|
BASEPLATE UNIVERSAL GLENOID POROUS SMALL AR-9120-01PC
|
Facility
|
IP
|
$8,770.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,469.19 |
| Max. Negotiated Rate |
$8,391.14 |
| Rate for Payer: Aetna Commercial |
$8,208.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,843.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.02
|
| Rate for Payer: Cash Price |
$2,631.00
|
| Rate for Payer: Cigna Commercial |
$8,391.14
|
| Rate for Payer: Health EOS Commercial |
$8,117.51
|
| Rate for Payer: HFN Commercial |
$8,391.14
|
| Rate for Payer: Multiplan Commercial |
$7,296.64
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.19
|
| Rate for Payer: Quartz Commercial |
$5,472.48
|
| Rate for Payer: WEA Trust Commercial |
$5,016.44
|
| Rate for Payer: WPS Commercial |
$6,755.53
|
|
|
BASEPLATE UNIVERSAL GLENOID POROUS SMALL AR-9120-01PC
|
Facility
|
OP
|
$8,770.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729645
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,553.82 |
| Max. Negotiated Rate |
$8,391.14 |
| Rate for Payer: Aetna Commercial |
$8,208.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,843.89
|
| Rate for Payer: Aetna Managed Medicare |
$2,553.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,928.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,560.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,377.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,834.02
|
| Rate for Payer: Cash Price |
$2,631.00
|
| Rate for Payer: Cigna Commercial |
$8,391.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,104.14
|
| Rate for Payer: Health EOS Commercial |
$8,117.51
|
| Rate for Payer: HFN Commercial |
$8,391.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,840.60
|
| Rate for Payer: Multiplan Commercial |
$7,296.64
|
| Rate for Payer: NAPHCARE Commercial |
$5,472.48
|
| Rate for Payer: Preferred Network Access Commercial |
$8,391.14
|
| Rate for Payer: Quartz Beloit One Network |
$4,469.19
|
| Rate for Payer: Quartz Commercial |
$5,928.52
|
| Rate for Payer: Quartz Medicare Advantage |
$5,472.48
|
| Rate for Payer: The Alliance Commercial |
$4,560.40
|
| Rate for Payer: WEA Trust Commercial |
$5,016.44
|
| Rate for Payer: WPS Commercial |
$6,755.53
|
|
|
BASEPLATE UNIVERSAL GLENOID SMALL AR-9120-01
|
Facility
|
IP
|
$9,121.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4240352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,648.06 |
| Max. Negotiated Rate |
$8,726.97 |
| Rate for Payer: Aetna Commercial |
$8,537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,157.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,027.50
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,726.97
|
| Rate for Payer: Health EOS Commercial |
$8,442.40
|
| Rate for Payer: HFN Commercial |
$8,726.97
|
| Rate for Payer: Multiplan Commercial |
$7,588.67
|
| Rate for Payer: Preferred Network Access Commercial |
$8,726.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.06
|
| Rate for Payer: Quartz Commercial |
$5,691.50
|
| Rate for Payer: WEA Trust Commercial |
$5,217.21
|
| Rate for Payer: WPS Commercial |
$7,025.91
|
|
|
BASEPLATE UNIVERSAL GLENOID SMALL AR-9120-01
|
Facility
|
OP
|
$9,121.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4240352
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,656.04 |
| Max. Negotiated Rate |
$8,726.97 |
| Rate for Payer: Aetna Commercial |
$8,537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,157.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,656.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,165.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,742.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,553.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,027.50
|
| Rate for Payer: Cash Price |
$2,736.30
|
| Rate for Payer: Cigna Commercial |
$8,726.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,308.42
|
| Rate for Payer: Health EOS Commercial |
$8,442.40
|
| Rate for Payer: HFN Commercial |
$8,726.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,114.38
|
| Rate for Payer: Multiplan Commercial |
$7,588.67
|
| Rate for Payer: NAPHCARE Commercial |
$5,691.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,726.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,648.06
|
| Rate for Payer: Quartz Commercial |
$6,165.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,691.50
|
| Rate for Payer: The Alliance Commercial |
$4,742.92
|
| Rate for Payer: WEA Trust Commercial |
$5,217.21
|
| Rate for Payer: WPS Commercial |
$7,025.91
|
|
|
BASIC CHEMISTRY TESTS
|
Facility
|
OP
|
$5.24
|
|
|
Service Code
|
EAPG 00402
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$5.24 |
| Rate for Payer: Anthem Medicaid |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.04
|
| Rate for Payer: Dean Health Medicaid |
$5.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.04
|
| Rate for Payer: Managed Health Services Medicaid |
$5.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$5.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.04
|
| Rate for Payer: United Healthcare Medicaid |
$5.04
|
|
|
Basic Dosimetry Calculation
|
Facility
|
OP
|
