|
Adenovirus Antibody
|
Professional
|
$98.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
980014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.87
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.87
|
| Rate for Payer: Health EOS Commercial |
$89.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.87
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Preferred Network Access Commercial |
$93.10
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$55.86
|
| Rate for Payer: Quartz Medicare Advantage |
$12.87
|
| Rate for Payer: The Alliance Commercial |
$50.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$56.63
|
|
|
Adenovirus Antibody
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
CPT 86603
|
| Hospital Charge Code |
980014
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$392.00 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$12.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.36
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.87
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.87
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.87
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.87
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.30
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$12.87
|
| Rate for Payer: The Alliance Commercial |
$392.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare PPO |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: Wellcare Medicare |
$12.87
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
Adenovirus DNA, Quant Real Time PCR
|
Facility
IP
|
$569.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3256217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$278.81 |
| Max. Negotiated Rate |
$523.48 |
| Rate for Payer: Aetna Commercial |
$512.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.57
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cigna Commercial |
$523.48
|
| Rate for Payer: Health EOS Commercial |
$506.41
|
| Rate for Payer: HFN Commercial |
$523.48
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: NAPHCARE Commercial |
$341.40
|
| Rate for Payer: Preferred Network Access Commercial |
$523.48
|
| Rate for Payer: Quartz Beloit One Network |
$278.81
|
| Rate for Payer: Quartz Commercial |
$341.40
|
| Rate for Payer: WEA Trust Commercial |
$312.95
|
| Rate for Payer: WPS Commercial |
$421.46
|
|
|
Adenovirus DNA, Quant Real Time PCR
|
Facility
OP
|
$569.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3256217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$2,276.00 |
| Rate for Payer: Aetna Commercial |
$512.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.34
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.11
|
| Rate for Payer: Anthem Medicaid |
$44.27
|
| Rate for Payer: Anthem Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.84
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cigna Commercial |
$523.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.27
|
| Rate for Payer: Dean Health Medicaid |
$44.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$506.41
|
| Rate for Payer: HFN Commercial |
$523.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.84
|
| Rate for Payer: Managed Health Services Medicaid |
$46.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$523.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$278.81
|
| Rate for Payer: Quartz Commercial |
$369.85
|
| Rate for Payer: Quartz Medicare Advantage |
$42.84
|
| Rate for Payer: The Alliance Commercial |
$2,276.00
|
| Rate for Payer: United Healthcare Medicaid |
$44.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare PPO |
$426.75
|
| Rate for Payer: WEA Trust Commercial |
$312.95
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$421.46
|
|
|
Adenovirus DNA, Quant Real Time PCR
|
Professional
|
$569.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3256217
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$540.55 |
| Rate for Payer: Aetna Commercial |
$540.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.34
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.84
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cash Price |
$170.70
|
| Rate for Payer: Cigna Commercial |
$540.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$517.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$455.20
|
| Rate for Payer: Preferred Network Access Commercial |
$540.55
|
| Rate for Payer: Quartz Beloit One Network |
$250.36
|
| Rate for Payer: Quartz Commercial |
$324.33
|
| Rate for Payer: Quartz Medicare Advantage |
$42.84
|
| Rate for Payer: The Alliance Commercial |
$169.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: WEA Trust Commercial |
$312.95
|
| Rate for Payer: WPS Commercial |
$188.50
|
|
|
ADHESIONS, LYSIS OF
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ADHESIONS, LYSIS OF
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960215
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ADHESIVE PAD ENT 9732500XOM
|
Facility
IP
|
$142.00
|
|
| Hospital Charge Code |
3157477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$85.20
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$85.20
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
ADHESIVE PAD ENT 9732500XOM
|
Facility
OP
|
$142.00
|
|
| Hospital Charge Code |
3157477
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.76 |
| Max. Negotiated Rate |
$568.00 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Aetna Managed Medicare |
$39.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.46
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.50
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$85.20
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$92.30
|
| Rate for Payer: Quartz Medicare Advantage |
$85.20
|
| Rate for Payer: The Alliance Commercial |
$568.00
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
ADHESIVE REMOVER WIPES 423780
|
Facility
OP
|
$3.00
|
|
|
