|
Echo Interpretation
|
Facility
|
OP
|
$1,348.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
5375696
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$377.44 |
| Max. Negotiated Rate |
$5,392.00 |
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.28
|
| Rate for Payer: Aetna Managed Medicare |
$377.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$674.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$647.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$754.34
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,011.00
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$876.20
|
| Rate for Payer: Quartz Medicare Advantage |
$808.80
|
| Rate for Payer: The Alliance Commercial |
$5,392.00
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
|
Echo Interpretation
|
Facility
|
OP
|
$1,408.00
|
|
|
Service Code
|
CPT 93314 26
|
| Hospital Charge Code |
5375705
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$394.24 |
| Max. Negotiated Rate |
$5,632.00 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| Rate for Payer: Aetna Managed Medicare |
$394.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$787.92
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.00
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$915.20
|
| Rate for Payer: Quartz Medicare Advantage |
$844.80
|
| Rate for Payer: The Alliance Commercial |
$5,632.00
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
Echo Interpretation
|
Facility
|
OP
|
$1,348.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
5375693
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$377.44 |
| Max. Negotiated Rate |
$5,392.00 |
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.28
|
| Rate for Payer: Aetna Managed Medicare |
$377.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$674.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$647.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$754.34
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,011.00
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$876.20
|
| Rate for Payer: Quartz Medicare Advantage |
$808.80
|
| Rate for Payer: The Alliance Commercial |
$5,392.00
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
|
Echo Interpretation
|
Facility
|
IP
|
$1,408.00
|
|
|
Service Code
|
CPT 93314 26
|
| Hospital Charge Code |
5375705
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$689.92 |
| Max. Negotiated Rate |
$1,295.36 |
| Rate for Payer: Aetna Commercial |
$1,267.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.24
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,295.36
|
| Rate for Payer: Health EOS Commercial |
$1,253.12
|
| Rate for Payer: HFN Commercial |
$1,295.36
|
| Rate for Payer: Multiplan Commercial |
$1,126.40
|
| Rate for Payer: NAPHCARE Commercial |
$844.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.36
|
| Rate for Payer: Quartz Beloit One Network |
$689.92
|
| Rate for Payer: Quartz Commercial |
$844.80
|
| Rate for Payer: WEA Trust Commercial |
$774.40
|
| Rate for Payer: WPS Commercial |
$1,042.91
|
|
|
Echo Interpretation
|
Facility
|
IP
|
$1,348.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
5375696
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$660.52 |
| Max. Negotiated Rate |
$1,240.16 |
| Rate for Payer: Aetna Commercial |
$1,213.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,159.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.44
|
| Rate for Payer: Cash Price |
$404.40
|
| Rate for Payer: Cigna Commercial |
$1,240.16
|
| Rate for Payer: Health EOS Commercial |
$1,199.72
|
| Rate for Payer: HFN Commercial |
$1,240.16
|
| Rate for Payer: Multiplan Commercial |
$1,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,240.16
|
| Rate for Payer: Quartz Beloit One Network |
$660.52
|
| Rate for Payer: Quartz Commercial |
$808.80
|
| Rate for Payer: WEA Trust Commercial |
$741.40
|
| Rate for Payer: WPS Commercial |
$998.46
|
|
|
Echo Interpretation
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 93350 26
|
| Hospital Charge Code |
5375675
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$52.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Echo Stress Test 93350
|
Facility
|
IP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5381792
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$2,110.92 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,584.80
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
Echo Stress Test 93350
|
Facility
|
OP
|
$4,308.00
|
|
|
Service Code
|
CPT 93350
|
| Hospital Charge Code |
5381792
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$545.28 |
| Max. Negotiated Rate |
$3,963.36 |
| Rate for Payer: Aetna Commercial |
$3,877.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,704.88
|
| Rate for Payer: Aetna Managed Medicare |
$545.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,800.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,067.84
|
| Rate for Payer: Anthem Medicare Advantage |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,283.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$545.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$545.28
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cash Price |
$1,292.40
|
| Rate for Payer: Cigna Commercial |
$3,963.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$545.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,410.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$545.28
|
| Rate for Payer: Health EOS Commercial |
$3,834.12
|
| Rate for Payer: HFN Commercial |
$3,963.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,028.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$545.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$545.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$545.28
|
| Rate for Payer: Multiplan Commercial |
$3,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$817.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,963.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,110.92
|
| Rate for Payer: Quartz Commercial |
$2,800.20
|
| Rate for Payer: Quartz Medicare Advantage |
$545.28
|
| Rate for Payer: The Alliance Commercial |
$2,181.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$545.28
|
| Rate for Payer: United Healthcare PPO |
$3,231.00
|
| Rate for Payer: WEA Trust Commercial |
$2,369.40
|
| Rate for Payer: Wellcare Medicare |
$545.28
|
| Rate for Payer: WPS Commercial |
$3,190.94
|
|
|
Echo Transeophag Congen Probe Plcmt 9331526
|
Professional