$1,130.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
3040379
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$141.45 |
| Max. Negotiated Rate |
$1,081.18 |
| Rate for Payer: Aetna Commercial |
$1,057.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,010.67
|
| Rate for Payer: Aetna Managed Medicare |
$141.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.50
|
| Rate for Payer: Anthem Medicare Advantage |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.45
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$1,081.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$657.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.45
|
| Rate for Payer: Health EOS Commercial |
$1,045.93
|
| Rate for Payer: HFN Commercial |
$1,081.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.45
|
| Rate for Payer: Multiplan Commercial |
$940.16
|
| Rate for Payer: NAPHCARE Commercial |
$212.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,081.18
|
| Rate for Payer: Quartz Beloit One Network |
$575.85
|
| Rate for Payer: Quartz Commercial |
$763.88
|
| Rate for Payer: Quartz Medicare Advantage |
$141.45
|
| Rate for Payer: The Alliance Commercial |
$565.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.45
|
| Rate for Payer: United Healthcare PPO |
$881.40
|
| Rate for Payer: WEA Trust Commercial |
$646.36
|
| Rate for Payer: Wellcare Medicare |
$141.45
|
| Rate for Payer: WPS Commercial |
$870.44
|
|
|
Basic Dosimetry Calculation
|
Facility
|
IP
|
$1,130.00
|
|
|
Service Code
|
CPT 77300
|
| Hospital Charge Code |
3040379
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$575.85 |
| Max. Negotiated Rate |
$1,081.18 |
| Rate for Payer: Aetna Commercial |
$1,057.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,010.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$622.86
|
| Rate for Payer: Cash Price |
$339.00
|
| Rate for Payer: Cigna Commercial |
$1,081.18
|
| Rate for Payer: Health EOS Commercial |
$1,045.93
|
| Rate for Payer: HFN Commercial |
$1,081.18
|
| Rate for Payer: Multiplan Commercial |
$940.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,081.18
|
| Rate for Payer: Quartz Beloit One Network |
$575.85
|
| Rate for Payer: Quartz Commercial |
$705.12
|
| Rate for Payer: WEA Trust Commercial |
$646.36
|
| Rate for Payer: WPS Commercial |
$870.44
|
|
|
Basic Metabolic Panel
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
633628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$247.81 |
| Rate for Payer: Aetna Commercial |
$242.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.65
|
| Rate for Payer: Aetna Managed Medicare |
$8.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.61
|
| Rate for Payer: Anthem Medicare Advantage |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.80
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$247.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.80
|
| Rate for Payer: Health EOS Commercial |
$239.73
|
| Rate for Payer: HFN Commercial |
$247.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$215.49
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$247.81
|
| Rate for Payer: Quartz Beloit One Network |
$131.99
|
| Rate for Payer: Quartz Commercial |
$175.08
|
| Rate for Payer: Quartz Medicare Advantage |
$8.80
|
| Rate for Payer: The Alliance Commercial |
$35.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.80
|
| Rate for Payer: United Healthcare PPO |
$202.02
|
| Rate for Payer: WEA Trust Commercial |
$148.15
|
| Rate for Payer: Wellcare Medicare |
$8.80
|
| Rate for Payer: WPS Commercial |
$199.51
|
|
|
Basic Metabolic Panel
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
633628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.99 |
| Max. Negotiated Rate |
$247.81 |
| Rate for Payer: Aetna Commercial |
$242.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.76
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$247.81
|
| Rate for Payer: Health EOS Commercial |
$239.73
|
| Rate for Payer: HFN Commercial |
$247.81
|
| Rate for Payer: Multiplan Commercial |
$215.49
|
| Rate for Payer: Preferred Network Access Commercial |
$247.81
|
| Rate for Payer: Quartz Beloit One Network |
$131.99
|
| Rate for Payer: Quartz Commercial |
$161.62
|
| Rate for Payer: WEA Trust Commercial |
$148.15
|
| Rate for Payer: WPS Commercial |
$199.51
|
|
|
Basic Metabolic Panel
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
CPT 80048
|
| Hospital Charge Code |
633628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.80 |
| Max. Negotiated Rate |
$255.89 |
| Rate for Payer: Aetna Commercial |
$255.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.65
|
| Rate for Payer: Aetna Managed Medicare |
$8.80
|
| Rate for Payer: Anthem Medicare Advantage |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.80
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$255.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.80
|
| Rate for Payer: Health EOS Commercial |
$245.12
|
| Rate for Payer: HFN Commercial |
$255.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.80
|
| Rate for Payer: Multiplan Commercial |
$215.49
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$255.89
|
