|
Complement C1q
|
Professional
|
$84.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3256215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$79.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$76.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$79.80
|
| Rate for Payer: Quartz Beloit One Network |
$36.96
|
| Rate for Payer: Quartz Commercial |
$47.88
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$47.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$52.80
|
|
|
Complement C1q
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 86160
|
| Hospital Charge Code |
3256215
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.92
|
| Rate for Payer: Anthem Medicaid |
$12.40
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.40
|
| Rate for Payer: Dean Health Medicaid |
$12.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Managed Health Services Medicaid |
$12.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.40
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare PPO |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: Wellcare Medicare |
$12.00
|
| Rate for Payer: WMAP Medicaid |
$12.40
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Complement Total
|
Professional
|
$252.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
977908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.72
|
| Rate for Payer: Aetna Managed Medicare |
$20.32
|
| Rate for Payer: Anthem Medicare Advantage |
$20.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.32
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$239.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.32
|
| Rate for Payer: Health EOS Commercial |
$229.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.32
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$239.40
|
| Rate for Payer: Quartz Beloit One Network |
$110.88
|
| Rate for Payer: Quartz Commercial |
$143.64
|
| Rate for Payer: Quartz Medicare Advantage |
$20.32
|
| Rate for Payer: The Alliance Commercial |
$80.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.32
|
| Rate for Payer: WEA Trust Commercial |
$138.60
|
| Rate for Payer: WPS Commercial |
$89.41
|
|
|
Complement Total
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
977908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$231.84 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.56
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$231.84
|
| Rate for Payer: Health EOS Commercial |
$224.28
|
| Rate for Payer: HFN Commercial |
$231.84
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: NAPHCARE Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.84
|
| Rate for Payer: Quartz Beloit One Network |
$123.48
|
| Rate for Payer: Quartz Commercial |
$151.20
|
| Rate for Payer: WEA Trust Commercial |
$138.60
|
| Rate for Payer: WPS Commercial |
$186.66
|
|
|
Complement Total
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT 86162
|
| Hospital Charge Code |
977908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.32 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.72
|
| Rate for Payer: Aetna Managed Medicare |
$20.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.73
|
| Rate for Payer: Anthem Medicare Advantage |
$20.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.32
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$231.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.32
|
| Rate for Payer: Health EOS Commercial |
$224.28
|
| Rate for Payer: HFN Commercial |
$231.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.32
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: NAPHCARE Commercial |
$30.48
|
| Rate for Payer: Preferred Network Access Commercial |
$231.84
|
| Rate for Payer: Quartz Beloit One Network |
$123.48
|
| Rate for Payer: Quartz Commercial |
$163.80
|
| Rate for Payer: Quartz Medicare Advantage |
$20.32
|
| Rate for Payer: The Alliance Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.32
|
| Rate for Payer: United Healthcare PPO |
$189.00
|
| Rate for Payer: WEA Trust Commercial |
$138.60
|
| Rate for Payer: Wellcare Medicare |
$20.32
|
| Rate for Payer: WPS Commercial |
$186.66
|
|
|
Complete-PFT - Pulmonary Function Test Charge
|
Facility
IP
|
$1,746.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
3006998
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$855.54 |
| Max. Negotiated Rate |
$1,606.32 |
| Rate for Payer: Aetna Commercial |
$1,571.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$925.38
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$1,606.32
|
| Rate for Payer: Health EOS Commercial |
$1,553.94
|
| Rate for Payer: HFN Commercial |
$1,606.32
|
| Rate for Payer: Multiplan Commercial |
$1,396.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,047.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$855.54
|
| Rate for Payer: Quartz Commercial |
$1,047.60
|
| Rate for Payer: WEA Trust Commercial |
$960.30
|
| Rate for Payer: WPS Commercial |
$1,293.26
|
|
|
Complete-PFT - Pulmonary Function Test Charge
|
Facility
OP
|
$1,746.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
3006998
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,606.32 |
| Rate for Payer: Aetna Commercial |
$1,571.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,501.56
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,134.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$873.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$838.08
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$925.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cash Price |
$523.80
|
| Rate for Payer: Cigna Commercial |
$1,606.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$977.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,553.94
|
| Rate for Payer: HFN Commercial |
$1,606.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$1,396.80
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,606.32
|
| Rate for Payer: Quartz Beloit One Network |
$855.54
|
| Rate for Payer: Quartz Commercial |
$1,134.90
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$1,309.50
|
| Rate for Payer: WEA Trust Commercial |
$960.30
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,293.26
|
|
|
COMPLEX DRAINAGE, WOUND 10180
|
Professional
|
$810.00
|
|
|
Service Code
|
CPT 10180
|
| Hospital Charge Code |
3013509
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$108.95 |
| Max. Negotiated Rate |
$769.50 |
| Rate for Payer: Aetna Commercial |
$769.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$696.60
|
| Rate for Payer: Aetna Managed Medicare |
$164.82
|
| Rate for Payer: Anthem Medicare Advantage |
$164.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$164.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$164.82
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$769.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$405.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.82
|
| Rate for Payer: Health EOS Commercial |
$737.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$583.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$164.82
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: Preferred Network Access Commercial |
$769.50
|
| Rate for Payer: Quartz Beloit One Network |
$356.40
|
| Rate for Payer: Quartz Commercial |
$461.70
|
| Rate for Payer: Quartz Medicare Advantage |
$164.82
|
| Rate for Payer: The Alliance Commercial |
$700.48
|
| Rate for Payer: United Healthcare Medicaid |
$108.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$164.82
|
| Rate for Payer: WEA Trust Commercial |
$445.50
|
| Rate for Payer: WPS Commercial |
$741.69
|
|
|
