.06
|
|
|
US Hips Infant Static Limited
|
Professional
|
Both
|
$899.00
|
|
|
Service Code
|
CPT 76886 TC
|
| Hospital Charge Code |
2544895
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$68.00 |
| Max. Negotiated Rate |
$888.21 |
| Rate for Payer: Aetna Commercial |
$888.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.07
|
| Rate for Payer: Aetna Managed Medicare |
$68.00
|
| Rate for Payer: Anthem Medicare Advantage |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.00
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cigna Commercial |
$888.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$467.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.00
|
| Rate for Payer: Health EOS Commercial |
$850.81
|
| Rate for Payer: HFN Commercial |
$888.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$263.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$263.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.00
|
| Rate for Payer: Multiplan Commercial |
$747.97
|
| Rate for Payer: NAPHCARE Commercial |
$101.99
|
| Rate for Payer: Preferred Network Access Commercial |
$888.21
|
| Rate for Payer: Quartz Beloit One Network |
$411.38
|
| Rate for Payer: Quartz Commercial |
$532.93
|
| Rate for Payer: Quartz Medicare Advantage |
$68.00
|
| Rate for Payer: The Alliance Commercial |
$258.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.00
|
| Rate for Payer: WEA Trust Commercial |
$514.23
|
| Rate for Payer: WPS Commercial |
$339.98
|
|
|
US Hips Infant Static Limited
|
Facility
|
OP
|
$899.00
|
|
|
Service Code
|
CPT 76886 TC
|
| Hospital Charge Code |
2544895
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$261.79 |
| Max. Negotiated Rate |
$860.16 |
| Rate for Payer: Aetna Commercial |
$841.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.07
|
| Rate for Payer: Aetna Managed Medicare |
$261.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.53
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cigna Commercial |
$860.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$523.22
|
| Rate for Payer: Health EOS Commercial |
$832.11
|
| Rate for Payer: HFN Commercial |
$860.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$701.22
|
| Rate for Payer: Multiplan Commercial |
$747.97
|
| Rate for Payer: NAPHCARE Commercial |
$560.98
|
| Rate for Payer: Preferred Network Access Commercial |
$860.16
|
| Rate for Payer: Quartz Beloit One Network |
$458.13
|
| Rate for Payer: Quartz Commercial |
$607.72
|
| Rate for Payer: Quartz Medicare Advantage |
$560.98
|
| Rate for Payer: The Alliance Commercial |
$271.98
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$514.23
|
| Rate for Payer: WPS Commercial |
$692.50
|
|
|
US Hips Infant Static Limited
|
Facility
|
IP
|
$899.00
|
|
|
Service Code
|
CPT 76886 TC
|
| Hospital Charge Code |
2544895
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$458.13 |
| Max. Negotiated Rate |
$860.16 |
| Rate for Payer: Aetna Commercial |
$841.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$495.53
|
| Rate for Payer: Cash Price |
$269.70
|
| Rate for Payer: Cigna Commercial |
$860.16
|
| Rate for Payer: Health EOS Commercial |
$832.11
|
| Rate for Payer: HFN Commercial |
$860.16
|
| Rate for Payer: Multiplan Commercial |
$747.97
|
| Rate for Payer: Preferred Network Access Commercial |
$860.16
|
| Rate for Payer: Quartz Beloit One Network |
$458.13
|
| Rate for Payer: Quartz Commercial |
$560.98
|
| Rate for Payer: WEA Trust Commercial |
$514.23
|
| Rate for Payer: WPS Commercial |
$692.50
|
|
|
US Inferior Vena Cava Duplex Complete
|
Facility
|
IP
|
$1,288.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
2544903
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$656.36 |
| Max. Negotiated Rate |
$1,232.36 |
| Rate for Payer: Aetna Commercial |
$1,205.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,151.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$709.95
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$1,232.36
|
| Rate for Payer: Health EOS Commercial |
$1,192.17
|
| Rate for Payer: HFN Commercial |
$1,232.36
|
| Rate for Payer: Multiplan Commercial |
$1,071.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.36
|
| Rate for Payer: Quartz Beloit One Network |
$656.36
|
| Rate for Payer: Quartz Commercial |
$803.71
|
| Rate for Payer: WEA Trust Commercial |
$736.74
|
| Rate for Payer: WPS Commercial |
$992.15
|
|
|
US Inferior Vena Cava Duplex Complete
|
Facility
|
OP
|
$1,288.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
2544903
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$375.07 |
| Max. Negotiated Rate |
$1,232.36 |
| Rate for Payer: Aetna Commercial |
$1,205.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,151.99
|
| Rate for Payer: Aetna Managed Medicare |
$375.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$709.95
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$1,232.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$749.62
|
| Rate for Payer: Health EOS Commercial |
$1,192.17
|
| Rate for Payer: HFN Commercial |
$1,232.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,004.64
|
| Rate for Payer: Multiplan Commercial |
$1,071.62
|
| Rate for Payer: NAPHCARE Commercial |
$803.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,232.36
|
| Rate for Payer: Quartz Beloit One Network |
$656.36
|
| Rate for Payer: Quartz Commercial |
$870.69
|
| Rate for Payer: Quartz Medicare Advantage |
$803.71
|
| Rate for Payer: The Alliance Commercial |
$567.01
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$736.74
|
| Rate for Payer: WPS Commercial |
$992.15
|
|
|
US Inferior Vena Cava Duplex Complete
|
Professional
|
