|
Electrolytes Fecal
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
977933
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.86 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$4.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.07
|
| Rate for Payer: Anthem Medicaid |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.86
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Dean Health Medicaid |
$5.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.86
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.86
|
| Rate for Payer: Managed Health Services Medicaid |
$5.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.86
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.29
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.02
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4.86
|
| Rate for Payer: The Alliance Commercial |
$19.44
|
| Rate for Payer: United Healthcare Medicaid |
$5.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.86
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$4.86
|
| Rate for Payer: WMAP Medicaid |
$5.02
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Electrolytes Fecal
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 84302
|
| Hospital Charge Code |
977933
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.40
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: HFN Commercial |
$84.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: The Alliance Commercial |
$44.50
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Electromylography
|
Facility
|
OP
|
$809.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
3005554
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$728.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.74
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$388.32
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$744.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$720.01
|
| Rate for Payer: HFN Commercial |
$744.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$744.28
|
| Rate for Payer: Quartz Beloit One Network |
$396.41
|
| Rate for Payer: Quartz Commercial |
$525.85
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$606.75
|
| Rate for Payer: WEA Trust Commercial |
$444.95
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$599.23
|
|
|
Electromylography
|
Facility
|
IP
|
$809.00
|
|
|
Service Code
|
CPT 51784
|
| Hospital Charge Code |
3005554
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$396.41 |
| Max. Negotiated Rate |
$744.28 |
| Rate for Payer: Aetna Commercial |
$728.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.77
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$744.28
|
| Rate for Payer: Health EOS Commercial |
$720.01
|
| Rate for Payer: HFN Commercial |
$744.28
|
| Rate for Payer: Multiplan Commercial |
$647.20
|
| Rate for Payer: NAPHCARE Commercial |
$485.40
|
| Rate for Payer: Preferred Network Access Commercial |
$744.28
|
| Rate for Payer: Quartz Beloit One Network |
$396.41
|
| Rate for Payer: Quartz Commercial |
$485.40
|
| Rate for Payer: WEA Trust Commercial |
$444.95
|
| Rate for Payer: WPS Commercial |
$599.23
|
|
|
Electronic Analysis of Implant 93285
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
4163353
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.35 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$202.06
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: United Healthcare Medicaid |
$34.35
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Electronic Analysis of Implant 9328526
|
Professional
|
Both
|
$448.00
|
|
|
Service Code
|
CPT 93285 26
|
| Hospital Charge Code |
3219473
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.13 |
| Max. Negotiated Rate |
$425.60 |
| Rate for Payer: Aetna Commercial |
$425.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.28
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$425.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$224.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.80
|
| Rate for Payer: Health EOS Commercial |
$407.68
|
| Rate for Payer: HFN Commercial |
$425.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.13
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: Preferred Network Access Commercial |
$425.60
|
| Rate for Payer: Quartz Beloit One Network |
$197.12
|
| Rate for Payer: Quartz Commercial |
$255.36
|
| Rate for Payer: The Alliance Commercial |
$224.00
|
| Rate for Payer: WEA Trust Commercial |
$246.40
|
| Rate for Payer: WPS Commercial |
$331.83
|
|
|
ELEVIEW SUBMUCOSAL INJECTABLE 9000020
|
Facility
|
OP
|
$1,398.00
|
|
| Hospital Charge Code |
5415878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.44 |
| Max. Negotiated Rate |
$5,592.00 |
| Rate for Payer: Aetna Commercial |
$1,258.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,202.28
|
| Rate for Payer: Aetna Managed Medicare |
$391.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$908.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.94
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,286.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$782.32
|
| Rate for Payer: Health EOS Commercial |
$1,244.22
|
| Rate for Payer: HFN Commercial |
$1,286.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,048.50
|
| Rate for Payer: Multiplan Commercial |
$1,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$838.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,286.16
|
| Rate for Payer: Quartz Beloit One Network |
$685.02
|
| Rate for Payer: Quartz Commercial |
$908.70
|
| Rate for Payer: Quartz Medicare Advantage |
$838.80
|
| Rate for Payer: The Alliance Commercial |
$5,592.00
|
| Rate for Payer: WEA Trust Commercial |
$768.90
|
| Rate for Payer: WPS Commercial |
$1,035.50
|
|
|
ELEVIEW SUBMUCOSAL INJECTABLE 9000020
|
Facility
|
IP
|
$1,398.00
|
|
| Hospital Charge Code |
5415878
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$685.02 |
| Max. Negotiated Rate |
$1,286.16 |
| Rate for Payer: Aetna Commercial |
$1,258.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,202.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.94
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,286.16
|
| Rate for Payer: Health EOS Commercial |
$1,244.22
|
| Rate for Payer: HFN Commercial |
$1,286.16
|
| Rate for Payer: Multiplan Commercial |
$1,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$838.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,286.16
|
| Rate for Payer: Quartz Beloit One Network |
$685.02
|
