|
Estradiol valerate 10 mg inj J1380
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
3382888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$41.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.66
|
| Rate for Payer: Health EOS Commercial |
$40.04
|
| Rate for Payer: HFN Commercial |
$41.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.91
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Preferred Network Access Commercial |
$41.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.08
|
| Rate for Payer: The Alliance Commercial |
$22.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.66
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$21.64
|
|
|
Estradiol valerate 10 mg inj J1380
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
3382888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.45 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.45
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$21.64
|
|
|
Estradiol valerate 10 mg inj J1380
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
3382888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
Estriol Free
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
2942983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Aetna Managed Medicare |
$24.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.14
|
| Rate for Payer: Anthem Medicaid |
$24.99
|
| Rate for Payer: Anthem Medicare Advantage |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.18
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.39
|
| Rate for Payer: Dean Health Medicaid |
$24.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.18
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.18
|
| Rate for Payer: Managed Health Services Medicaid |
$25.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.18
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$36.27
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.99
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$206.05
|
| Rate for Payer: Quartz Medicare Advantage |
$24.18
|
| Rate for Payer: The Alliance Commercial |
$96.72
|
| Rate for Payer: United Healthcare Medicaid |
$24.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.18
|
| Rate for Payer: United Healthcare PPO |
$237.75
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: Wellcare Medicare |
$24.18
|
| Rate for Payer: WMAP Medicaid |
$24.99
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
Estriol Free
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
2942983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Aetna Commercial |
$301.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$301.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.20
|
| Rate for Payer: Health EOS Commercial |
$288.47
|
| Rate for Payer: HFN Commercial |
$301.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.36
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Preferred Network Access Commercial |
$301.15
|
| Rate for Payer: Quartz Beloit One Network |
$139.48
|
| Rate for Payer: Quartz Commercial |
$180.69
|
| Rate for Payer: The Alliance Commercial |
$158.50
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
Estriol Free
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
2942983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$190.20
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
Estriol Level
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
633724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Aetna Managed Medicare |
$24.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.14
|
| Rate for Payer: Anthem Medicaid |
$24.99
|
| Rate for Payer: Anthem Medicare Advantage |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.18
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.88
|
| Rate for Payer: Dean Health Medicaid |
$24.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.18
|
| Rate for Payer: Health EOS Commercial |
$267.00
|
| Rate for Payer: HFN Commercial |
$276.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.18
|
| Rate for Payer: Managed Health Services Medicaid |
$25.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.18
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.27
|
| Rate for Payer: Preferred Network Access Commercial |
$276.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.99
|
| Rate for Payer: Quartz Beloit One Network |
$147.00
|
| Rate for Payer: Quartz Commercial |
$195.00
|
| Rate for Payer: Quartz Medicare Advantage |
$24.18
|
| Rate for Payer: The Alliance Commercial |
$96.72
|
| Rate for Payer: United Healthcare Medicaid |
$24.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.18
|
| Rate for Payer: United Healthcare PPO |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: Wellcare Medicare |
$24.18
|
| Rate for Payer: WMAP Medicaid |
$24.99
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
Estriol Level
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
633724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.00 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Health EOS Commercial |
$267.00
|
| Rate for Payer: HFN Commercial |
$276.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: NAPHCARE Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$276.00
|
| Rate for Payer: Quartz Beloit One Network |
$147.00
|
| Rate for Payer: Quartz Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
Estriol Level
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
CPT 82677
|
| Hospital Charge Code |
633724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$285.00 |
| Rate for Payer: Aetna Commercial |
$285.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$285.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.00
|
| Rate for Payer: Health EOS Commercial |
$273.00
|
| Rate for Payer: HFN Commercial |
$285.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.36
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: Preferred Network Access Commercial |
$285.00
|
| Rate for Payer: Quartz Beloit One Network |
$132.00
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
|
Estrogens, Fractionated
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
3665492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Estrogens, Fractionated
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
3665492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.02 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna Commercial |
$468.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$468.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$246.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$295.80
|
| Rate for Payer: Health EOS Commercial |
$448.63
|
| Rate for Payer: HFN Commercial |
$468.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.02
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.35
|
| Rate for Payer: Quartz Beloit One Network |
$216.92
|
| Rate for Payer: Quartz Commercial |
$281.01
|
| Rate for Payer: The Alliance Commercial |
$246.50
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Estrogens, Fractionated
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 82671
|
| Hospital Charge Code |
3665492