Both
|
$1,288.00
|
|
|
Service Code
|
CPT 93978 TC
|
| Hospital Charge Code |
2544903
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$134.98 |
| Max. Negotiated Rate |
$1,272.54 |
| Rate for Payer: Aetna Commercial |
$1,272.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,151.99
|
| Rate for Payer: Aetna Managed Medicare |
$141.75
|
| Rate for Payer: Anthem Medicare Advantage |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.75
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cash Price |
$386.40
|
| Rate for Payer: Cigna Commercial |
$1,272.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.75
|
| Rate for Payer: Health EOS Commercial |
$1,218.96
|
| Rate for Payer: HFN Commercial |
$1,272.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$529.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$1,071.62
|
| Rate for Payer: NAPHCARE Commercial |
$212.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.54
|
| Rate for Payer: Quartz Beloit One Network |
$589.39
|
| Rate for Payer: Quartz Commercial |
$763.53
|
| Rate for Payer: Quartz Medicare Advantage |
$141.75
|
| Rate for Payer: The Alliance Commercial |
$354.38
|
| Rate for Payer: United Healthcare Medicaid |
$134.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.75
|
| Rate for Payer: WEA Trust Commercial |
$736.74
|
| Rate for Payer: WPS Commercial |
$567.01
|
|
|
US Inferior Vena Cava Duplex Limited
|
Facility
|
OP
|
$766.00
|
|
|
Service Code
|
CPT 93979 TC
|
| Hospital Charge Code |
2544905
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$223.06 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Aetna Managed Medicare |
$223.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$422.22
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$732.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.81
|
| Rate for Payer: Health EOS Commercial |
$709.01
|
| Rate for Payer: HFN Commercial |
$732.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$597.48
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: NAPHCARE Commercial |
$477.98
|
| Rate for Payer: Preferred Network Access Commercial |
$732.91
|
| Rate for Payer: Quartz Beloit One Network |
$390.35
|
| Rate for Payer: Quartz Commercial |
$517.82
|
| Rate for Payer: Quartz Medicare Advantage |
$477.98
|
| Rate for Payer: The Alliance Commercial |
$370.91
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$590.05
|
|
|
US Inferior Vena Cava Duplex Limited
|
Professional
|
Both
|
$766.00
|
|
|
Service Code
|
CPT 93979 TC
|
| Hospital Charge Code |
2544905
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$92.73 |
| Max. Negotiated Rate |
$756.81 |
| Rate for Payer: Aetna Commercial |
$756.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Aetna Managed Medicare |
$92.73
|
| Rate for Payer: Anthem Medicare Advantage |
$92.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.73
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$756.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.73
|
| Rate for Payer: Health EOS Commercial |
$724.94
|
| Rate for Payer: HFN Commercial |
$756.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$345.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.73
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: NAPHCARE Commercial |
$139.09
|
| Rate for Payer: Preferred Network Access Commercial |
$756.81
|
| Rate for Payer: Quartz Beloit One Network |
$350.52
|
| Rate for Payer: Quartz Commercial |
$454.08
|
| Rate for Payer: Quartz Medicare Advantage |
$92.73
|
| Rate for Payer: The Alliance Commercial |
$231.82
|
| Rate for Payer: United Healthcare Medicaid |
$99.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.73
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$370.91
|
|
|
US Inferior Vena Cava Duplex Limited
|
Facility
|
IP
|
$766.00
|
|
|
Service Code
|
CPT 93979 TC
|
| Hospital Charge Code |
2544905
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$390.35 |
| Max. Negotiated Rate |
$732.91 |
| Rate for Payer: Aetna Commercial |
$716.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$685.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$422.22
|
| Rate for Payer: Cash Price |
$229.80
|
| Rate for Payer: Cigna Commercial |
$732.91
|
| Rate for Payer: Health EOS Commercial |
$709.01
|
| Rate for Payer: HFN Commercial |
$732.91
|
| Rate for Payer: Multiplan Commercial |
$637.31
|
| Rate for Payer: Preferred Network Access Commercial |
$732.91
|
| Rate for Payer: Quartz Beloit One Network |
$390.35
|
| Rate for Payer: Quartz Commercial |
$477.98
|
| Rate for Payer: WEA Trust Commercial |
$438.15
|
| Rate for Payer: WPS Commercial |
$590.05
|
|
|
US Kidney Transplant Left
|
Facility
|
IP
|
$1,332.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$678.79 |
| Max. Negotiated Rate |
$1,274.46 |
| Rate for Payer: Aetna Commercial |
$1,246.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.20
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$1,274.46
|
| Rate for Payer: Health EOS Commercial |
$1,232.90
|
| Rate for Payer: HFN Commercial |
$1,274.46
|
| Rate for Payer: Multiplan Commercial |
$1,108.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.46
|
| Rate for Payer: Quartz Beloit One Network |
$678.79
|
| Rate for Payer: Quartz Commercial |
$831.17
|
| Rate for Payer: WEA Trust Commercial |
$761.90
|
| Rate for Payer: WPS Commercial |
$1,026.04
|
|
|
US Kidney Transplant Left
|
Facility
|
OP
|
$1,332.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$387.88 |
| Max. Negotiated Rate |
$1,274.46 |
| Rate for Payer: Aetna Commercial |
$1,246.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.34
|
| Rate for Payer: Aetna Managed Medicare |
