|
Cancellation Include Discharge
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3243535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
Cancellation Include Discharge
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3243535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
CANCELLOUS CHIPS 30CC FREEZE DRIED 400150
|
Facility
|
OP
|
$4,930.00
|
|
| Hospital Charge Code |
3167481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,435.62 |
| Max. Negotiated Rate |
$4,717.02 |
| Rate for Payer: Aetna Commercial |
$4,614.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,409.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,435.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,332.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,563.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,461.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,717.42
|
| Rate for Payer: Cash Price |
$1,479.00
|
| Rate for Payer: Cigna Commercial |
$4,717.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,869.26
|
| Rate for Payer: Health EOS Commercial |
$4,563.21
|
| Rate for Payer: HFN Commercial |
$4,717.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,845.40
|
| Rate for Payer: Multiplan Commercial |
$4,101.76
|
| Rate for Payer: NAPHCARE Commercial |
$3,076.32
|
| Rate for Payer: Preferred Network Access Commercial |
$4,717.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,512.33
|
| Rate for Payer: Quartz Commercial |
$3,332.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,076.32
|
| Rate for Payer: The Alliance Commercial |
$2,563.60
|
| Rate for Payer: WEA Trust Commercial |
$2,819.96
|
| Rate for Payer: WPS Commercial |
$3,797.58
|
|
|
CANCELLOUS CHIPS 30CC FREEZE DRIED 400150
|
Facility
|
IP
|
$4,930.00
|
|
| Hospital Charge Code |
3167481
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,512.33 |
| Max. Negotiated Rate |
$4,717.02 |
| Rate for Payer: Aetna Commercial |
$4,614.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,409.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,717.42
|
| Rate for Payer: Cash Price |
$1,479.00
|
| Rate for Payer: Cigna Commercial |
$4,717.02
|
| Rate for Payer: Health EOS Commercial |
$4,563.21
|
| Rate for Payer: HFN Commercial |
$4,717.02
|
| Rate for Payer: Multiplan Commercial |
$4,101.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,717.02
|
| Rate for Payer: Quartz Beloit One Network |
$2,512.33
|
| Rate for Payer: Quartz Commercial |
$3,076.32
|
| Rate for Payer: WEA Trust Commercial |
$2,819.96
|
| Rate for Payer: WPS Commercial |
$3,797.58
|
|
|
CANCELLOUS CHIPS 4-10MM 30CC 100430
|
Facility
|
OP
|
$7,437.00
|
|
| Hospital Charge Code |
4212606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,165.65 |
| Max. Negotiated Rate |
$7,115.72 |
| Rate for Payer: Aetna Commercial |
$6,961.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,651.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,165.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,027.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,867.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,712.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,099.27
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cigna Commercial |
$7,115.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,328.33
|
| Rate for Payer: Health EOS Commercial |
$6,883.69
|
| Rate for Payer: HFN Commercial |
$7,115.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,800.86
|
| Rate for Payer: Multiplan Commercial |
$6,187.58
|
| Rate for Payer: NAPHCARE Commercial |
$4,640.69
|
| Rate for Payer: Preferred Network Access Commercial |
$7,115.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,789.90
|
| Rate for Payer: Quartz Commercial |
$5,027.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4,640.69
|
| Rate for Payer: The Alliance Commercial |
$3,867.24
|
| Rate for Payer: WEA Trust Commercial |
$4,253.96
|
| Rate for Payer: WPS Commercial |
$5,728.72
|
|
|
CANCELLOUS CHIPS 4-10MM 30CC 100430
|
Facility
|
IP
|
$7,437.00
|
|
| Hospital Charge Code |
4212606
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,789.90 |
| Max. Negotiated Rate |
$7,115.72 |
| Rate for Payer: Aetna Commercial |
$6,961.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,651.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,099.27
|
| Rate for Payer: Cash Price |
$2,231.10
|
| Rate for Payer: Cigna Commercial |
$7,115.72
|
| Rate for Payer: Health EOS Commercial |
$6,883.69
|
| Rate for Payer: HFN Commercial |
$7,115.72
|
| Rate for Payer: Multiplan Commercial |
$6,187.58
|
| Rate for Payer: Preferred Network Access Commercial |
$7,115.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,789.90
|
| Rate for Payer: Quartz Commercial |
$4,640.69
|
| Rate for Payer: WEA Trust Commercial |
$4,253.96
|
| Rate for Payer: WPS Commercial |
$5,728.72
|
|
|
Cancer Antigen 125
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
633692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$328.02 |
| Rate for Payer: Aetna Commercial |
$328.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$328.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$314.20
|
| Rate for Payer: HFN Commercial |
$328.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$328.02
|
| Rate for Payer: Quartz Beloit One Network |
$151.92
|
| Rate for Payer: Quartz Commercial |
$196.81