| Rate for Payer: Quartz Commercial |
$838.80
|
| Rate for Payer: WEA Trust Commercial |
$768.90
|
| Rate for Payer: WPS Commercial |
$1,035.50
|
|
|
Eligard 22.5 mg/3 months Charge
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$824.60 |
| Rate for Payer: Aetna Commercial |
$824.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$746.48
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$824.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.66
|
| Rate for Payer: Health EOS Commercial |
$789.88
|
| Rate for Payer: HFN Commercial |
$824.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.94
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Preferred Network Access Commercial |
$824.60
|
| Rate for Payer: Quartz Beloit One Network |
$381.92
|
| Rate for Payer: Quartz Commercial |
$494.76
|
| Rate for Payer: The Alliance Commercial |
$434.00
|
| Rate for Payer: United Healthcare Medicaid |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$477.40
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Eligard 22.5 mg/3 months Charge
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$425.32 |
| Max. Negotiated Rate |
$798.56 |
| Rate for Payer: Aetna Commercial |
$781.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$746.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.04
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$798.56
|
| Rate for Payer: Health EOS Commercial |
$772.52
|
| Rate for Payer: HFN Commercial |
$798.56
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: NAPHCARE Commercial |
$520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$798.56
|
| Rate for Payer: Quartz Beloit One Network |
$425.32
|
| Rate for Payer: Quartz Commercial |
$520.80
|
| Rate for Payer: WEA Trust Commercial |
$477.40
|
| Rate for Payer: WPS Commercial |
$642.93
|
|
|
Eligard 22.5 mg/3 months Charge
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551742
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$798.56 |
| Rate for Payer: Aetna Commercial |
$781.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$746.48
|
| Rate for Payer: Aetna Managed Medicare |
$181.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$564.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$434.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$416.64
|
| Rate for Payer: Anthem Medicare Advantage |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.30
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$798.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.30
|
| Rate for Payer: Health EOS Commercial |
$772.52
|
| Rate for Payer: HFN Commercial |
$798.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$674.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.95
|
| Rate for Payer: Preferred Network Access Commercial |
$798.56
|
| Rate for Payer: Quartz Beloit One Network |
$425.32
|
| Rate for Payer: Quartz Commercial |
$564.20
|
| Rate for Payer: Quartz Medicare Advantage |
$181.30
|
| Rate for Payer: The Alliance Commercial |
$725.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$477.40
|
| Rate for Payer: Wellcare Medicare |
$181.30
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Eligard 30 mg/4 months Charge
|
Facility
|
IP
|
$1,158.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$567.42 |
| Max. Negotiated Rate |
$1,065.36 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$694.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$694.80
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$857.73
|
|
|
Eligard 30 mg/4 months Charge
|
Professional
|
Both
|
$1,158.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$1,100.10 |
| Rate for Payer: Aetna Commercial |
$1,100.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,100.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.66
|
| Rate for Payer: Health EOS Commercial |
$1,053.78
|
| Rate for Payer: HFN Commercial |
$1,100.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.94
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,100.10
|
| Rate for Payer: Quartz Beloit One Network |
$509.52
|
| Rate for Payer: Quartz Commercial |
$660.06
|
| Rate for Payer: The Alliance Commercial |
$579.00
|
| Rate for Payer: United Healthcare Medicaid |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Eligard 30 mg/4 months Charge
|
Facility
|
OP
|
$1,158.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551744
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$1,065.36 |
| Rate for Payer: Aetna Commercial |
$1,042.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$995.88
|
| Rate for Payer: Aetna Managed Medicare |
$181.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$752.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$579.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$555.84
|
| Rate for Payer: Anthem Medicare Advantage |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$613.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.30
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cash Price |
$347.40
|
| Rate for Payer: Cigna Commercial |
$1,065.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.30
|
| Rate for Payer: Health EOS Commercial |
$1,030.62
|
| Rate for Payer: HFN Commercial |
$1,065.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$674.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$926.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.36
|
| Rate for Payer: Quartz Beloit One Network |
$567.42
|
| Rate for Payer: Quartz Commercial |
$752.70
|
| Rate for Payer: Quartz Medicare Advantage |
$181.30
|
| Rate for Payer: The Alliance Commercial |
$725.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$636.90
|
| Rate for Payer: Wellcare Medicare |
$181.30
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Eligard 45 mg/6 months Charge
|
Professional
|
Both
|
$1,736.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$1,649.20 |
| Rate for Payer: Aetna Commercial |
$1,649.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,492.96
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,649.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.66
|
| Rate for Payer: Health EOS Commercial |
$1,579.76
|
| Rate for Payer: HFN Commercial |
$1,649.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.94
|
| Rate for Payer: Multiplan Commercial |
$1,388.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,649.20
|
| Rate for Payer: Quartz Beloit One Network |
$763.84
|
| Rate for Payer: Quartz Commercial |
$989.52
|
| Rate for Payer: The Alliance Commercial |
$868.00
