|
BCE COVID-19 Collection/Transport Fee
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Aetna Commercial |
$27.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.40
|
| Rate for Payer: Health EOS Commercial |
$26.39
|
| Rate for Payer: HFN Commercial |
$27.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.67
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Preferred Network Access Commercial |
$27.55
|
| Rate for Payer: Quartz Beloit One Network |
$12.76
|
| Rate for Payer: Quartz Commercial |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$14.50
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
BCE COVID-19 Collection/Transport Fee
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.92
|
| Rate for Payer: Anthem Medicaid |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.23
|
| Rate for Payer: Dean Health Medicaid |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.92
|
| Rate for Payer: Managed Health Services Medicaid |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.92
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$17.40
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.92
|
| Rate for Payer: United Healthcare PPO |
$21.75
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WMAP Medicaid |
$3.92
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
BCE Crossmatch IS
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
5282636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$70.50
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
BCE Crossmatch IS
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
5282636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
BCE Crossmatch IS
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
CPT 86920
|
| Hospital Charge Code |
5282636
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.36 |
| Max. Negotiated Rate |
$120.66 |
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.40
|
| Rate for Payer: Health EOS Commercial |
$85.54
|
| Rate for Payer: HFN Commercial |
$89.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.66
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.30
|
| Rate for Payer: Quartz Beloit One Network |
$41.36
|
| Rate for Payer: Quartz Commercial |
$53.58
|
| Rate for Payer: The Alliance Commercial |
$47.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
BCE CTA Abdomen
|
Facility
|
IP
|
$6,136.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
4139402
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$3,006.64 |
| Max. Negotiated Rate |
$5,645.12 |
| Rate for Payer: Aetna Commercial |
$5,522.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,276.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,252.08
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cigna Commercial |
$5,645.12
|
| Rate for Payer: Health EOS Commercial |
$5,461.04
|
| Rate for Payer: HFN Commercial |
$5,645.12
|
| Rate for Payer: Multiplan Commercial |
$4,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,645.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,006.64
|
| Rate for Payer: Quartz Commercial |
$3,681.60
|
| Rate for Payer: WEA Trust Commercial |
$3,374.80
|
| Rate for Payer: WPS Commercial |
$4,544.94
|
|
|
BCE CTA Abdomen
|
Professional
|
Both
|
$6,136.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
4139402
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$817.58 |
| Max. Negotiated Rate |
$5,829.20 |
| Rate for Payer: Aetna Commercial |
$5,829.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,276.96
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cigna Commercial |
$5,829.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,068.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,681.60
|
| Rate for Payer: Health EOS Commercial |
$5,583.76
|
| Rate for Payer: HFN Commercial |
$5,829.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$817.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$817.58
|
| Rate for Payer: Multiplan Commercial |
$4,908.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,829.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,699.84
|
| Rate for Payer: Quartz Commercial |
$3,497.52
|
| Rate for Payer: The Alliance Commercial |
$3,068.00
|
| Rate for Payer: WEA Trust Commercial |
$3,374.80
|
| Rate for Payer: WPS Commercial |
$4,544.94
|
|
|
BCE CTA Abdomen
|
Facility
|
OP
|
$6,136.00
|
|
|
Service Code
|
CPT 74175 TC
|
| Hospital Charge Code |
4139402
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,718.08 |
| Max. Negotiated Rate |
$24,544.00 |
| Rate for Payer: Aetna Commercial |
$5,522.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,276.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,718.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,252.08
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cash Price |
$1,840.80
|
| Rate for Payer: Cigna Commercial |
$5,645.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,433.71
|
| Rate for Payer: Health EOS Commercial |
$5,461.04
|
| Rate for Payer: HFN Commercial |
$5,645.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,602.00
|
| Rate for Payer: Multiplan Commercial |
$4,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,645.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,006.64
|
| Rate for Payer: Quartz Commercial |
$3,988.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,681.60
|
| Rate for Payer: The Alliance Commercial |
$24,544.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,374.80
|
| Rate for Payer: WPS Commercial |
$4,544.94
|
|
|
BCE CT Chest w/ Contrast R/O PE
|
Professional
|
Both
|
$4,184.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
4139401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$727.07 |
| Max. Negotiated Rate |
$3,974.80 |
| Rate for Payer: Aetna Commercial |
$3,974.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,598.24
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cigna Commercial |
$3,974.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,092.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,510.40
|
| Rate for Payer: Health EOS Commercial |
$3,807.44
|
| Rate for Payer: HFN Commercial |
$3,974.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$727.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$727.07