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$85.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: WPS Commercial |
$95.23
|
|
|
Cancer Antigen 125
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
633692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.19 |
| Max. Negotiated Rate |
$317.66 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.00
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$317.66
|
| Rate for Payer: Health EOS Commercial |
$307.30
|
| Rate for Payer: HFN Commercial |
$317.66
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: Preferred Network Access Commercial |
$317.66
|
| Rate for Payer: Quartz Beloit One Network |
$169.19
|
| Rate for Payer: Quartz Commercial |
$207.17
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: WPS Commercial |
$255.74
|
|
|
Cancer Antigen 125
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 86304
|
| Hospital Charge Code |
633692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$317.66 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$317.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$307.30
|
| Rate for Payer: HFN Commercial |
$317.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$317.66
|
| Rate for Payer: Quartz Beloit One Network |
$169.19
|
| Rate for Payer: Quartz Commercial |
$224.43
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$86.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: United Healthcare PPO |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: Wellcare Medicare |
$21.64
|
| Rate for Payer: WPS Commercial |
$255.74
|
|
|
Cancer Antigen 27 29
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
977890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.94 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$190.94
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
Cancer Antigen 27 29
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
977890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$302.33 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$302.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$159.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$289.60
|
| Rate for Payer: HFN Commercial |
$302.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$302.33
|
| Rate for Payer: Quartz Beloit One Network |
$140.03
|
| Rate for Payer: Quartz Commercial |
$181.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$85.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$95.23
|
|
|
Cancer Antigen 27 29
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
977890
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$206.86
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$86.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: United Healthcare PPO |
$238.68
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: Wellcare Medicare |
$21.64
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
Candida albicans Antibodies (IgG, IgA, IgM)
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3322168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$100.78 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$12.49
|
| Rate for Payer: Anthem Medicare Advantage |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.49
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.49
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$18.74
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$12.49
|
| Rate for Payer: The Alliance Commercial |
$49.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.49
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$54.96
|
|
|
Candida albicans Antibodies (IgG, IgA, IgM)
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3322168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$12.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.73
|
| Rate for Payer: Anthem Medicare Advantage |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.49
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.49
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$18.74
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$12.49
|
| Rate for Payer: The Alliance Commercial |
$49.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.49
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$12.49
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Candida albicans Antibodies (IgG, IgA, IgM)
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3322168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Candida Albicans Antibodies (IgG, IgA, IgM)
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3331548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Candida Albicans Antibodies (IgG, IgA, IgM)
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3331548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$84.97 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$12.49
|
| Rate for Payer: Anthem Medicare Advantage |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.49
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.49
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$18.74
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$12.49
|
| Rate for Payer: The Alliance Commercial |
$49.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.49
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$54.96
|
|
|
Candida Albicans Antibodies (IgG, IgA, IgM)
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
3331548
