|
US Retroperitoneal Complete
|
Facility
|
OP
|
$1,269.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
630892
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,214.18 |
| Rate for Payer: Aetna Commercial |
$1,187.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.99
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$857.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$659.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.48
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.47
|
| 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 |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna Commercial |
$1,214.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,174.59
|
| Rate for Payer: HFN Commercial |
$1,214.18
|
| 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 |
$1,055.81
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,214.18
|
| Rate for Payer: Quartz Beloit One Network |
$646.68
|
| Rate for Payer: Quartz Commercial |
$857.84
|
| 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 |
$725.87
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$977.51
|
|
|
US Retroperitoneal Complete
|
Professional
|
Both
|
$1,269.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
630892
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$1,253.77 |
| Rate for Payer: Aetna Commercial |
$1,253.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.99
|
| Rate for Payer: Aetna Managed Medicare |
$105.75
|
| Rate for Payer: Anthem Medicare Advantage |
$105.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$105.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$105.75
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna Commercial |
$1,253.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$659.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.75
|
| Rate for Payer: Health EOS Commercial |
$1,200.98
|
| Rate for Payer: HFN Commercial |
$1,253.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$1,055.81
|
| Rate for Payer: NAPHCARE Commercial |
$158.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,253.77
|
| Rate for Payer: Quartz Beloit One Network |
$580.69
|
| Rate for Payer: Quartz Commercial |
$752.26
|
| Rate for Payer: Quartz Medicare Advantage |
$105.75
|
| Rate for Payer: The Alliance Commercial |
$401.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.75
|
| Rate for Payer: WEA Trust Commercial |
$725.87
|
| Rate for Payer: WPS Commercial |
$528.74
|
|
|
US Retroperitoneal Complete
|
Facility
|
IP
|
$1,649.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2544965
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$840.33 |
| Max. Negotiated Rate |
$1,577.76 |
| Rate for Payer: Aetna Commercial |
$1,543.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,474.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$908.93
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cigna Commercial |
$1,577.76
|
| Rate for Payer: Health EOS Commercial |
$1,526.31
|
| Rate for Payer: HFN Commercial |
$1,577.76
|
| Rate for Payer: Multiplan Commercial |
$1,371.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,577.76
|
| Rate for Payer: Quartz Beloit One Network |
$840.33
|
| Rate for Payer: Quartz Commercial |
$1,028.98
|
| Rate for Payer: WEA Trust Commercial |
$943.23
|
| Rate for Payer: WPS Commercial |
$1,270.22
|
|
|
US Retroperitoneal Complete
|
Facility
|
OP
|
$1,649.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2544965
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.62 |
| Max. Negotiated Rate |
$1,577.76 |
| Rate for Payer: Aetna Commercial |
$1,543.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,474.87
|
| Rate for Payer: Aetna Managed Medicare |
$480.19
|
| 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 |
$908.93
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cash Price |
$494.70
|
| Rate for Payer: Cigna Commercial |
$1,577.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$959.72
|
| Rate for Payer: Health EOS Commercial |
$1,526.31
|
| Rate for Payer: HFN Commercial |
$1,577.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,286.22
|
| Rate for Payer: Multiplan Commercial |
$1,371.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,028.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,577.76
|
| Rate for Payer: Quartz Beloit One Network |
$840.33
|
| Rate for Payer: Quartz Commercial |
$1,114.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,028.98
|
| Rate for Payer: The Alliance Commercial |
$286.62
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$943.23
|
| Rate for Payer: WPS Commercial |
$1,270.22
|
|
|
US Retroperitoneal Complete
|
Facility
|
IP
|
$1,269.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
630892
|
| Min. Negotiated Rate |
$646.68 |
| Max. Negotiated Rate |
$1,214.18 |
| Rate for Payer: Aetna Commercial |
$1,187.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,134.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.47
|
| Rate for Payer: Cash Price |
$380.70
|
| Rate for Payer: Cigna Commercial |
$1,214.18
|
| Rate for Payer: Health EOS Commercial |
$1,174.59
|
| Rate for Payer: HFN Commercial |
$1,214.18
|
| Rate for Payer: Multiplan Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,214.18
|
| Rate for Payer: Quartz Beloit One Network |
$646.68
|
| Rate for Payer: Quartz Commercial |
$791.86
|
| Rate for Payer: WEA Trust Commercial |
$725.87
|
| Rate for Payer: WPS Commercial |
$977.51
|
|
|
US Retroperitoneal Limited
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3072700
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$2,019.47 |
| Rate for Payer: Aetna Commercial |
$2,019.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,828.15
|
| Rate for Payer: Aetna Managed Medicare |
$33.38
|
| Rate for Payer: Anthem Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.38
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$2,019.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,062.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.38
|
| Rate for Payer: Health EOS Commercial |
$1,934.44
|
| Rate for Payer: HFN Commercial |
$2,019.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$1,700.61
|
| Rate for Payer: NAPHCARE Commercial |
$50.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.47
|
| Rate for Payer: Quartz Beloit One Network |
$935.33
|
| Rate for Payer: Quartz Commercial |
$1,211.68
|
| Rate for Payer: Quartz Medicare Advantage |
$33.38
|
| Rate for Payer: The Alliance Commercial |
$126.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.38
|
| Rate for Payer: WEA Trust Commercial |
$1,169.17
|
| Rate for Payer: WPS Commercial |
$166.92
|
|
|
US Retroperitoneal Limited
|
Professional
|
Both
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
630854
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$1,552.15 |
| Rate for Payer: Aetna Commercial |
$1,552.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Aetna Managed Medicare |
$60.50
|
| Rate for Payer: Anthem Medicare Advantage |
$60.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.50