|
| Rate for Payer: United Healthcare Medicaid |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$954.80
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Eligard 45 mg/6 months Charge
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$850.64 |
| Max. Negotiated Rate |
$1,597.12 |
| Rate for Payer: Aetna Commercial |
$1,562.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,492.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$920.08
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,597.12
|
| Rate for Payer: Health EOS Commercial |
$1,545.04
|
| Rate for Payer: HFN Commercial |
$1,597.12
|
| Rate for Payer: Multiplan Commercial |
$1,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,041.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,597.12
|
| Rate for Payer: Quartz Beloit One Network |
$850.64
|
| Rate for Payer: Quartz Commercial |
$1,041.60
|
| Rate for Payer: WEA Trust Commercial |
$954.80
|
| Rate for Payer: WPS Commercial |
$1,285.86
|
|
|
Eligard 45 mg/6 months Charge
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551746
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$1,597.12 |
| Rate for Payer: Aetna Commercial |
$1,562.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,492.96
|
| Rate for Payer: Aetna Managed Medicare |
$181.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,128.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$868.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$833.28
|
| Rate for Payer: Anthem Medicare Advantage |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$920.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.30
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,597.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.30
|
| Rate for Payer: Health EOS Commercial |
$1,545.04
|
| Rate for Payer: HFN Commercial |
$1,597.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$674.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$1,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$271.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,597.12
|
| Rate for Payer: Quartz Beloit One Network |
$850.64
|
| Rate for Payer: Quartz Commercial |
$1,128.40
|
| Rate for Payer: Quartz Medicare Advantage |
$181.30
|
| Rate for Payer: The Alliance Commercial |
$725.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$954.80
|
| Rate for Payer: Wellcare Medicare |
$181.30
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Eligard 7.5 mg/month Charge
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$265.88 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.17
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$265.88
|
| Rate for Payer: Health EOS Commercial |
$257.21
|
| Rate for Payer: HFN Commercial |
$265.88
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: NAPHCARE Commercial |
$173.40
|
| Rate for Payer: Preferred Network Access Commercial |
$265.88
|
| Rate for Payer: Quartz Beloit One Network |
$141.61
|
| Rate for Payer: Quartz Commercial |
$173.40
|
| Rate for Payer: WEA Trust Commercial |
$158.95
|
| Rate for Payer: WPS Commercial |
$214.06
|
|
|
Eligard 7.5 mg/month Charge
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$138.72 |
| Max. Negotiated Rate |
$725.21 |
| Rate for Payer: Aetna Commercial |
$260.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.54
|
| Rate for Payer: Aetna Managed Medicare |
$181.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.72
|
| Rate for Payer: Anthem Medicare Advantage |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.30
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$265.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.30
|
| Rate for Payer: Health EOS Commercial |
$257.21
|
| Rate for Payer: HFN Commercial |
$265.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$674.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: NAPHCARE Commercial |
$271.95
|
| Rate for Payer: Preferred Network Access Commercial |
$265.88
|
| Rate for Payer: Quartz Beloit One Network |
$141.61
|
| Rate for Payer: Quartz Commercial |
$187.85
|
| Rate for Payer: Quartz Medicare Advantage |
$181.30
|
| Rate for Payer: The Alliance Commercial |
$725.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$158.95
|
| Rate for Payer: Wellcare Medicare |
$181.30
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Eligard 7.5 mg/month Charge
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
5551748
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.16 |
| Max. Negotiated Rate |
$464.16 |
| Rate for Payer: Aetna Commercial |
$274.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$248.54
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$274.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.66
|
| Rate for Payer: Health EOS Commercial |
$262.99
|
| Rate for Payer: HFN Commercial |
$274.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.94
|
| Rate for Payer: Multiplan Commercial |
$231.20
|
| Rate for Payer: Preferred Network Access Commercial |
$274.55
|
| Rate for Payer: Quartz Beloit One Network |
$127.16
|
| Rate for Payer: Quartz Commercial |
$164.73
|
| Rate for Payer: The Alliance Commercial |
$144.50
|
| Rate for Payer: United Healthcare Medicaid |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$158.95
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Eloxatin 0.005 mg Charge
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
2958925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.07 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.07
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: HFN Commercial |
$45.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.18
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.07
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$0.18
|
|
|
Eloxatin 0.005 mg Charge
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
2958925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Eloxatin 0.005 mg Charge
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
HCPCS J9263
|
| Hospital Charge Code |
2958925
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.10
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$0.18
|
|
|
Elution
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
973770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$140.25
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Elution
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 86860
|
| Hospital Charge Code |
973770
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