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$12.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.73
|
| Rate for Payer: Anthem Medicare Advantage |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.49
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.49
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$18.74
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$12.49
|
| Rate for Payer: The Alliance Commercial |
$49.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.49
|
| Rate for Payer: United Healthcare PPO |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$12.49
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Candida auris Surveillance, Qual, Real-Time PCR
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
6165887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$160.57 |
| Rate for Payer: Aetna Commercial |
$110.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$110.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$106.00
|
| Rate for Payer: HFN Commercial |
$110.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$110.66
|
| Rate for Payer: Quartz Beloit One Network |
$51.25
|
| Rate for Payer: Quartz Commercial |
$66.39
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Candida auris Surveillance, Qual, Real-Time PCR
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
6165887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$75.71
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
Candida auris Surveillance, Qual, Real-Time PCR
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 87481
|
| Hospital Charge Code |
6165887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$69.89
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
CANISTER 250ML WITH ISOLYZER VIACAN05
|
Facility
|
IP
|
$719.00
|
|
| Hospital Charge Code |
2973138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.40 |
| Max. Negotiated Rate |
$687.94 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.31
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$687.94
|
| Rate for Payer: Health EOS Commercial |
$665.51
|
| Rate for Payer: HFN Commercial |
$687.94
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: Preferred Network Access Commercial |
$687.94
|
| Rate for Payer: Quartz Beloit One Network |
$366.40
|
| Rate for Payer: Quartz Commercial |
$448.66
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$553.85
|
|
|
CANISTER 250ML WITH ISOLYZER VIACAN05
|
Facility
|
OP
|
$719.00
|
|
| Hospital Charge Code |
2973138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.37 |
| Max. Negotiated Rate |
$687.94 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Aetna Managed Medicare |
$209.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.31
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$687.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.46
|
| Rate for Payer: Health EOS Commercial |
$665.51
|
| Rate for Payer: HFN Commercial |
$687.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.82
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: NAPHCARE Commercial |
$448.66
|
| Rate for Payer: Preferred Network Access Commercial |
$687.94
|
| Rate for Payer: Quartz Beloit One Network |
$366.40
|
| Rate for Payer: Quartz Commercial |
$486.04
|
| Rate for Payer: Quartz Medicare Advantage |
$448.66
|
| Rate for Payer: The Alliance Commercial |
$373.88
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$553.85
|
|
|
CANISTER INFOV.A.C. 1000ML M8275093/5.S
|
Facility
|
IP
|
$821.00
|
|
| Hospital Charge Code |
5415134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$418.38 |
| Max. Negotiated Rate |
$785.53 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.54
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$785.53
|
| Rate for Payer: Health EOS Commercial |
$759.92
|
| Rate for Payer: HFN Commercial |
$785.53
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: Preferred Network Access Commercial |
$785.53
|
| Rate for Payer: Quartz Beloit One Network |
$418.38
|
| Rate for Payer: Quartz Commercial |
$512.30
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
|
CANISTER INFOV.A.C. 1000ML M8275093/5.S
|
Facility
|
OP
|
$821.00
|
|
| Hospital Charge Code |
5415134
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.08 |
| Max. Negotiated Rate |
$785.53 |
| Rate for Payer: Aetna Commercial |
$768.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$734.30
|
| Rate for Payer: Aetna Managed Medicare |
$239.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$555.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$426.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$409.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$452.54
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$785.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.82
|
| Rate for Payer: Health EOS Commercial |
$759.92
|
| Rate for Payer: HFN Commercial |
$785.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.38
|
| Rate for Payer: Multiplan Commercial |
$683.07
|
| Rate for Payer: NAPHCARE Commercial |
$512.30
|
| Rate for Payer: Preferred Network Access Commercial |
$785.53
|
| Rate for Payer: Quartz Beloit One Network |
$418.38
|
| Rate for Payer: Quartz Commercial |
$555.00
|
| Rate for Payer: Quartz Medicare Advantage |
$512.30
|
| Rate for Payer: The Alliance Commercial |
$426.92
|
| Rate for Payer: WEA Trust Commercial |
$469.61
|
| Rate for Payer: WPS Commercial |
$632.42
|
|
