|
BCE Nuclear Acquisition Treadmill/Chemical
|
Facility
|
OP
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5410684
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,403.50 |
| Max. Negotiated Rate |
$6,872.40 |
| Rate for Payer: Aetna Commercial |
$6,723.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,424.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,403.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,263.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.98
|
| Rate for Payer: Anthem Medicare Advantage |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,959.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,403.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,403.50
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$6,872.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,403.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,180.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,403.50
|
| Rate for Payer: Health EOS Commercial |
$6,648.30
|
| Rate for Payer: HFN Commercial |
$6,872.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,221.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,403.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,403.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,403.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,403.50
|
| Rate for Payer: Multiplan Commercial |
$5,976.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,105.25
|
| Rate for Payer: Preferred Network Access Commercial |
$6,872.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,660.30
|
| Rate for Payer: Quartz Commercial |
$4,855.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,403.50
|
| Rate for Payer: The Alliance Commercial |
$5,614.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,403.50
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$4,108.50
|
| Rate for Payer: Wellcare Medicare |
$1,403.50
|
| Rate for Payer: WPS Commercial |
$5,533.03
|
|
|
BCE Peritoneal Cath
|
Facility
|
OP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5360638
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$752.36 |
| Max. Negotiated Rate |
$10,748.00 |
| Rate for Payer: Aetna Commercial |
$2,418.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,310.82
|
| Rate for Payer: Aetna Managed Medicare |
$752.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,746.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.11
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,472.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.65
|
| Rate for Payer: Health EOS Commercial |
$2,391.43
|
| Rate for Payer: HFN Commercial |
$2,472.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,015.25
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.63
|
| Rate for Payer: Quartz Commercial |
$1,746.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,612.20
|
| Rate for Payer: The Alliance Commercial |
$10,748.00
|
| Rate for Payer: WEA Trust Commercial |
$1,477.85
|
| Rate for Payer: WPS Commercial |
$1,990.26
|
|
|
BCE Peritoneal Cath
|
Facility
|
IP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5360638
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$1,316.63 |
| Max. Negotiated Rate |
$2,472.04 |
| Rate for Payer: Aetna Commercial |
$2,418.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,310.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.11
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,472.04
|
| Rate for Payer: Health EOS Commercial |
$2,391.43
|
| Rate for Payer: HFN Commercial |
$2,472.04
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.63
|
| Rate for Payer: Quartz Commercial |
$1,612.20
|
| Rate for Payer: WEA Trust Commercial |
$1,477.85
|
| Rate for Payer: WPS Commercial |
$1,990.26
|
|
|
BCE Placement Of Soft-Tissue Localization Device
|
Facility
|
OP
|
$2,137.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
5793693
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$1,923.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.82
|
| Rate for Payer: Aetna Managed Medicare |
$695.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Anthem Medicare Advantage |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$695.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$695.42
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$1,966.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$695.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$695.42
|
| Rate for Payer: Health EOS Commercial |
$1,901.93
|
| Rate for Payer: HFN Commercial |
$1,966.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,586.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$695.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$695.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$695.42
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,043.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.13
|
| Rate for Payer: Quartz Commercial |
$1,389.05
|
| Rate for Payer: Quartz Medicare Advantage |
$695.42
|
| Rate for Payer: The Alliance Commercial |
$2,781.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$695.42
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: Wellcare Medicare |
$695.42
|
| Rate for Payer: WPS Commercial |
$1,582.88
|
|
|
BCE Placement Of Soft-Tissue Localization Device
|
Professional
|
Both
|
$2,137.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
5793693
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$285.65 |
| Max. Negotiated Rate |
$2,030.15 |
| Rate for Payer: Aetna Commercial |
$2,030.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.82
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$2,030.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$415.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,282.20
