|
Vitamin D 25 Hydroxy Level
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$340.86 |
| Rate for Payer: Aetna Commercial |
$340.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$30.78
|
| Rate for Payer: Anthem Medicare Advantage |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.78
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$340.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$326.51
|
| Rate for Payer: HFN Commercial |
$340.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.78
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$340.86
|
| Rate for Payer: Quartz Beloit One Network |
$157.87
|
| Rate for Payer: Quartz Commercial |
$204.52
|
| Rate for Payer: Quartz Medicare Advantage |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$121.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.78
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$135.45
|
|
|
Vitamin D 25 Hydroxy Level
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
Vitamin D 25 Hydroxy Level
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$30.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.10
|
| Rate for Payer: Anthem Medicare Advantage |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.78
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.78
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$123.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.78
|
| Rate for Payer: United Healthcare PPO |
$269.10
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: Wellcare Medicare |
$30.78
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
Vitamin E Beta/Gamma Tocopherol
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2943024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$17.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Anthem Medicare Advantage |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.74
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.74
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$26.61
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$79.77
|
| Rate for Payer: Quartz Medicare Advantage |
$17.74
|
| Rate for Payer: The Alliance Commercial |
$70.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.74
|
| Rate for Payer: United Healthcare PPO |
$92.04
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: Wellcare Medicare |
$17.74
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Vitamin E Beta/Gamma Tocopherol
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2943024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Vitamin E Beta/Gamma Tocopherol
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2943024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$17.74
|
| Rate for Payer: Anthem Medicare Advantage |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.74
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.74
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$26.61
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.74
|
| Rate for Payer: The Alliance Commercial |
$70.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.74
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$78.07
|
|
|
Vitamin E Level
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
978094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$14.75
|
| Rate for Payer: Anthem Medicare Advantage |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.75
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$188.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.75
|
| Rate for Payer: Health EOS Commercial |
$180.76
|
| Rate for Payer: HFN Commercial |
$188.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$22.12
|
| Rate for Payer: Preferred Network Access Commercial |
$188.71
|
| Rate for Payer: Quartz Beloit One Network |
$87.40
|
| Rate for Payer: Quartz Commercial |
$113.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.75
|
| Rate for Payer: The Alliance Commercial |
$58.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.75
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$64.89
|
|
|
Vitamin E Level
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
978094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$119.18
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Vitamin E Level
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
978094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$14.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.48
|
| Rate for Payer: Anthem Medicare Advantage |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.75
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$22.12
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$129.12
|
| Rate for Payer: Quartz Medicare Advantage |
$14.75
|
| Rate for Payer: The Alliance Commercial |
$58.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.75
|
| Rate for Payer: United Healthcare PPO |
$148.98
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: Wellcare Medicare |
$14.75
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Vitamin K
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
983438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$222.70 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$272.69
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
Vitamin K
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
983438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$14.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.69
|
| Rate for Payer: Anthem Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.27
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.27
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$21.40
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$295.41
|
| Rate for Payer: Quartz Medicare Advantage |
$14.27
|
| Rate for Payer: The Alliance Commercial |
$57.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: United Healthcare PPO |
$340.86
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: Wellcare Medicare |
$14.27
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
Vitamin K
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
983438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$431.76 |
| Rate for Payer: Aetna Commercial |
$431.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$14.27
|
| Rate for Payer: Anthem Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.27
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$431.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.27
|
| Rate for Payer: Health EOS Commercial |
$413.58
|
| Rate for Payer: HFN Commercial |
$431.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$21.40
|
| Rate for Payer: Preferred Network Access Commercial |
$431.76
|
| Rate for Payer: Quartz Beloit One Network |
$199.97
|
| Rate for Payer: Quartz Commercial |
$259.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14.27
|
| Rate for Payer: The Alliance Commercial |
$56.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$62.78
|
|
|
Vitamin K 1 mg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2958928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Vitamin K 1 mg Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2958928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.86
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
Vitamin K 1 mg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2958928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$3.38
|
| Rate for Payer: Anthem Medicare Advantage |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.38
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.92
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.38
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$5.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3.38