Service Code
|
HCPCS A4456
|
| Hospital Charge Code |
2969238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Aetna Managed Medicare |
$0.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.68
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1.80
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
ADHESIVE REMOVER WIPES 423780
|
Facility
IP
|
$3.00
|
|
|
Service Code
|
HCPCS A4456
|
| Hospital Charge Code |
2969238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.80
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM
|
Facility
OP
|
$13,191.23
|
|
|
Service Code
|
CPT 14301
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,546.03 |
| Max. Negotiated Rate |
$13,191.23 |
| Rate for Payer: Aetna Managed Medicare |
$3,546.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,546.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,546.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,546.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,546.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,546.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,191.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,546.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,546.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,546.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,546.03
|
| Rate for Payer: NAPHCARE Commercial |
$5,319.04
|
| Rate for Payer: Quartz Medicare Advantage |
$3,546.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,546.03
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,546.03
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
OP
|
$7,795.33
|
|
|
Service Code
|
CPT 14302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,795.33 |
| Max. Negotiated Rate |
$7,795.33 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
OP
|
$6,705.23
|
|
|
Service Code
|
CPT 14061
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS
|
Facility
OP
|
$6,705.23
|
|
|
Service Code
|
CPT 14060
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
OP
|
$6,705.23
|
|
|
Service Code
|
CPT 14041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS
|
Facility
OP
|
$6,705.23
|
|
|
Service Code
|
CPT 14040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS AND/OR LEGS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
OP
|
$6,705.23
|
|
|
Service Code
|
CPT 14021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10.1 SQ CM TO 30.0 SQ CM
|
Facility
OP
|
$6,705.23
|
|
|
Service Code
|
CPT 14001
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
|
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS
|
Facility
OP
|
$6,705.23
|
|
|
Service Code
|
CPT 14000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,802.48 |
| Max. Negotiated Rate |
$6,705.23 |
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
|
|
ADJUSTMENT INSTRUMENTD HOFFMANN LIMB 4934-9-100
|
Facility
IP
|
$4,461.00
|
|
| Hospital Charge Code |
6206984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,185.89 |
| Max. Negotiated Rate |
$4,104.12 |
| Rate for Payer: Aetna Commercial |
$4,014.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,364.33
|
| Rate for Payer: Cash Price |
$1,338.30
|
| Rate for Payer: Cigna Commercial |
$4,104.12
|
| Rate for Payer: Health EOS Commercial |
$3,970.29
|
| Rate for Payer: HFN Commercial |
$4,104.12
|
| Rate for Payer: Multiplan Commercial |
$3,568.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,104.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.89
|
| Rate for Payer: Quartz Commercial |
$2,676.60
|
| Rate for Payer: WEA Trust Commercial |
$2,453.55
|
| Rate for Payer: WPS Commercial |
$3,304.26
|
|
|
ADJUSTMENT INSTRUMENTD HOFFMANN LIMB 4934-9-100
|
Facility
OP
|
$4,461.00
|
|
| Hospital Charge Code |
6206984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,249.08 |
| Max. Negotiated Rate |
$17,844.00 |
| Rate for Payer: Aetna Commercial |
$4,014.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,836.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,249.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,141.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,364.33
|
| Rate for Payer: Cash Price |
$1,338.30
|
| Rate for Payer: Cigna Commercial |
$4,104.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,496.38
|
| Rate for Payer: Health EOS Commercial |
$3,970.29
|
| Rate for Payer: HFN Commercial |
$4,104.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.75
|
| Rate for Payer: Multiplan Commercial |
$3,568.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,104.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.89
|
| Rate for Payer: Quartz Commercial |
$2,899.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.60
|
| Rate for Payer: The Alliance Commercial |
$17,844.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.55
|
| Rate for Payer: WPS Commercial |
$3,304.26
|
|
|
ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEM REQUIRING ANESTHESIA (EG, NEW PIN[S] OR WIRE[S] AND/OR NEW RING[S] OR BAR[S])
|
Facility
OP
|
$26,304.57
|
|
|
Service Code
|
CPT 20693
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$801.96 |
| Max. Negotiated Rate |
$26,304.57 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$801.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
Admin All Other - Admin Flu Virus
|
Facility
IP
|
$18.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
5542822
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Admin All Other - Admin Flu Virus
|
Professional
|
$18.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
5542822
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$77.56 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$16.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.10
|
| Rate for Payer: Quartz Beloit One Network |
$7.92
|
| Rate for Payer: Quartz Commercial |
$10.26
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$48.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$77.56
|
|