| Rate for Payer: Quartz Beloit One Network |
$118.52
|
| Rate for Payer: Quartz Commercial |
$153.54
|
| Rate for Payer: Quartz Medicare Advantage |
$8.80
|
| Rate for Payer: The Alliance Commercial |
$34.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.80
|
| Rate for Payer: WEA Trust Commercial |
$148.15
|
| Rate for Payer: WPS Commercial |
$38.71
|
|
|
Basic Vestibular Eval
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
3856720
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$84.47 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: Aetna Commercial |
$724.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.60
|
| Rate for Payer: Aetna Managed Medicare |
$104.84
|
| Rate for Payer: Anthem Medicare Advantage |
$104.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$104.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$104.84
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.84
|
| Rate for Payer: Health EOS Commercial |
$693.71
|
| Rate for Payer: HFN Commercial |
$724.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$104.84
|
| Rate for Payer: Multiplan Commercial |
$609.86
|
| Rate for Payer: NAPHCARE Commercial |
$157.26
|
| Rate for Payer: Preferred Network Access Commercial |
$724.20
|
| Rate for Payer: Quartz Beloit One Network |
$335.42
|
| Rate for Payer: Quartz Commercial |
$434.52
|
| Rate for Payer: Quartz Medicare Advantage |
$104.84
|
| Rate for Payer: The Alliance Commercial |
$262.11
|
| Rate for Payer: United Healthcare Medicaid |
$84.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.84
|
| Rate for Payer: WEA Trust Commercial |
$419.28
|
| Rate for Payer: WPS Commercial |
$419.37
|
|
|
Basic Vestibular Eval
|
Facility
|
OP
|
$733.00
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
3856720
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$686.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.60
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$495.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$381.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$365.91
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$701.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$426.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$678.46
|
| Rate for Payer: HFN Commercial |
$701.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$609.86
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$701.33
|
| Rate for Payer: Quartz Beloit One Network |
$373.54
|
| Rate for Payer: Quartz Commercial |
$495.51
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$571.74
|
| Rate for Payer: WEA Trust Commercial |
$419.28
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$564.63
|
|
|
Basic Vestibular Eval
|
Facility
|
IP
|
$733.00
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
3856720
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$373.54 |
| Max. Negotiated Rate |
$701.33 |
| Rate for Payer: Aetna Commercial |
$686.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$404.03
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$701.33
|
| Rate for Payer: Health EOS Commercial |
$678.46
|
| Rate for Payer: HFN Commercial |
$701.33
|
| Rate for Payer: Multiplan Commercial |
$609.86
|
| Rate for Payer: Preferred Network Access Commercial |
$701.33
|
| Rate for Payer: Quartz Beloit One Network |
$373.54
|
| Rate for Payer: Quartz Commercial |
$457.39
|
| Rate for Payer: WEA Trust Commercial |
$419.28
|
| Rate for Payer: WPS Commercial |
$564.63
|
|
|
Basic Vestibular Eval 9254026
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
CPT 92540 26
|
| Hospital Charge Code |
3206200
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$784.47 |
| Rate for Payer: Aetna Commercial |
$784.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$710.15
|
| Rate for Payer: Aetna Managed Medicare |
$76.12
|
| Rate for Payer: Anthem Medicare Advantage |
$76.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.12
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$784.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.12
|
| Rate for Payer: Health EOS Commercial |
$751.44
|
| Rate for Payer: HFN Commercial |
$784.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.12
|
| Rate for Payer: Multiplan Commercial |
$660.61
|
| Rate for Payer: NAPHCARE Commercial |
$114.18
|
| Rate for Payer: Preferred Network Access Commercial |
$784.47
|
| Rate for Payer: Quartz Beloit One Network |
$363.33
|
| Rate for Payer: Quartz Commercial |
$470.68
|
| Rate for Payer: Quartz Medicare Advantage |
$76.12
|
| Rate for Payer: The Alliance Commercial |
$190.29
|
| Rate for Payer: United Healthcare Medicaid |
$70.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.12
|
| Rate for Payer: WEA Trust Commercial |
$454.17
|
| Rate for Payer: WPS Commercial |
$304.47
|
|
|
Basic Vestibular Eval 92540TC
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 92540 TC
|
| Hospital Charge Code |
3206194
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$28.72
|
| Rate for Payer: Anthem Medicare Advantage |
$28.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.72
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.72