|
| Rate for Payer: Multiplan Commercial |
$3,347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,974.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,840.96
|
| Rate for Payer: Quartz Commercial |
$2,384.88
|
| Rate for Payer: The Alliance Commercial |
$2,092.00
|
| Rate for Payer: WEA Trust Commercial |
$2,301.20
|
| Rate for Payer: WPS Commercial |
$3,099.09
|
|
|
BCE CT Chest w/ Contrast R/O PE
|
Facility
|
OP
|
$4,184.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
4139401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,171.52 |
| Max. Negotiated Rate |
$16,736.00 |
| Rate for Payer: Aetna Commercial |
$3,765.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,598.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,171.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,217.52
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cigna Commercial |
$3,849.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,341.37
|
| Rate for Payer: Health EOS Commercial |
$3,723.76
|
| Rate for Payer: HFN Commercial |
$3,849.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,138.00
|
| Rate for Payer: Multiplan Commercial |
$3,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,510.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,849.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,050.16
|
| Rate for Payer: Quartz Commercial |
$2,719.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,510.40
|
| Rate for Payer: The Alliance Commercial |
$16,736.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,301.20
|
| Rate for Payer: WPS Commercial |
$3,099.09
|
|
|
BCE CT Chest w/ Contrast R/O PE
|
Facility
|
IP
|
$4,184.00
|
|
|
Service Code
|
CPT 71275 TC
|
| Hospital Charge Code |
4139401
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,050.16 |
| Max. Negotiated Rate |
$3,849.28 |
| Rate for Payer: Aetna Commercial |
$3,765.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,598.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,217.52
|
| Rate for Payer: Cash Price |
$1,255.20
|
| Rate for Payer: Cigna Commercial |
$3,849.28
|
| Rate for Payer: Health EOS Commercial |
$3,723.76
|
| Rate for Payer: HFN Commercial |
$3,849.28
|
| Rate for Payer: Multiplan Commercial |
$3,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,510.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,849.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,050.16
|
| Rate for Payer: Quartz Commercial |
$2,510.40
|
| Rate for Payer: WEA Trust Commercial |
$2,301.20
|
| Rate for Payer: WPS Commercial |
$3,099.09
|
|
|
BCE CT Guided Fine Needle Aspiration
|
Professional
|
Both
|
$3,802.00
|
|
|
Service Code
|
CPT 10009 TC
|
| Hospital Charge Code |
5582787
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,672.88 |
| Max. Negotiated Rate |
$3,611.90 |
| Rate for Payer: Aetna Commercial |
$3,611.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,269.72
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cigna Commercial |
$3,611.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,901.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,281.20
|
| Rate for Payer: Health EOS Commercial |
$3,459.82
|
| Rate for Payer: HFN Commercial |
$3,611.90
|
| Rate for Payer: Multiplan Commercial |
$3,041.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,611.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.88
|
| Rate for Payer: Quartz Commercial |
$2,167.14
|
| Rate for Payer: The Alliance Commercial |
$1,901.00
|
| Rate for Payer: WEA Trust Commercial |
$2,091.10
|
| Rate for Payer: WPS Commercial |
$2,816.14
|
|
|
BCE CT Guided Fine Needle Aspiration
|
Facility
|
OP
|
$3,802.00
|
|
|
Service Code
|
CPT 10009 TC
|
| Hospital Charge Code |
5582787
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,064.56 |
| Max. Negotiated Rate |
$15,208.00 |
| Rate for Payer: Aetna Commercial |
$3,421.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,269.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,064.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.06
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cigna Commercial |
$3,497.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,127.60
|
| Rate for Payer: Health EOS Commercial |
$3,383.78
|
| Rate for Payer: HFN Commercial |
$3,497.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,851.50
|
| Rate for Payer: Multiplan Commercial |
$3,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,497.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,862.98
|
| Rate for Payer: Quartz Commercial |
$2,471.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,281.20
|
| Rate for Payer: The Alliance Commercial |
$15,208.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,091.10
|
| Rate for Payer: WPS Commercial |
$2,816.14
|
|
|
BCE CT Guided Fine Needle Aspiration
|
Facility
|
IP
|
$3,802.00
|
|
|
Service Code
|
CPT 10009 TC
|
| Hospital Charge Code |
5582787
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,862.98 |
| Max. Negotiated Rate |
$3,497.84 |
| Rate for Payer: Aetna Commercial |
$3,421.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,269.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,015.06
|
| Rate for Payer: Cash Price |
$1,140.60
|
| Rate for Payer: Cigna Commercial |
$3,497.84
|
| Rate for Payer: Health EOS Commercial |
$3,383.78
|
| Rate for Payer: HFN Commercial |
$3,497.84
|
| Rate for Payer: Multiplan Commercial |
$3,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,281.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,497.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,862.98
|
| Rate for Payer: Quartz Commercial |
$2,281.20
|
| Rate for Payer: WEA Trust Commercial |
$2,091.10
|
| Rate for Payer: WPS Commercial |
$2,816.14
|
|
|
BCE CV Echocardiogram W Contrast Acquisition
|
Facility
|
OP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388711
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$3,179.52 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,246.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,658.88
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,933.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,246.40
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$2,592.00