|
| Rate for Payer: The Alliance Commercial |
$9.29
|
| Rate for Payer: United Healthcare Medicaid |
$2.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.38
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
Vit K phytonadione inj 1 mg J3430
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
3697521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Vit K phytonadione inj 1 mg J3430
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
3697521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$9.29 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$3.38
|
| Rate for Payer: Anthem Medicare Advantage |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.38
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.92
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.38
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$5.07
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3.38
|
| Rate for Payer: The Alliance Commercial |
$9.29
|
| Rate for Payer: United Healthcare Medicaid |
$2.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.38
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
Vit K phytonadione inj 1 mg J3430
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
3697521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$13.52 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.86
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
VITRECTOMY
|
Facility
|
IP
|
$5,660.00
|
|
| Hospital Charge Code |
2960505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,884.34 |
| Max. Negotiated Rate |
$5,415.49 |
| Rate for Payer: Aetna Commercial |
$5,297.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,119.79
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,415.49
|
| Rate for Payer: Health EOS Commercial |
$5,238.90
|
| Rate for Payer: HFN Commercial |
$5,415.49
|
| Rate for Payer: Multiplan Commercial |
$4,709.12
|
| Rate for Payer: Preferred Network Access Commercial |
$5,415.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.34
|
| Rate for Payer: Quartz Commercial |
$3,531.84
|
| Rate for Payer: WEA Trust Commercial |
$3,237.52
|
| Rate for Payer: WPS Commercial |
$4,359.90
|
|
|
VITRECTOMY
|
Facility
|
OP
|
$5,660.00
|
|
| Hospital Charge Code |
2960505
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,648.19 |
| Max. Negotiated Rate |
$5,415.49 |
| Rate for Payer: Aetna Commercial |
$5,297.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,062.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,648.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,826.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,943.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,825.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,119.79
|
| Rate for Payer: Cash Price |
$1,698.00
|
| Rate for Payer: Cigna Commercial |
$5,415.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,294.12
|
| Rate for Payer: Health EOS Commercial |
$5,238.90
|
| Rate for Payer: HFN Commercial |
$5,415.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,414.80
|
| Rate for Payer: Multiplan Commercial |
$4,709.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,531.84
|
| Rate for Payer: Preferred Network Access Commercial |
$5,415.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,884.34
|
| Rate for Payer: Quartz Commercial |
$3,826.16
|
| Rate for Payer: Quartz Medicare Advantage |
$3,531.84
|
| Rate for Payer: The Alliance Commercial |
$2,943.20
|
| Rate for Payer: WEA Trust Commercial |
$3,237.52
|
| Rate for Payer: WPS Commercial |
$4,359.90
|
|
|
VL ANkle Pressure Single Level
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3077325
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$151.72 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Aetna Managed Medicare |
$151.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.22
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.38
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: NAPHCARE Commercial |
$325.10
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$352.20
|
| Rate for Payer: Quartz Medicare Advantage |
$325.10
|
| Rate for Payer: The Alliance Commercial |
$283.05
|
| Rate for Payer: United Healthcare PPO |
$406.38
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$401.33
|
|
|
VL ANkle Pressure Single Level
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3077325
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$325.10
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$401.33
|
|
|
VL ANkle Pressure Single Level
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
CPT 93922 TC
|
| Hospital Charge Code |
3077325
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$514.75 |
| Rate for Payer: Aetna Commercial |
$514.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Medicare Advantage |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.76
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$514.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.76
|
| Rate for Payer: Health EOS Commercial |
$493.07
|
| Rate for Payer: HFN Commercial |
$514.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$256.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.76
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: NAPHCARE Commercial |
$106.14
|
| Rate for Payer: Preferred Network Access Commercial |
$514.75
|
| Rate for Payer: Quartz Beloit One Network |
$238.41
|
| Rate for Payer: Quartz Commercial |
$308.85
|
| Rate for Payer: Quartz Medicare Advantage |
$70.76
|
| Rate for Payer: The Alliance Commercial |
$176.90
|
| Rate for Payer: United Healthcare Medicaid |
$71.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.76
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$283.05
|
|
|
VL Carotid Duplex Bilateral
|
Facility
|
IP
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
1482841
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$912.69 |
| Max. Negotiated Rate |
$1,713.63 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.20
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,713.63
|
| Rate for Payer: Health EOS Commercial |
$1,657.75
|
| Rate for Payer: HFN Commercial |
$1,713.63
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.63
|
| Rate for Payer: Quartz Beloit One Network |
$912.69
|
| Rate for Payer: Quartz Commercial |
$1,117.58
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$1,379.61
|
|
|
VL Carotid Duplex Bilateral
|
Professional
|
Both
|
$1,791.00
|
|
|
Service Code
|
CPT 93880 TC
|
| Hospital Charge Code |
1482841
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$142.02 |
| Max. Negotiated Rate |
$1,769.51 |
| Rate for Payer: Aetna Commercial |
$1,769.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Aetna Managed Medicare |
$150.40
|
| Rate for Payer: Anthem Medicare Advantage |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.40
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,769.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.40
|
| Rate for Payer: Health EOS Commercial |
$1,695.00
|
| Rate for Payer: HFN Commercial |
$1,769.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$569.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.40
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: NAPHCARE Commercial |
$225.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,769.51
|
| Rate for Payer: Quartz Beloit One Network |
$819.56
|
| Rate for Payer: Quartz Commercial |
$1,061.70
|
| Rate for Payer: Quartz Medicare Advantage |
$150.40
|
| Rate for Payer: The Alliance Commercial |
$376.01
|
| Rate for Payer: United Healthcare Medicaid |
$142.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.40
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$601.62
|
|