|
Both
|
$2,125.00
|
|
|
Service Code
|
CPT 93315 26
|
| Hospital Charge Code |
4834611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$440.19 |
| Max. Negotiated Rate |
$2,018.75 |
| Rate for Payer: Aetna Commercial |
$2,018.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,827.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$2,018.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,062.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.00
|
| Rate for Payer: Health EOS Commercial |
$1,933.75
|
| Rate for Payer: HFN Commercial |
$2,018.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$440.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$440.19
|
| Rate for Payer: Multiplan Commercial |
$1,700.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,018.75
|
| Rate for Payer: Quartz Beloit One Network |
$935.00
|
| Rate for Payer: Quartz Commercial |
$1,211.25
|
| Rate for Payer: The Alliance Commercial |
$1,062.50
|
| Rate for Payer: WEA Trust Commercial |
$1,168.75
|
| Rate for Payer: WPS Commercial |
$1,573.99
|
|
|
ECHO TRANSESOPHAGEAL 9331226
|
Professional
|
Both
|
$1,458.00
|
|
|
Service Code
|
CPT 93312 26
|
| Hospital Charge Code |
3015375
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$372.45 |
| Max. Negotiated Rate |
$1,385.10 |
| Rate for Payer: Aetna Commercial |
$1,385.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.88
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cash Price |
$437.40
|
| Rate for Payer: Cigna Commercial |
$1,385.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$729.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$874.80
|
| Rate for Payer: Health EOS Commercial |
$1,326.78
|
| Rate for Payer: HFN Commercial |
$1,385.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$372.45
|
| Rate for Payer: Multiplan Commercial |
$1,166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,385.10
|
| Rate for Payer: Quartz Beloit One Network |
$641.52
|
| Rate for Payer: Quartz Commercial |
$831.06
|
| Rate for Payer: The Alliance Commercial |
$729.00
|
| Rate for Payer: WEA Trust Commercial |
$801.90
|
| Rate for Payer: WPS Commercial |
$1,079.94
|
|
|
Echo Transthoracic 9330326
|
Professional
|
Both
|
$815.00
|
|
|
Service Code
|
CPT 93303 26
|
| Hospital Charge Code |
4075841
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$214.94 |
| Max. Negotiated Rate |
$774.25 |
| Rate for Payer: Aetna Commercial |
$774.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.90
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$774.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$407.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.00
|
| Rate for Payer: Health EOS Commercial |
$741.65
|
| Rate for Payer: HFN Commercial |
$774.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$214.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$214.94
|
| Rate for Payer: Multiplan Commercial |
$652.00
|
| Rate for Payer: Preferred Network Access Commercial |
$774.25
|
| Rate for Payer: Quartz Beloit One Network |
$358.60
|
| Rate for Payer: Quartz Commercial |
$464.55
|
| Rate for Payer: The Alliance Commercial |
$407.50
|
| Rate for Payer: WEA Trust Commercial |
$448.25
|
| Rate for Payer: WPS Commercial |
$603.67
|
|
|
ECHO TRANSTHORACIC 9330826
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
CPT 93308 26
|
| Hospital Charge Code |
3015373
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.91 |
| Max. Negotiated Rate |
$362.90 |
| Rate for Payer: Aetna Commercial |
$362.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.52
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$362.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.20
|
| Rate for Payer: Health EOS Commercial |
$347.62
|
| Rate for Payer: HFN Commercial |
$362.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.91
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$362.90
|
| Rate for Payer: Quartz Beloit One Network |
$168.08
|
| Rate for Payer: Quartz Commercial |
$217.74
|
| Rate for Payer: The Alliance Commercial |
$191.00
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: WPS Commercial |
$282.95
|
|
|
ECHO TRANSTHORACIC 9335026
|
Professional
|
Both
|
$1,017.00
|
|
|
Service Code
|
CPT 93350 26
|
| Hospital Charge Code |
3015380
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.98 |
| Max. Negotiated Rate |
$966.15 |
| Rate for Payer: Aetna Commercial |
$966.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$874.62
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cash Price |
$305.10
|
| Rate for Payer: Cigna Commercial |
$966.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$508.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$610.20
|
| Rate for Payer: Health EOS Commercial |
$925.47
|
| Rate for Payer: HFN Commercial |
$966.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.98
|
| Rate for Payer: Multiplan Commercial |
$813.60
|
| Rate for Payer: Preferred Network Access Commercial |
$966.15
|
| Rate for Payer: Quartz Beloit One Network |
$447.48
|
| Rate for Payer: Quartz Commercial |
$579.69
|
| Rate for Payer: The Alliance Commercial |
$508.50
|
| Rate for Payer: WEA Trust Commercial |
$559.35
|
| Rate for Payer: WPS Commercial |
$753.29
|
|
|
ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP -93307
|
Facility
|
OP
|
$1,035.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
5927629
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$968.80 |
| Rate for Payer: Aetna Commercial |
$931.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$890.10
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$672.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$517.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$496.80
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$548.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$952.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$579.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$921.15
|
| Rate for Payer: HFN Commercial |
$952.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$952.20
|
| Rate for Payer: Quartz Beloit One Network |
$507.15
|
| Rate for Payer: Quartz Commercial |
$672.75
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$776.25
|
| Rate for Payer: WEA Trust Commercial |
$569.25
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$766.62
|
|
|
ECHO TRANSTHORAC R-T 2D W/WO M-MODE REC COMP -93307
|
Facility
|
IP
|
$1,035.00
|
|
|
Service Code
|
CPT 93307
|
| Hospital Charge Code |
5927629