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
BCE CV Echocardiogram W Contrast Acquisition
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388711
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,693.44 |
| Max. Negotiated Rate |
$3,179.52 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,073.60
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
BCE CV Echo Complete WO Contrast Acqusition
|
Facility
|
OP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388647
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$3,179.52 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,246.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,658.88
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,933.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,246.40
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$2,592.00
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
BCE CV Echo Complete WO Contrast Acqusition
|
Facility
|
IP
|
$3,456.00
|
|
|
Service Code
|
CPT 93306
|
| Hospital Charge Code |
5388647
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$1,693.44 |
| Max. Negotiated Rate |
$3,179.52 |
| Rate for Payer: Aetna Commercial |
$3,110.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.68
|
| Rate for Payer: Cash Price |
$1,036.80
|
| Rate for Payer: Cigna Commercial |
$3,179.52
|
| Rate for Payer: Health EOS Commercial |
$3,075.84
|
| Rate for Payer: HFN Commercial |
$3,179.52
|
| Rate for Payer: Multiplan Commercial |
$2,764.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.44
|
| Rate for Payer: Quartz Commercial |
$2,073.60
|
| Rate for Payer: WEA Trust Commercial |
$1,900.80
|
| Rate for Payer: WPS Commercial |
$2,559.86
|
|
|
BCE CV Echo TEE Adult wo Probe Plcmt Cong Acquisition
|
Facility
|
OP
|
$1,917.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
5388648
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$536.76 |
| Max. Negotiated Rate |
$7,668.00 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Aetna Managed Medicare |
$536.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$958.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,072.75
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,437.75
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,246.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.20
|
| Rate for Payer: The Alliance Commercial |
$7,668.00
|
| Rate for Payer: United Healthcare PPO |
$1,437.75
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
BCE CV Echo TEE Adult wo Probe Plcmt Cong Acquisition
|
Facility
|
IP
|
$1,917.00
|
|
|
Service Code
|
CPT 93317
|
| Hospital Charge Code |
5388648
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$939.33 |
| Max. Negotiated Rate |
$1,763.64 |
| Rate for Payer: Aetna Commercial |
$1,725.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,648.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.01
|
| Rate for Payer: Cash Price |
$575.10
|
| Rate for Payer: Cigna Commercial |
$1,763.64
|
| Rate for Payer: Health EOS Commercial |
$1,706.13
|
| Rate for Payer: HFN Commercial |
$1,763.64
|
| Rate for Payer: Multiplan Commercial |
$1,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,763.64
|
| Rate for Payer: Quartz Beloit One Network |
$939.33
|
| Rate for Payer: Quartz Commercial |
$1,150.20
|
| Rate for Payer: WEA Trust Commercial |
$1,054.35
|
| Rate for Payer: WPS Commercial |
$1,419.92
|
|
|
BCE CV NM Cardiac Blood Pool Gated Single Acqusition
|
Facility
|
IP
|
$5,516.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5386670
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,702.84 |
| Max. Negotiated Rate |
$5,074.72 |
| Rate for Payer: Aetna Commercial |
$4,964.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,743.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,923.48
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cigna Commercial |
$5,074.72
|
| Rate for Payer: Health EOS Commercial |
$4,909.24
|
| Rate for Payer: HFN Commercial |
$5,074.72
|
| Rate for Payer: Multiplan Commercial |
$4,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,309.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,074.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,702.84
|
| Rate for Payer: Quartz Commercial |
$3,309.60
|
| Rate for Payer: WEA Trust Commercial |
$3,033.80
|
| Rate for Payer: WPS Commercial |
$4,085.70
|
|
|
BCE CV NM Cardiac Blood Pool Gated Single Acqusition
|
Facility
|
OP
|
$5,516.00
|
|
|
Service Code
|
CPT 78472
|
| Hospital Charge Code |
5386670
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$5,074.72 |
| Rate for Payer: Aetna Commercial |
$4,964.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,743.76
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,923.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cash Price |
$1,654.80
|
| Rate for Payer: Cigna Commercial |
$5,074.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,086.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$4,909.24
|
| Rate for Payer: HFN Commercial |
$5,074.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$4,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$5,074.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,702.84
|
| Rate for Payer: Quartz Commercial |
$3,585.40
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$3,033.80
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$4,085.70
|
|
|
BCE CV VL Arterial Duplex Right
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5383360
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$343.56 |
| Max. Negotiated Rate |
$4,908.00 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$920.25
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$736.20
|
| Rate for Payer: The Alliance Commercial |
$4,908.00
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
BCE CV VL Arterial Duplex Right
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93926 RT
|
| Hospital Charge Code |
5383360
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
BCE CV VL LE PVR Resting Acquisition
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5388650
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.96
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$920.25
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