Complex Dressing - Incision, Wound Dressing:
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3003559
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Aetna Managed Medicare |
$48.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$86.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.25
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.00
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$111.80
|
| Rate for Payer: Quartz Medicare Advantage |
$103.20
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Complex Dressing - Incision, Wound Dressing:
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3003559
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$103.20
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Complex Uroflometry 51741
|
Professional
|
$527.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
1188974
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.16 |
| Max. Negotiated Rate |
$500.65 |
| Rate for Payer: Aetna Commercial |
$500.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$453.22
|
| Rate for Payer: Aetna Managed Medicare |
$13.16
|
| Rate for Payer: Anthem Medicare Advantage |
$13.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.16
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Cash Price |
$158.10
|
| Rate for Payer: Cigna Commercial |
$500.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$263.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.16
|
| Rate for Payer: Health EOS Commercial |
$479.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.16
|
| Rate for Payer: Multiplan Commercial |
$421.60
|
| Rate for Payer: Preferred Network Access Commercial |
$500.65
|
| Rate for Payer: Quartz Beloit One Network |
$231.88
|
| Rate for Payer: Quartz Commercial |
$300.39
|
| Rate for Payer: Quartz Medicare Advantage |
$13.16
|
| Rate for Payer: The Alliance Commercial |
$55.93
|
| Rate for Payer: United Healthcare Medicaid |
$74.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.16
|
| Rate for Payer: WEA Trust Commercial |
$289.85
|
| Rate for Payer: WPS Commercial |
$59.22
|
|
|
COMPLICATED PEPTIC ULCER WITH CC
|
Facility
IP
|
$28,847.00
|
|
|
Service Code
|
MS-DRG 381
|
| Min. Negotiated Rate |
$10,376.68 |
| Max. Negotiated Rate |
$28,847.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,376.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,448.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,206.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,347.46
|
| Rate for Payer: Anthem Medicare Advantage |
$10,376.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,376.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,376.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,376.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,147.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,376.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,923.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,376.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,376.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,376.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,376.68
|
| Rate for Payer: NAPHCARE Commercial |
$15,565.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10,376.68
|
| Rate for Payer: The Alliance Commercial |
$28,847.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,376.68
|
| Rate for Payer: United Healthcare PPO |
$16,289.21
|
| Rate for Payer: Wellcare Medicare |
$10,376.68
|
|
|
COMPLICATED PEPTIC ULCER WITH MCC
|
Facility
IP
|
$52,123.00
|
|
|
Service Code
|
MS-DRG 380
|
| Min. Negotiated Rate |
$18,749.35 |
| Max. Negotiated Rate |
$52,123.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,749.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,911.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,357.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,792.10
|
| Rate for Payer: Anthem Medicare Advantage |
$18,749.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,749.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,749.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,749.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,071.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,749.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,995.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,749.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,749.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,749.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,749.35
|
| Rate for Payer: NAPHCARE Commercial |
$28,124.02
|
| Rate for Payer: Quartz Medicare Advantage |
$18,749.35
|
| Rate for Payer: The Alliance Commercial |
$52,123.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,749.35
|
| Rate for Payer: United Healthcare PPO |
$29,580.18
|
| Rate for Payer: Wellcare Medicare |
$18,749.35
|
|
|
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC
|
Facility
IP
|
$20,449.00
|
|
|
Service Code
|
MS-DRG 382
|
| Min. Negotiated Rate |
$7,355.62 |
| Max. Negotiated Rate |
$20,449.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,355.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,944.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,221.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,611.28
|
| Rate for Payer: Anthem Medicare Advantage |
$7,355.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,355.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,355.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,355.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,889.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,355.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,763.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,355.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,355.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,355.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,355.62
|
| Rate for Payer: NAPHCARE Commercial |
$11,033.43
|
| Rate for Payer: Quartz Medicare Advantage |
$7,355.62
|
| Rate for Payer: The Alliance Commercial |
$20,449.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,355.62
|
| Rate for Payer: United Healthcare PPO |
$11,493.54
|
| Rate for Payer: Wellcare Medicare |
$7,355.62
|
|
|
COMPLICATIONS OF TREATMENT WITH CC
|
Facility
IP
|
$27,805.00
|
|
|
Service Code
|
MS-DRG 920
|
| Min. Negotiated Rate |
$10,001.80 |
| Max. Negotiated Rate |
$27,805.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,001.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,563.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,736.34
|
| Rate for Payer: Anthem Medicare Advantage |
$10,001.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,001.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,001.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,001.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,468.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,001.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,159.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,001.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,001.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,001.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,001.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,002.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10,001.80
|
| Rate for Payer: The Alliance Commercial |
$27,805.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,001.80
|
| Rate for Payer: United Healthcare PPO |
$15,694.12
|
| Rate for Payer: Wellcare Medicare |
$10,001.80
|
|
|
COMPLICATIONS OF TREATMENT WITH MCC
|
Facility
IP
|
$48,832.00
|
|
|