|
| Rate for Payer: Health EOS Commercial |
$1,944.67
|
| Rate for Payer: HFN Commercial |
$2,030.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$285.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$285.65
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,030.15
|
| Rate for Payer: Quartz Beloit One Network |
$940.28
|
| Rate for Payer: Quartz Commercial |
$1,218.09
|
| Rate for Payer: The Alliance Commercial |
$1,068.50
|
| Rate for Payer: United Healthcare Medicaid |
$415.81
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: WPS Commercial |
$1,582.88
|
|
|
BCE Placement Of Soft-Tissue Localization Device
|
Facility
|
IP
|
$2,137.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
5793693
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,047.13 |
| Max. Negotiated Rate |
$1,966.04 |
| Rate for Payer: Aetna Commercial |
$1,923.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.61
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$1,966.04
|
| Rate for Payer: Health EOS Commercial |
$1,901.93
|
| Rate for Payer: HFN Commercial |
$1,966.04
|
| Rate for Payer: Multiplan Commercial |
$1,709.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.13
|
| Rate for Payer: Quartz Commercial |
$1,282.20
|
| Rate for Payer: WEA Trust Commercial |
$1,175.35
|
| Rate for Payer: WPS Commercial |
$1,582.88
|
|
|
BCE Plueral Cath
|
Facility
|
OP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5228671
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$752.36 |
| Max. Negotiated Rate |
$10,748.00 |
| Rate for Payer: Aetna Commercial |
$2,418.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,310.82
|
| Rate for Payer: Aetna Managed Medicare |
$752.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,746.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.11
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,472.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.65
|
| Rate for Payer: Health EOS Commercial |
$2,391.43
|
| Rate for Payer: HFN Commercial |
$2,472.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,015.25
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.63
|
| Rate for Payer: Quartz Commercial |
$1,746.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,612.20
|
| Rate for Payer: The Alliance Commercial |
$10,748.00
|
| Rate for Payer: WEA Trust Commercial |
$1,477.85
|
| Rate for Payer: WPS Commercial |
$1,990.26
|
|
|
BCE Plueral Cath
|
Facility
|
IP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5228671
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$1,316.63 |
| Max. Negotiated Rate |
$2,472.04 |
| Rate for Payer: Aetna Commercial |
$2,418.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,310.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.11
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,472.04
|
| Rate for Payer: Health EOS Commercial |
$2,391.43
|
| Rate for Payer: HFN Commercial |
$2,472.04
|
| Rate for Payer: Multiplan Commercial |
$2,149.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.63
|
| Rate for Payer: Quartz Commercial |
$1,612.20
|
| Rate for Payer: WEA Trust Commercial |
$1,477.85
|
| Rate for Payer: WPS Commercial |
$1,990.26
|
|
|
BCE Protein/Creatinine Ratio Urine
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3119367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: HFN Commercial |
$76.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
BCE Protein/Creatinine Ratio Urine
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3119367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
BCE Protein/Creatinine Ratio Urine
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3119367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
BCE Puncture Aspiration Abscess hematoma Bulla/Cyst
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
CPT 10160 TC
|
| Hospital Charge Code |
5439090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$264.88 |
| Max. Negotiated Rate |
$571.90 |
| Rate for Payer: Aetna Commercial |
$571.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$571.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.20
|
| Rate for Payer: Health EOS Commercial |
$547.82
|
| Rate for Payer: HFN Commercial |
$571.90
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.90
|
| Rate for Payer: Quartz Beloit One Network |
$264.88
|
| Rate for Payer: Quartz Commercial |
$343.14
|
| Rate for Payer: The Alliance Commercial |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
BCE Puncture Aspiration Abscess hematoma Bulla/Cyst
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 10160 TC
|
| Hospital Charge Code |
5439090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Aetna Managed Medicare |
$168.56
|
| 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 |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.88
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.50
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$391.30
|
| Rate for Payer: Quartz Medicare Advantage |
$361.20
|
| Rate for Payer: The Alliance Commercial |
$2,408.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
BCE Puncture Aspiration Abscess hematoma Bulla/Cyst
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 10160 TC
|
| Hospital Charge Code |
5439090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$294.98 |
| Max. Negotiated Rate |
$553.84 |
| Rate for Payer: Aetna Commercial |
$541.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$517.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.06
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$553.84
|
| Rate for Payer: Health EOS Commercial |
$535.78
|
| Rate for Payer: HFN Commercial |
$553.84
|
| Rate for Payer: Multiplan Commercial |
