|
US Pregnancy 1st Trimester
|
Facility
|
IP
|
$1,777.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544947
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$905.56 |
| Max. Negotiated Rate |
$1,700.23 |
| Rate for Payer: Aetna Commercial |
$1,663.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$979.48
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,700.23
|
| Rate for Payer: Health EOS Commercial |
$1,644.79
|
| Rate for Payer: HFN Commercial |
$1,700.23
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.23
|
| Rate for Payer: Quartz Beloit One Network |
$905.56
|
| Rate for Payer: Quartz Commercial |
$1,108.85
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$1,368.82
|
|
|
US Pregnancy 1st Trimester
|
Facility
|
OP
|
$1,777.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544947
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$279.97 |
| Max. Negotiated Rate |
$1,700.23 |
| Rate for Payer: Aetna Commercial |
$1,663.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Aetna Managed Medicare |
$517.46
|
| 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 |
$979.48
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,700.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,034.21
|
| Rate for Payer: Health EOS Commercial |
$1,644.79
|
| Rate for Payer: HFN Commercial |
$1,700.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,386.06
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,108.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.23
|
| Rate for Payer: Quartz Beloit One Network |
$905.56
|
| Rate for Payer: Quartz Commercial |
$1,201.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,108.85
|
| Rate for Payer: The Alliance Commercial |
$279.97
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$1,368.82
|
|
|
US Pregnancy 1st Trimester
|
Professional
|
Both
|
$1,709.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
630921
|
| Min. Negotiated Rate |
$116.53 |
| Max. Negotiated Rate |
$1,688.49 |
| Rate for Payer: Aetna Commercial |
$1,688.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Aetna Managed Medicare |
$116.53
|
| Rate for Payer: Anthem Medicare Advantage |
$116.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.53
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,688.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$888.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.53
|
| Rate for Payer: Health EOS Commercial |
$1,617.40
|
| Rate for Payer: HFN Commercial |
$1,688.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$432.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$432.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.53
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: NAPHCARE Commercial |
$174.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,688.49
|
| Rate for Payer: Quartz Beloit One Network |
$782.04
|
| Rate for Payer: Quartz Commercial |
$1,013.10
|
| Rate for Payer: Quartz Medicare Advantage |
$116.53
|
| Rate for Payer: The Alliance Commercial |
$442.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.53
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$582.66
|
|
|
US Pregnancy 1st Trimester
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$1,823.85 |
| Rate for Payer: Aetna Commercial |
$1,823.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$69.99
|
| Rate for Payer: Anthem Medicare Advantage |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.99
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,823.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$959.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.99
|
| Rate for Payer: Health EOS Commercial |
$1,747.05
|
| Rate for Payer: HFN Commercial |
$1,823.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$104.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,823.85
|
| Rate for Payer: Quartz Beloit One Network |
$844.73
|
| Rate for Payer: Quartz Commercial |
$1,094.31
|
| Rate for Payer: Quartz Medicare Advantage |
$69.99
|
| Rate for Payer: The Alliance Commercial |
$265.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.99
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$349.96
|
|
|
US Pregnancy 1st Trimester
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$279.97 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$537.56
|
| 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 |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.37
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.88
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,247.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.90
|
| Rate for Payer: The Alliance Commercial |
$279.97
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Pregnancy 1st Trimester
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
CPT 76801
|
| Hospital Charge Code |
630921
|
| Min. Negotiated Rate |
$870.91 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,066.42
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
US Pregnancy 1st Trimester
|
Professional
|
Both
|
$1,777.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544947
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$1,755.68 |
| Rate for Payer: Aetna Commercial |
$1,755.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Aetna Managed Medicare |
$69.99
|
| Rate for Payer: Anthem Medicare Advantage |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.99
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,755.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$924.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.99
|
| Rate for Payer: Health EOS Commercial |
$1,681.75
|
| Rate for Payer: HFN Commercial |
$1,755.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: NAPHCARE Commercial |
$104.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,755.68
|
| Rate for Payer: Quartz Beloit One Network |
$813.16
|
| Rate for Payer: Quartz Commercial |
$1,053.41
|
| Rate for Payer: Quartz Medicare Advantage |
$69.99
|
| Rate for Payer: The Alliance Commercial |
$265.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.99
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$349.96
|
|
|
US Pregnancy 1st Trimester
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
2544946
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,151.90
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Pregnancy After 1st Trimester
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
630919
|
| Min. Negotiated Rate |
$870.91 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,066.42
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
US Pregnancy After 1st Trimester
|
Professional
|
Both
|
$1,709.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
630919
|
| Min. Negotiated Rate |
$135.27 |
| Max. Negotiated Rate |
$1,688.49 |
| Rate for Payer: Aetna Commercial |
$1,688.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Aetna Managed Medicare |
$135.27
|
| Rate for Payer: Anthem Medicare Advantage |
$135.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.27
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,688.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$888.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.27