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.72
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$43.09
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$28.72
|
| Rate for Payer: The Alliance Commercial |
$71.81
|
| Rate for Payer: United Healthcare Medicaid |
$14.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.72
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$114.90
|
|
|
BASIC VESTIBULAR EVAL, INCL SPONT. NYSTAGMUS TEST 92540
|
Professional
|
Both
|
$733.00
|
|
|
Service Code
|
CPT 92540
|
| Hospital Charge Code |
3015329
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.47 |
| Max. Negotiated Rate |
$724.20 |
| Rate for Payer: Aetna Commercial |
$724.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$655.60
|
| Rate for Payer: Aetna Managed Medicare |
$104.84
|
| Rate for Payer: Anthem Medicare Advantage |
$104.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$104.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$104.84
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cash Price |
$219.90
|
| Rate for Payer: Cigna Commercial |
$724.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.84
|
| Rate for Payer: Health EOS Commercial |
$693.71
|
| Rate for Payer: HFN Commercial |
$724.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$104.84
|
| Rate for Payer: Multiplan Commercial |
$609.86
|
| Rate for Payer: NAPHCARE Commercial |
$157.26
|
| Rate for Payer: Preferred Network Access Commercial |
$724.20
|
| Rate for Payer: Quartz Beloit One Network |
$335.42
|
| Rate for Payer: Quartz Commercial |
$434.52
|
| Rate for Payer: Quartz Medicare Advantage |
$104.84
|
| Rate for Payer: The Alliance Commercial |
$262.11
|
| Rate for Payer: United Healthcare Medicaid |
$84.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.84
|
| Rate for Payer: WEA Trust Commercial |
$419.28
|
| Rate for Payer: WPS Commercial |
$419.37
|
|
|
Basic Vestibular Evaluation 26
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
CPT 92540 26
|
| Hospital Charge Code |
3203486
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$70.35 |
| Max. Negotiated Rate |
$784.47 |
| Rate for Payer: Aetna Commercial |
$784.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$710.15
|
| Rate for Payer: Aetna Managed Medicare |
$76.12
|
| Rate for Payer: Anthem Medicare Advantage |
$76.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.12
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$784.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.12
|
| Rate for Payer: Health EOS Commercial |
$751.44
|
| Rate for Payer: HFN Commercial |
$784.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.12
|
| Rate for Payer: Multiplan Commercial |
$660.61
|
| Rate for Payer: NAPHCARE Commercial |
$114.18
|
| Rate for Payer: Preferred Network Access Commercial |
$784.47
|
| Rate for Payer: Quartz Beloit One Network |
$363.33
|
| Rate for Payer: Quartz Commercial |
$470.68
|
| Rate for Payer: Quartz Medicare Advantage |
$76.12
|
| Rate for Payer: The Alliance Commercial |
$190.29
|
| Rate for Payer: United Healthcare Medicaid |
$70.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.12
|
| Rate for Payer: WEA Trust Commercial |
$454.17
|
| Rate for Payer: WPS Commercial |
$304.47
|
|
|
Basic Vestibular Evaluation 26
|
Facility
|
IP
|
$794.00
|
|
|
Service Code
|
CPT 92540 26
|
| Hospital Charge Code |
3203486
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$404.62 |
| Max. Negotiated Rate |
$759.70 |
| Rate for Payer: Aetna Commercial |
$743.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$710.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$437.65
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$759.70
|
| Rate for Payer: Health EOS Commercial |
$734.93
|
| Rate for Payer: HFN Commercial |
$759.70
|
| Rate for Payer: Multiplan Commercial |
$660.61
|
| Rate for Payer: Preferred Network Access Commercial |
$759.70
|
| Rate for Payer: Quartz Beloit One Network |
$404.62
|
| Rate for Payer: Quartz Commercial |
$495.46
|
| Rate for Payer: WEA Trust Commercial |
$454.17
|
| Rate for Payer: WPS Commercial |
$611.62
|
|
|
Basic Vestibular Evaluation 26
|
Facility
|
OP
|
$794.00
|
|
|
Service Code
|
CPT 92540 26
|
| Hospital Charge Code |
3203486
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$231.21 |
| Max. Negotiated Rate |
$759.70 |
| Rate for Payer: Aetna Commercial |
$743.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$710.15
|
| Rate for Payer: Aetna Managed Medicare |
$231.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$536.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$412.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$396.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$437.65
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$759.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.11
|
| Rate for Payer: Health EOS Commercial |
$734.93
|
| Rate for Payer: HFN Commercial |
$759.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$619.32
|
| Rate for Payer: Multiplan Commercial |
$660.61
|
| Rate for Payer: NAPHCARE Commercial |
$495.46
|
| Rate for Payer: Preferred Network Access Commercial |
$759.70
|