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,552.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$816.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.50
|
| Rate for Payer: Health EOS Commercial |
$1,486.79
|
| Rate for Payer: HFN Commercial |
$1,552.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$207.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: NAPHCARE Commercial |
$90.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,552.15
|
| Rate for Payer: Quartz Beloit One Network |
$718.89
|
| Rate for Payer: Quartz Commercial |
$931.29
|
| Rate for Payer: Quartz Medicare Advantage |
$60.50
|
| Rate for Payer: The Alliance Commercial |
$229.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.50
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$302.48
|
|
|
US Retroperitoneal Limited
|
Facility
|
OP
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2544967
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$133.54 |
| Max. Negotiated Rate |
$1,563.41 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Aetna Managed Medicare |
$475.82
|
| 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 |
$900.66
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,563.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$950.99
|
| Rate for Payer: Health EOS Commercial |
$1,512.43
|
| Rate for Payer: HFN Commercial |
$1,563.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,274.52
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,019.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.41
|
| Rate for Payer: Quartz Beloit One Network |
$832.69
|
| Rate for Payer: Quartz Commercial |
$1,104.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,019.62
|
| Rate for Payer: The Alliance Commercial |
$133.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$1,258.67
|
|
|
US Retroperitoneal Limited
|
Facility
|
IP
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
630854
|
| Min. Negotiated Rate |
$800.58 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$980.30
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
US Retroperitoneal Limited
|
Professional
|
Both
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2544967
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$1,614.39 |
| Rate for Payer: Aetna Commercial |
$1,614.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Aetna Managed Medicare |
$33.38
|
| Rate for Payer: Anthem Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.38
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,614.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$849.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.38
|
| Rate for Payer: Health EOS Commercial |
$1,546.42
|
| Rate for Payer: HFN Commercial |
$1,614.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: NAPHCARE Commercial |
$50.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,614.39
|
| Rate for Payer: Quartz Beloit One Network |
$747.72
|
| Rate for Payer: Quartz Commercial |
$968.64
|
| Rate for Payer: Quartz Medicare Advantage |
$33.38
|
| Rate for Payer: The Alliance Commercial |
$126.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.38
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$166.92
|
|
|
US Retroperitoneal Limited
|
Facility
|
OP
|
$1,571.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
630854
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,062.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$784.24
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| 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 |
$471.30
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$914.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| 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 |
$1,307.07
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$1,062.00
|
| 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 |
$898.61
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
US Retroperitoneal Limited
|
Facility
|
IP
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3072700
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,041.62 |
| Max. Negotiated Rate |
$1,955.70 |
| Rate for Payer: Aetna Commercial |
$1,913.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,828.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,126.65
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,955.70
|
| Rate for Payer: Health EOS Commercial |
$1,891.93
|
| Rate for Payer: HFN Commercial |
$1,955.70
|
| Rate for Payer: Multiplan Commercial |
$1,700.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.62
|
| Rate for Payer: Quartz Commercial |
$1,275.46
|
| Rate for Payer: WEA Trust Commercial |
$1,169.17
|
| Rate for Payer: WPS Commercial |
$1,574.49
|
|
|
US Retroperitoneal Limited
|
Facility
|
IP
|
$1,634.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2544967
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$832.69 |
| Max. Negotiated Rate |
$1,563.41 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$900.66
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,563.41
|
| Rate for Payer: Health EOS Commercial |
$1,512.43
|
| Rate for Payer: HFN Commercial |
$1,563.41
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.41
|
| Rate for Payer: Quartz Beloit One Network |
$832.69
|
| Rate for Payer: Quartz Commercial |
$1,019.62
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$1,258.67
|
|
|
US Retroperitoneal Limited
|
Facility
|
OP
|
$2,044.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
3072700
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$133.54 |
| Max. Negotiated Rate |
$1,955.70 |
| Rate for Payer: Aetna Commercial |
$1,913.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,828.15
|
| Rate for Payer: Aetna Managed Medicare |
$595.21
|
| 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 |
$1,126.65
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,955.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,189.61
|
| Rate for Payer: Health EOS Commercial |
$1,891.93
|
| Rate for Payer: HFN Commercial |
$1,955.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,594.32
|
| Rate for Payer: Multiplan Commercial |
$1,700.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,275.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.62
|
| Rate for Payer: Quartz Commercial |
$1,381.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,275.46
|
| Rate for Payer: The Alliance Commercial |
$133.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,169.17
|
| Rate for Payer: WPS Commercial |
$1,574.49
|
|
|
US Right Lower Quadrant
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544969
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Aetna Managed Medicare |
$445.83
|
| 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 |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.04
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.18
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: NAPHCARE Commercial |
$955.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$1,034.96
|