$481.60
|
| Rate for Payer: NAPHCARE Commercial |
$361.20
|
| Rate for Payer: Preferred Network Access Commercial |
$553.84
|
| Rate for Payer: Quartz Beloit One Network |
$294.98
|
| Rate for Payer: Quartz Commercial |
$361.20
|
| Rate for Payer: WEA Trust Commercial |
$331.10
|
| Rate for Payer: WPS Commercial |
$445.90
|
|
|
BCE Renal Biopsy
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
5418644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$893.76 |
| Max. Negotiated Rate |
$1,678.08 |
| Rate for Payer: Aetna Commercial |
$1,641.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.72
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,678.08
|
| Rate for Payer: Health EOS Commercial |
$1,623.36
|
| Rate for Payer: HFN Commercial |
$1,678.08
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,094.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.08
|
| Rate for Payer: Quartz Beloit One Network |
$893.76
|
| Rate for Payer: Quartz Commercial |
$1,094.40
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
BCE Renal Biopsy
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
5418644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$510.72 |
| Max. Negotiated Rate |
$7,296.00 |
| Rate for Payer: Aetna Commercial |
$1,641.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Aetna Managed Medicare |
$510.72
|
| 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 |
$966.72
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,678.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,020.71
|
| Rate for Payer: Health EOS Commercial |
$1,623.36
|
| Rate for Payer: HFN Commercial |
$1,678.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,368.00
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,094.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.08
|
| Rate for Payer: Quartz Beloit One Network |
$893.76
|
| Rate for Payer: Quartz Commercial |
$1,185.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,094.40
|
| Rate for Payer: The Alliance Commercial |
$7,296.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
BCE Renal Biopsy
|
Professional
|
Both
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
5418644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$802.56 |
| Max. Negotiated Rate |
$1,732.80 |
| Rate for Payer: Aetna Commercial |
$1,732.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,732.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$912.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,094.40
|
| Rate for Payer: Health EOS Commercial |
$1,659.84
|
| Rate for Payer: HFN Commercial |
$1,732.80
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,732.80
|
| Rate for Payer: Quartz Beloit One Network |
$802.56
|
| Rate for Payer: Quartz Commercial |
$1,039.68
|
| Rate for Payer: The Alliance Commercial |
$912.00
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
BCE Sacroiliac Joint Injection
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
5595259
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$178.92 |
| Max. Negotiated Rate |
$3,205.00 |
| Rate for Payer: Aetna Commercial |
$575.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Aetna Managed Medicare |
$178.92
|
| 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 |
$338.67
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$587.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.58
|
| Rate for Payer: Health EOS Commercial |
$568.71
|
| Rate for Payer: HFN Commercial |
$587.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$479.25
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: NAPHCARE Commercial |
$383.40
|
| Rate for Payer: Preferred Network Access Commercial |
$587.88
|
| Rate for Payer: Quartz Beloit One Network |
$313.11
|
| Rate for Payer: Quartz Commercial |
$415.35
|
| Rate for Payer: Quartz Medicare Advantage |
$383.40
|
| Rate for Payer: The Alliance Commercial |
$2,556.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
BCE Sacroiliac Joint Injection
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
5595259
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$313.11 |
| Max. Negotiated Rate |
$587.88 |
| Rate for Payer: Aetna Commercial |
$575.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.67
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$587.88
|
| Rate for Payer: Health EOS Commercial |
$568.71
|
| Rate for Payer: HFN Commercial |
$587.88
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: NAPHCARE Commercial |
$383.40
|
| Rate for Payer: Preferred Network Access Commercial |
$587.88
|
| Rate for Payer: Quartz Beloit One Network |
$313.11
|
| Rate for Payer: Quartz Commercial |
$383.40
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
BCE Sacroiliac Joint Injection
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
5595259
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$281.16 |
| Max. Negotiated Rate |
$607.05 |
| Rate for Payer: Aetna Commercial |
$607.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.54
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$607.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$383.40
|
| Rate for Payer: Health EOS Commercial |
$581.49
|
| Rate for Payer: HFN Commercial |
$607.05
|
| Rate for Payer: Multiplan Commercial |
$511.20
|
| Rate for Payer: Preferred Network Access Commercial |
$607.05
|
| Rate for Payer: Quartz Beloit One Network |
$281.16
|
| Rate for Payer: Quartz Commercial |
$364.23
|
| Rate for Payer: The Alliance Commercial |
$319.50
|
| Rate for Payer: WEA Trust Commercial |
$351.45
|
| Rate for Payer: WPS Commercial |
$473.31
|
|
|
BCE Saliva Confirmation 15-21
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.80 |
| Max. Negotiated Rate |
$794.96 |