|
| Rate for Payer: Health EOS Commercial |
$1,617.40
|
| Rate for Payer: HFN Commercial |
$1,688.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$497.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$497.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.27
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: NAPHCARE Commercial |
$202.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,688.49
|
| Rate for Payer: Quartz Beloit One Network |
$782.04
|
| Rate for Payer: Quartz Commercial |
$1,013.10
|
| Rate for Payer: Quartz Medicare Advantage |
$135.27
|
| Rate for Payer: The Alliance Commercial |
$514.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.27
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$676.36
|
|
|
US Pregnancy After 1st Trimester
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
2544948
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.27 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$537.56
|
| 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 |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.37
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.88
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,247.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.90
|
| Rate for Payer: The Alliance Commercial |
$352.27
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Pregnancy After 1st Trimester
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
2544948
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,151.90
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Pregnancy After 1st Trimester
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
CPT 76805
|
| Hospital Charge Code |
630919
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$853.13
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| 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 |
$512.70
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| 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 |
$1,421.89
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,155.28
|
| 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 |
$977.55
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
US Pregnancy After 1st Trimester
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
2544948
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$88.07 |
| Max. Negotiated Rate |
$1,823.85 |
| Rate for Payer: Aetna Commercial |
$1,823.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$88.07
|
| Rate for Payer: Anthem Medicare Advantage |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.07
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,823.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$959.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.07
|
| Rate for Payer: Health EOS Commercial |
$1,747.05
|
| Rate for Payer: HFN Commercial |
$1,823.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$324.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.07
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$132.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,823.85
|
| Rate for Payer: Quartz Beloit One Network |
$844.73
|
| Rate for Payer: Quartz Commercial |
$1,094.31
|
| Rate for Payer: Quartz Medicare Advantage |
$88.07
|
| Rate for Payer: The Alliance Commercial |
$334.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.07
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$440.34
|
|
|
US Pregnancy After 1St Trimester
|
Professional
|
Both
|
$1,777.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
3072698
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$88.07 |
| Max. Negotiated Rate |
$1,755.68 |
| Rate for Payer: Aetna Commercial |
$1,755.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Aetna Managed Medicare |
$88.07
|
| Rate for Payer: Anthem Medicare Advantage |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.07
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,755.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$924.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.07
|
| Rate for Payer: Health EOS Commercial |
$1,681.75
|
| Rate for Payer: HFN Commercial |
$1,755.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$324.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.07
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: NAPHCARE Commercial |
$132.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,755.68
|
| Rate for Payer: Quartz Beloit One Network |
$813.16
|
| Rate for Payer: Quartz Commercial |
$1,053.41
|
| Rate for Payer: Quartz Medicare Advantage |
$88.07
|
| Rate for Payer: The Alliance Commercial |
$334.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.07
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$440.34
|
|
|
US Pregnancy After 1St Trimester
|
Facility
|
IP
|
$1,777.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
3072698
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$905.56 |
| Max. Negotiated Rate |
$1,700.23 |
| Rate for Payer: Aetna Commercial |
$1,663.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$979.48
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,700.23
|
| Rate for Payer: Health EOS Commercial |
$1,644.79
|
| Rate for Payer: HFN Commercial |
$1,700.23
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.23
|
| Rate for Payer: Quartz Beloit One Network |
$905.56
|
| Rate for Payer: Quartz Commercial |
$1,108.85
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$1,368.82
|
|
|
US Pregnancy After 1St Trimester
|
Facility
|
OP
|
$1,777.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
3072698
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.27 |
| Max. Negotiated Rate |
$1,700.23 |
| Rate for Payer: Aetna Commercial |
$1,663.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,589.35
|
| Rate for Payer: Aetna Managed Medicare |
$517.46
|
| 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 |
$979.48
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cash Price |
$533.10
|
| Rate for Payer: Cigna Commercial |
$1,700.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,034.21
|
| Rate for Payer: Health EOS Commercial |
$1,644.79
|
| Rate for Payer: HFN Commercial |
$1,700.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,386.06
|
| Rate for Payer: Multiplan Commercial |
$1,478.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,108.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.23
|
| Rate for Payer: Quartz Beloit One Network |
$905.56
|
| Rate for Payer: Quartz Commercial |
$1,201.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,108.85
|
| Rate for Payer: The Alliance Commercial |
$352.27
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,016.44
|
| Rate for Payer: WPS Commercial |
$1,368.82
|
|
|
US Pregnancy After 1st Trimester TWINS
|
Facility
|
IP
|
$2,598.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
4566911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,323.94 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,621.15
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
US Pregnancy After 1st Trimester TWINS
|