| Rate for Payer: Quartz Beloit One Network |
$404.62
|
| Rate for Payer: Quartz Commercial |
$536.74
|
| Rate for Payer: Quartz Medicare Advantage |
$495.46
|
| Rate for Payer: The Alliance Commercial |
$304.47
|
| Rate for Payer: United Healthcare PPO |
$619.32
|
| Rate for Payer: WEA Trust Commercial |
$454.17
|
| Rate for Payer: WPS Commercial |
$611.62
|
|
|
Basic Vestibular Evaluation TC
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 92540 TC
|
| Hospital Charge Code |
1230809
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$101.09
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
Basic Vestibular Evaluation TC
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 92540 TC
|
| Hospital Charge Code |
1230809
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$14.13 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$28.72
|
| Rate for Payer: Anthem Medicare Advantage |
$28.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.72
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.72
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.72
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$43.09
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$28.72
|
| Rate for Payer: The Alliance Commercial |
$71.81
|
| Rate for Payer: United Healthcare Medicaid |
$14.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.72
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$114.90
|
|
|
Basic Vestibular Evaluation TC
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 92540 TC
|
| Hospital Charge Code |
1230809
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$47.17 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$47.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.28
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.36
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$101.09
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$109.51
|
| Rate for Payer: Quartz Medicare Advantage |
$101.09
|
| Rate for Payer: The Alliance Commercial |
$114.90
|
| Rate for Payer: United Healthcare PPO |
$126.36
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
BASKET 3.2FR NFORCE STONE
|
Facility
|
OP
|
$2,747.00
|
|
| Hospital Charge Code |
2964975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$799.93 |
| Max. Negotiated Rate |
$2,628.33 |
| Rate for Payer: Aetna Commercial |
$2,571.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,456.92
|
| Rate for Payer: Aetna Managed Medicare |
$799.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,856.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,428.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,371.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,514.15
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,628.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,598.75
|
| Rate for Payer: Health EOS Commercial |
$2,542.62
|
| Rate for Payer: HFN Commercial |
$2,628.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,142.66
|
| Rate for Payer: Multiplan Commercial |
$2,285.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,714.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,628.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,399.87
|
| Rate for Payer: Quartz Commercial |
$1,856.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,714.13
|
| Rate for Payer: The Alliance Commercial |
$1,428.44
|
| Rate for Payer: WEA Trust Commercial |
$1,571.28
|
| Rate for Payer: WPS Commercial |
$2,116.01
|
|
|
BASKET 3.2FR NFORCE STONE
|
Facility
|
IP
|
$2,747.00
|
|
| Hospital Charge Code |
2964975
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.87 |
| Max. Negotiated Rate |
$2,628.33 |
| Rate for Payer: Aetna Commercial |
$2,571.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,456.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,514.15
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,628.33
|
| Rate for Payer: Health EOS Commercial |
$2,542.62
|
| Rate for Payer: HFN Commercial |
$2,628.33
|
| Rate for Payer: Multiplan Commercial |
$2,285.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,628.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,399.87
|
| Rate for Payer: Quartz Commercial |
$1,714.13
|
| Rate for Payer: WEA Trust Commercial |
$1,571.28
|
| Rate for Payer: WPS Commercial |
$2,116.01
|
|
|
BASKET 5-WIRE GEMINI HELICAL 330-115
|
Facility
|
OP
|
$2,412.00
|
|
| Hospital Charge Code |
2964804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.37 |
| Max. Negotiated Rate |
$2,307.80 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Aetna Managed Medicare |
$702.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,630.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,254.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,204.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,403.78
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,881.36
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,505.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,630.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,505.09
|
| Rate for Payer: The Alliance Commercial |
$1,254.24
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$1,857.96
|
|