| Rate for Payer: Aetna Commercial |
$576.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Aetna Managed Medicare |
$198.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$416.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$320.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.20
|
| Rate for Payer: Anthem Medicaid |
$132.80
|
| Rate for Payer: Anthem Medicare Advantage |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$198.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$198.74
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$588.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$198.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.14
|
| Rate for Payer: Dean Health Medicaid |
$132.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$198.74
|
| Rate for Payer: Health EOS Commercial |
$569.60
|
| Rate for Payer: HFN Commercial |
$588.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$739.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$198.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$132.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$198.74
|
| Rate for Payer: Managed Health Services Medicaid |
$138.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$198.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$198.74
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: NAPHCARE Commercial |
$298.11
|
| Rate for Payer: Preferred Network Access Commercial |
$588.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132.80
|
| Rate for Payer: Quartz Beloit One Network |
$313.60
|
| Rate for Payer: Quartz Commercial |
$416.00
|
| Rate for Payer: Quartz Medicare Advantage |
$198.74
|
| Rate for Payer: The Alliance Commercial |
$794.96
|
| Rate for Payer: United Healthcare Medicaid |
$132.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$198.74
|
| Rate for Payer: United Healthcare PPO |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: Wellcare Medicare |
$198.74
|
| Rate for Payer: WMAP Medicaid |
$132.80
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
BCE Saliva Confirmation 15-21
|
Professional
|
Both
|
$640.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$281.60 |
| Max. Negotiated Rate |
$701.55 |
| Rate for Payer: Aetna Commercial |
$608.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$608.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$320.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.00
|
| Rate for Payer: Health EOS Commercial |
$582.40
|
| Rate for Payer: HFN Commercial |
$608.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$701.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$701.55
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: Preferred Network Access Commercial |
$608.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.60
|
| Rate for Payer: Quartz Commercial |
$364.80
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
BCE Saliva Confirmation 15-21
|
Facility
|
IP
|
$640.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.60 |
| Max. Negotiated Rate |
$588.80 |
| Rate for Payer: Aetna Commercial |
$576.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.20
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$588.80
|
| Rate for Payer: Health EOS Commercial |
$569.60
|
| Rate for Payer: HFN Commercial |
$588.80
|
| Rate for Payer: Multiplan Commercial |
$512.00
|
| Rate for Payer: NAPHCARE Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$588.80
|
| Rate for Payer: Quartz Beloit One Network |
$313.60
|
| Rate for Payer: Quartz Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$352.00
|
| Rate for Payer: WPS Commercial |
$474.05
|
|
|
BCE Saliva Confirmation 1-7
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.32 |
| Max. Negotiated Rate |
$403.94 |
| Rate for Payer: Aetna Commercial |
$169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$169.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.80
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$169.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$403.94
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.10
|
| Rate for Payer: Quartz Beloit One Network |
$78.32
|
| Rate for Payer: Quartz Commercial |
$101.46
|
| Rate for Payer: The Alliance Commercial |
$89.00
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
BCE Saliva Confirmation 1-7
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
HCPCS G0480
|
| Hospital Charge Code |
5542875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.95 |
| Max. Negotiated Rate |
$457.72 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$114.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.44
|
| Rate for Payer: Anthem Medicaid |
$63.95
|
| Rate for Payer: Anthem Medicare Advantage |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$114.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.61
|
| Rate for Payer: Dean Health Medicaid |
$63.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$114.43
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
| Rate for Payer: Managed Health Services Medicaid |
$66.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$114.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$114.43
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$171.64
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.95
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$114.43
|
| Rate for Payer: The Alliance Commercial |
$457.72
|
| Rate for Payer: United Healthcare Medicaid |
$63.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
| Rate for Payer: United Healthcare PPO |
$133.50
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: Wellcare Medicare |
$114.43
|
| Rate for Payer: WMAP Medicaid |
$63.95
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