Facility
|
OP
|
$2,598.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
4566911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$352.27 |
| Max. Negotiated Rate |
$2,485.77 |
| Rate for Payer: Aetna Commercial |
$2,431.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Aetna Managed Medicare |
$756.54
|
| 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 |
$1,432.02
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,485.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.04
|
| Rate for Payer: Health EOS Commercial |
$2,404.71
|
| Rate for Payer: HFN Commercial |
$2,485.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,026.44
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.94
|
| Rate for Payer: Quartz Commercial |
$1,756.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,621.15
|
| Rate for Payer: The Alliance Commercial |
$352.27
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$2,001.24
|
|
|
US Pregnancy After 1st Trimester TWINS
|
Professional
|
Both
|
$2,598.00
|
|
|
Service Code
|
CPT 76805 TC
|
| Hospital Charge Code |
4566911
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$88.07 |
| Max. Negotiated Rate |
$2,566.82 |
| Rate for Payer: Aetna Commercial |
$2,566.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.65
|
| Rate for Payer: Aetna Managed Medicare |
$88.07
|
| Rate for Payer: Anthem Medicare Advantage |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.07
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cash Price |
$779.40
|
| Rate for Payer: Cigna Commercial |
$2,566.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,350.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.07
|
| Rate for Payer: Health EOS Commercial |
$2,458.75
|
| Rate for Payer: HFN Commercial |
$2,566.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$324.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.07
|
| Rate for Payer: Multiplan Commercial |
$2,161.54
|
| Rate for Payer: NAPHCARE Commercial |
$132.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.84
|
| Rate for Payer: Quartz Commercial |
$1,540.09
|
| Rate for Payer: Quartz Medicare Advantage |
$88.07
|
| Rate for Payer: The Alliance Commercial |
$334.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.07
|
| Rate for Payer: WEA Trust Commercial |
$1,486.06
|
| Rate for Payer: WPS Commercial |
$440.34
|
|
|
US Pregnancy Before 1st Trimester TWINS
|
Facility
|
IP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
4566914
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$940.72 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,151.90
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Pregnancy Before 1st Trimester TWINS
|
Facility
|
OP
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
4566914
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$279.97 |
| Max. Negotiated Rate |
$1,766.25 |
| Rate for Payer: Aetna Commercial |
$1,727.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$537.56
|
| 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 |
$1,017.52
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,766.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.37
|
| Rate for Payer: Health EOS Commercial |
$1,708.66
|
| Rate for Payer: HFN Commercial |
$1,766.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,439.88
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$1,151.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,766.25
|
| Rate for Payer: Quartz Beloit One Network |
$940.72
|
| Rate for Payer: Quartz Commercial |
$1,247.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,151.90
|
| Rate for Payer: The Alliance Commercial |
$279.97
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$1,421.97
|
|
|
US Pregnancy Before 1st Trimester TWINS
|
Professional
|
Both
|
$1,846.00
|
|
|
Service Code
|
CPT 76801 TC
|
| Hospital Charge Code |
4566914
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$1,823.85 |
| Rate for Payer: Aetna Commercial |
$1,823.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,651.06
|
| Rate for Payer: Aetna Managed Medicare |
$69.99
|
| Rate for Payer: Anthem Medicare Advantage |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.99
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cash Price |
$553.80
|
| Rate for Payer: Cigna Commercial |
$1,823.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$959.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.99
|
| Rate for Payer: Health EOS Commercial |
$1,747.05
|
| Rate for Payer: HFN Commercial |
$1,823.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$1,535.87
|
| Rate for Payer: NAPHCARE Commercial |
$104.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,823.85
|
| Rate for Payer: Quartz Beloit One Network |
$844.73
|
| Rate for Payer: Quartz Commercial |
$1,094.31
|
| Rate for Payer: Quartz Medicare Advantage |
$69.99
|
| Rate for Payer: The Alliance Commercial |
$265.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.99
|
| Rate for Payer: WEA Trust Commercial |
$1,055.91
|
| Rate for Payer: WPS Commercial |
$349.96
|
|
|
US Pregnancy Follow Up
|
Facility
|
IP
|
$909.00
|
|
|
Service Code
|
CPT 76816
|
| Hospital Charge Code |
630910
|
| Min. Negotiated Rate |
$463.23 |
| Max. Negotiated Rate |
$869.73 |
| Rate for Payer: Aetna Commercial |
$850.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.04
|
| Rate for Payer: Cash Price |
$272.70
|
| Rate for Payer: Cigna Commercial |
$869.73
|
| Rate for Payer: Health EOS Commercial |
$841.37
|
| Rate for Payer: HFN Commercial |
$869.73
|
| Rate for Payer: Multiplan Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$869.73
|
| Rate for Payer: Quartz Beloit One Network |
$463.23
|
| Rate for Payer: Quartz Commercial |
$567.22
|
| Rate for Payer: WEA Trust Commercial |
$519.95
|
| Rate for Payer: WPS Commercial |
$700.20
|
|
|
US Pregnancy Follow Up
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
CPT 76816 TC
|
| Hospital Charge Code |
2544952
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.99 |
| Max. Negotiated Rate |
$1,306.14 |
| Rate for Payer: Aetna Commercial |
$1,306.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Aetna Managed Medicare |
$69.99
|
| Rate for Payer: Anthem Medicare Advantage |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.99
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,306.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$687.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.99
|
| Rate for Payer: Health EOS Commercial |
$1,251.14
|
| Rate for Payer: HFN Commercial |
$1,306.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$255.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.99
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: NAPHCARE Commercial |
$104.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,306.14
|
| Rate for Payer: Quartz Beloit One Network |
$604.95
|
| Rate for Payer: Quartz Commercial |
$783.68
|
| Rate for Payer: Quartz Medicare Advantage |
$69.99
|
| Rate for Payer: The Alliance Commercial |
$265.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.99
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$349.96
|
|