$387.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.20
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$1,274.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$775.22
|
| Rate for Payer: Health EOS Commercial |
$1,232.90
|
| Rate for Payer: HFN Commercial |
$1,274.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,038.96
|
| Rate for Payer: Multiplan Commercial |
$1,108.22
|
| Rate for Payer: NAPHCARE Commercial |
$831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.46
|
| Rate for Payer: Quartz Beloit One Network |
$678.79
|
| Rate for Payer: Quartz Commercial |
$900.43
|
| Rate for Payer: Quartz Medicare Advantage |
$831.17
|
| Rate for Payer: The Alliance Commercial |
$430.81
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$761.90
|
| Rate for Payer: WPS Commercial |
$1,026.04
|
|
|
US Kidney Transplant Left
|
Professional
|
Both
|
$1,332.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$1,316.02 |
| Rate for Payer: Aetna Commercial |
$1,316.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.34
|
| Rate for Payer: Aetna Managed Medicare |
$107.70
|
| Rate for Payer: Anthem Medicare Advantage |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.70
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cash Price |
$399.60
|
| Rate for Payer: Cigna Commercial |
$1,316.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$692.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.70
|
| Rate for Payer: Health EOS Commercial |
$1,260.60
|
| Rate for Payer: HFN Commercial |
$1,316.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$419.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$419.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.70
|
| Rate for Payer: Multiplan Commercial |
$1,108.22
|
| Rate for Payer: NAPHCARE Commercial |
$161.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,316.02
|
| Rate for Payer: Quartz Beloit One Network |
$609.52
|
| Rate for Payer: Quartz Commercial |
$789.61
|
| Rate for Payer: Quartz Medicare Advantage |
$107.70
|
| Rate for Payer: The Alliance Commercial |
$409.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.70
|
| Rate for Payer: WEA Trust Commercial |
$761.90
|
| Rate for Payer: WPS Commercial |
$538.51
|
|
|
US Kidney Transplant Right
|
Professional
|
Both
|
$1,383.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544913
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$107.70 |
| Max. Negotiated Rate |
$1,366.40 |
| Rate for Payer: Aetna Commercial |
$1,366.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Aetna Managed Medicare |
$107.70
|
| Rate for Payer: Anthem Medicare Advantage |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.70
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,366.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$719.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.70
|
| Rate for Payer: Health EOS Commercial |
$1,308.87
|
| Rate for Payer: HFN Commercial |
$1,366.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$419.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$419.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.70
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: NAPHCARE Commercial |
$161.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,366.40
|
| Rate for Payer: Quartz Beloit One Network |
$632.86
|
| Rate for Payer: Quartz Commercial |
$819.84
|
| Rate for Payer: Quartz Medicare Advantage |
$107.70
|
| Rate for Payer: The Alliance Commercial |
$409.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.70
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$538.51
|
|
|
US Kidney Transplant Right
|
Facility
|
IP
|
$1,383.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544913
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$704.78 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$862.99
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
US Kidney Transplant Right
|
Facility
|
OP
|
$1,383.00
|
|
|
Service Code
|
CPT 76776 TC
|
| Hospital Charge Code |
2544913
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$402.73 |
| Max. Negotiated Rate |
$1,323.25 |
| Rate for Payer: Aetna Commercial |
$1,294.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,236.96
|
| Rate for Payer: Aetna Managed Medicare |
$402.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$762.31
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cash Price |
$414.90
|
| Rate for Payer: Cigna Commercial |
$1,323.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$804.91
|
| Rate for Payer: Health EOS Commercial |
$1,280.10
|
| Rate for Payer: HFN Commercial |
$1,323.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,078.74
|
| Rate for Payer: Multiplan Commercial |
$1,150.66
|
| Rate for Payer: NAPHCARE Commercial |
$862.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,323.25
|
| Rate for Payer: Quartz Beloit One Network |
$704.78
|
| Rate for Payer: Quartz Commercial |
$934.91
|
| Rate for Payer: Quartz Medicare Advantage |
$862.99
|
| Rate for Payer: The Alliance Commercial |
$430.81
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$791.08
|
| Rate for Payer: WPS Commercial |
$1,065.32
|
|
|
US Left Lower Quadrant
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711775
|
| Min. Negotiated Rate |
$763.89 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$935.38
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Left Lower Quadrant
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711775
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,481.01 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$779.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