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$507.15 |
| Max. Negotiated Rate |
$952.20 |
| Rate for Payer: Aetna Commercial |
$931.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$890.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$548.55
|
| Rate for Payer: Cash Price |
$310.50
|
| Rate for Payer: Cigna Commercial |
$952.20
|
| Rate for Payer: Health EOS Commercial |
$921.15
|
| Rate for Payer: HFN Commercial |
$952.20
|
| Rate for Payer: Multiplan Commercial |
$828.00
|
| Rate for Payer: NAPHCARE Commercial |
$621.00
|
| Rate for Payer: Preferred Network Access Commercial |
$952.20
|
| Rate for Payer: Quartz Beloit One Network |
$507.15
|
| Rate for Payer: Quartz Commercial |
$621.00
|
| Rate for Payer: WEA Trust Commercial |
$569.25
|
| Rate for Payer: WPS Commercial |
$766.62
|
|
|
ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$567,141.00
|
|
|
Service Code
|
MSDRG 003
|
| Min. Negotiated Rate |
$204,007.58 |
| Max. Negotiated Rate |
$567,141.00 |
| Rate for Payer: Aetna Managed Medicare |
$204,007.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$447,293.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$342,846.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$325,726.96
|
| Rate for Payer: Anthem Medicare Advantage |
$204,007.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$204,007.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$204,007.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$204,007.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361,586.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$204,007.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$415,745.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204,007.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$204,007.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$204,007.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$204,007.58
|
| Rate for Payer: NAPHCARE Commercial |
$306,011.37
|
| Rate for Payer: Quartz Medicare Advantage |
$204,007.58
|
| Rate for Payer: The Alliance Commercial |
$567,141.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$204,007.58
|
| Rate for Payer: United Healthcare PPO |
$323,663.47
|
| Rate for Payer: Wellcare Medicare |
$204,007.58
|
|
|
ECTROPION/ENTROPION REPAIR
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
ECTROPION/ENTROPION REPAIR
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960011
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
ED Abdominal paracentesis (diagn or therap), w/ imaging guidance
|
Facility
|
IP
|
$777.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
6177678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$380.73 |
| Max. Negotiated Rate |
$714.84 |
| Rate for Payer: Aetna Commercial |
$699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.81
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$714.84
|
| Rate for Payer: Health EOS Commercial |
$691.53
|
| Rate for Payer: HFN Commercial |
$714.84
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: NAPHCARE Commercial |
$466.20
|
| Rate for Payer: Preferred Network Access Commercial |
$714.84
|
| Rate for Payer: Quartz Beloit One Network |
$380.73
|
| Rate for Payer: Quartz Commercial |
$466.20
|
| Rate for Payer: WEA Trust Commercial |
$427.35
|
| Rate for Payer: WPS Commercial |
$575.52
|
|
|
ED Abdominal paracentesis (diagn or therap), w/ imaging guidance
|
Facility
|
OP
|
$777.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
6177678
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$699.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.22
|
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$505.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.96
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cash Price |
$233.10
|
| Rate for Payer: Cigna Commercial |
$714.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Health EOS Commercial |
$691.53
|
| Rate for Payer: HFN Commercial |
$714.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: Multiplan Commercial |
$621.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Preferred Network Access Commercial |
$714.84
|
| Rate for Payer: Quartz Beloit One Network |
$380.73
|
| Rate for Payer: Quartz Commercial |
$505.05
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$427.35
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
| Rate for Payer: WPS Commercial |
$575.52
|
|
|
ED Abdom paracentesis dx/ther w/o Imaging Guidance
|
Facility
|
IP
|
$568.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
6222460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$278.32 |
| Max. Negotiated Rate |
$522.56 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$340.80
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
ED Abdom paracentesis dx/ther w/o Imaging Guidance
|
Facility
|
OP
|
$568.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
6222460
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.64
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$369.20
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
ED Anorectal Manometry
|
Facility
|
OP
|
$1,638.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
6174450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,064.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$819.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$786.24
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| 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 |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$916.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| 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 |
$1,310.40
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$1,064.70
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,213.27
|
|
|
ED Anorectal Manometry
|
Facility
|
IP
|
$1,638.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
6174450
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$802.62 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: NAPHCARE Commercial |
$982.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$982.80
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.27
|
|
|
ED Anoscopy Diagnostic With Or Without Collection Of Specimen
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
6174088
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$95.52 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.52
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$129.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