Service Code
|
MS-DRG 919
|
| Min. Negotiated Rate |
$17,565.41 |
| Max. Negotiated Rate |
$48,832.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,565.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,183.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,267.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,805.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17,565.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,565.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,565.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,565.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,867.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,565.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,581.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,565.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,565.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,565.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,565.41
|
| Rate for Payer: NAPHCARE Commercial |
$26,348.12
|
| Rate for Payer: Quartz Medicare Advantage |
$17,565.41
|
| Rate for Payer: The Alliance Commercial |
$48,832.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,565.41
|
| Rate for Payer: United Healthcare PPO |
$27,700.77
|
| Rate for Payer: Wellcare Medicare |
$17,565.41
|
|
|
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC
|
Facility
IP
|
$18,872.00
|
|
|
Service Code
|
MS-DRG 921
|
| Min. Negotiated Rate |
$6,788.53 |
| Max. Negotiated Rate |
$18,872.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,788.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,686.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,256.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,694.60
|
| Rate for Payer: Anthem Medicare Advantage |
$6,788.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,788.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,788.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,788.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,871.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,788.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,607.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,788.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,788.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,788.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,788.53
|
| Rate for Payer: NAPHCARE Commercial |
$10,182.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6,788.53
|
| Rate for Payer: The Alliance Commercial |
$18,872.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,788.53
|
| Rate for Payer: United Healthcare PPO |
$10,593.30
|
| Rate for Payer: Wellcare Medicare |
$6,788.53
|
|
|
COMPONENT ARTICULAR 15MM 9152-2040-W
|
Facility
OP
|
$12,202.00
|
|
| Hospital Charge Code |
2964724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,416.56 |
| Max. Negotiated Rate |
$48,808.00 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,493.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,416.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,931.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,856.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,828.24
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,151.50
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,931.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,321.20
|
| Rate for Payer: The Alliance Commercial |
$48,808.00
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
COMPONENT ARTICULAR 15MM 9152-2040-W
|
Facility
IP
|
$12,202.00
|
|
| Hospital Charge Code |
2964724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,978.98 |
| Max. Negotiated Rate |
$11,225.84 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,321.20
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
COMPONENT ARTICULAR 9152-1525
|
Facility
IP
|
$12,202.00
|
|
| Hospital Charge Code |
2964725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,978.98 |
| Max. Negotiated Rate |
$11,225.84 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,321.20
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
COMPONENT ARTICULAR 9152-1525
|
Facility
OP
|
$12,202.00
|
|
| Hospital Charge Code |
2964725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,416.56 |
| Max. Negotiated Rate |
$48,808.00 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,493.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,416.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,931.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,856.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,828.24
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,151.50
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,931.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,321.20
|
| Rate for Payer: The Alliance Commercial |
$48,808.00
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
COMPONENT ARTICULAR 9152-2030
|
Facility
OP
|
$12,202.00
|
|
| Hospital Charge Code |
2964726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,416.56 |
| Max. Negotiated Rate |
$48,808.00 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,493.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,416.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,931.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,856.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,828.24
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,151.50
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,931.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,321.20
|
| Rate for Payer: The Alliance Commercial |
$48,808.00
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
COMPONENT ARTICULAR 9152-2030
|
Facility
IP
|
$12,202.00
|
|
| Hospital Charge Code |
2964726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,978.98 |
| Max. Negotiated Rate |
$11,225.84 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,321.20
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
COMPONENT ARTICULAR 9152-2535
|
Facility
IP
|
$12,202.00
|
|
| Hospital Charge Code |
2964727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,978.98 |
| Max. Negotiated Rate |
$11,225.84 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,321.20
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
|
COMPONENT ARTICULAR 9152-2535
|
Facility
OP
|
$12,202.00
|
|
| Hospital Charge Code |
2964727
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,416.56 |
| Max. Negotiated Rate |
$48,808.00 |
| Rate for Payer: Aetna Commercial |
$10,981.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,493.72
|
| Rate for Payer: Aetna Managed Medicare |
$3,416.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,931.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,101.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,856.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,467.06
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,225.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,828.24
|
| Rate for Payer: Health EOS Commercial |
$10,859.78
|
| Rate for Payer: HFN Commercial |
$11,225.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,151.50
|
| Rate for Payer: Multiplan Commercial |
$9,761.60
|
| Rate for Payer: NAPHCARE Commercial |
$7,321.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11,225.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,978.98
|
| Rate for Payer: Quartz Commercial |
$7,931.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7,321.20
|
| Rate for Payer: The Alliance Commercial |
$48,808.00
|
| Rate for Payer: WEA Trust Commercial |
$6,711.10
|
| Rate for Payer: WPS Commercial |
$9,038.02
|
|