| Rate for Payer: Quartz Medicare Advantage |
$955.34
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
US Right Lower Quadrant
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544969
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$780.20 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$955.34
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
US Right Lower Quadrant
|
Professional
|
Both
|
$1,531.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544969
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,512.63 |
| Rate for Payer: Aetna Commercial |
$1,512.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,512.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$796.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,448.94
|
| Rate for Payer: HFN Commercial |
$1,512.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.63
|
| Rate for Payer: Quartz Beloit One Network |
$700.59
|
| Rate for Payer: Quartz Commercial |
$907.58
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Right Lower Quadrant
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711781
|
| Min. Negotiated Rate |
$750.13 |
| Max. Negotiated Rate |
$1,408.41 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| Rate for Payer: Multiplan Commercial |
$1,224.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$918.53
|
| Rate for Payer: WEA Trust Commercial |
$841.98
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
US Right Lower Quadrant
|
Facility
|
OP
|
$1,472.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711781
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,408.41 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$995.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$765.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$734.82
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| 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 |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$856.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| 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 |
$1,224.70
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$995.07
|
| 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 |
$841.98
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
US Right Lower Quadrant
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711781
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,454.34 |
| Rate for Payer: Aetna Commercial |
$1,454.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| 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 |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,454.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$765.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,393.10
|
| Rate for Payer: HFN Commercial |
$1,454.34
|
| 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 |
$1,224.70
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,454.34
|
| Rate for Payer: Quartz Beloit One Network |
$673.59
|
| Rate for Payer: Quartz Commercial |
$872.60
|
| 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 |
$841.98
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US Right Upper Quadrant
|
Professional
|
Both
|
$1,472.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711782
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,454.34 |
| Rate for Payer: Aetna Commercial |
$1,454.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| 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 |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,454.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$765.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,393.10
|
| Rate for Payer: HFN Commercial |
$1,454.34
|
| 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 |
$1,224.70
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,454.34
|
| Rate for Payer: Quartz Beloit One Network |
$673.59
|
| Rate for Payer: Quartz Commercial |
$872.60
|
| 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 |
$841.98
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US Right Upper Quadrant
|
Facility
|
IP
|
$1,531.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544972
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$780.20 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$955.34
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
US Right Upper Quadrant
|
Facility
|
IP
|
$1,472.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711782
|
| Min. Negotiated Rate |
$750.13 |
| Max. Negotiated Rate |
$1,408.41 |
| Rate for Payer: Aetna Commercial |
$1,377.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,316.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$811.37
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,408.41
|
| Rate for Payer: Health EOS Commercial |
$1,362.48
|
| Rate for Payer: HFN Commercial |
$1,408.41
|
| Rate for Payer: Multiplan Commercial |
$1,224.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,408.41
|
| Rate for Payer: Quartz Beloit One Network |
$750.13
|
| Rate for Payer: Quartz Commercial |
$918.53
|
| Rate for Payer: WEA Trust Commercial |
$841.98
|
| Rate for Payer: WPS Commercial |
$1,133.88
|
|
|
US Right Upper Quadrant
|
Facility
|
OP
|
$1,531.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544972
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,464.86 |
| Rate for Payer: Aetna Commercial |
$1,433.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Aetna Managed Medicare |
$445.83
|
| 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 |
$843.89
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,464.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.04
|
| Rate for Payer: Health EOS Commercial |
$1,417.09
|
| Rate for Payer: HFN Commercial |
$1,464.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,194.18
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: NAPHCARE Commercial |
$955.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,464.86
|
| Rate for Payer: Quartz Beloit One Network |
$780.20
|
| Rate for Payer: Quartz Commercial |
$1,034.96
|
| Rate for Payer: Quartz Medicare Advantage |
$955.34
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$1,179.33
|
|
|
US Right Upper Quadrant
|
Professional
|
Both
|
$1,531.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544972
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,512.63 |
| Rate for Payer: Aetna Commercial |
$1,512.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,369.33
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cash Price |
$459.30
|
| Rate for Payer: Cigna Commercial |
$1,512.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$796.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,448.94
|
| Rate for Payer: HFN Commercial |
$1,512.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,273.79
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,512.63
|
| Rate for Payer: Quartz Beloit One Network |
$700.59
|
| Rate for Payer: Quartz Commercial |
$907.58
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$875.73
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