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.30 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$32.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.62
|
| Rate for Payer: Anthem Medicaid |
$33.38
|
| Rate for Payer: Anthem Medicare Advantage |
$32.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.30
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Dean Health Medicaid |
$33.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32.30
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$33.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.30
|
| Rate for Payer: Managed Health Services Medicaid |
$34.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32.30
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$48.45
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33.38
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$32.30
|
| Rate for Payer: The Alliance Commercial |
$129.20
|
| Rate for Payer: United Healthcare Medicaid |
$33.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.30
|
| Rate for Payer: United Healthcare PPO |
$369.75
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: Wellcare Medicare |
$32.30
|
| Rate for Payer: WMAP Medicaid |
$33.38
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Estrogens Total
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
977937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Estrogens Total
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
977937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$21.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.02
|
| Rate for Payer: Anthem Medicaid |
$22.42
|
| Rate for Payer: Anthem Medicare Advantage |
$21.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.70
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.87
|
| Rate for Payer: Dean Health Medicaid |
$22.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.70
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.70
|
| Rate for Payer: Managed Health Services Medicaid |
$23.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.70
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.55
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.42
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$282.10
|
| Rate for Payer: Quartz Medicare Advantage |
$21.70
|
| Rate for Payer: The Alliance Commercial |
$86.80
|
| Rate for Payer: United Healthcare Medicaid |
$22.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.70
|
| Rate for Payer: United Healthcare PPO |
$325.50
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: Wellcare Medicare |
$21.70
|
| Rate for Payer: WMAP Medicaid |
$22.42
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Estrogens Total
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 82672
|
| Hospital Charge Code |
977937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.60 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$412.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.40
|
| Rate for Payer: Health EOS Commercial |
$394.94
|
| Rate for Payer: HFN Commercial |
$412.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.60
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$412.30
|
| Rate for Payer: Quartz Beloit One Network |
$190.96
|
| Rate for Payer: Quartz Commercial |
$247.38
|
| Rate for Payer: The Alliance Commercial |
$217.00
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Estrone Level
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
977938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Estrone Level
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
977938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.07 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$412.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.40
|
| Rate for Payer: Health EOS Commercial |
$394.94
|
| Rate for Payer: HFN Commercial |
$412.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.07
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$412.30
|
| Rate for Payer: Quartz Beloit One Network |
$190.96
|
| Rate for Payer: Quartz Commercial |
$247.38
|
| Rate for Payer: The Alliance Commercial |
$217.00
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Estrone Level
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 82679
|
| Hospital Charge Code |
977938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.95 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$24.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.42
|
| Rate for Payer: Anthem Medicaid |
$25.78
|
| Rate for Payer: Anthem Medicare Advantage |
$24.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.95
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.87
|
| Rate for Payer: Dean Health Medicaid |
$25.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.95
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.95
|
| Rate for Payer: Managed Health Services Medicaid |
$26.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.95
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$37.42
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$25.78
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$282.10
|
| Rate for Payer: Quartz Medicare Advantage |
$24.95
|
| Rate for Payer: The Alliance Commercial |
$99.80
|
| Rate for Payer: United Healthcare Medicaid |
$25.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.95
|
| Rate for Payer: United Healthcare PPO |
$325.50
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: Wellcare Medicare |
$24.95
|
| Rate for Payer: WMAP Medicaid |
$25.78
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Ethanol Level
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
1037117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna Commercial |
$320.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$320.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.20
|
| Rate for Payer: Health EOS Commercial |
$306.67
|
| Rate for Payer: HFN Commercial |
$320.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$320.15
|
| Rate for Payer: Quartz Beloit One Network |
$148.28
|
| Rate for Payer: Quartz Commercial |
$192.09
|
| Rate for Payer: The Alliance Commercial |
$168.50
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
Ethanol Level
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
633725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.72 |
| Max. Negotiated Rate |
$1,396.00 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Aetna Managed Medicare |
$97.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.30
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.75
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$226.85
|
| Rate for Payer: Quartz Medicare Advantage |
$209.40
|
| Rate for Payer: The Alliance Commercial |
$1,396.00
|
| Rate for Payer: United Healthcare PPO |
$261.75
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Ethanol Level
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
1037117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$310.04 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$202.20
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
Ethanol Level
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
1037117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.36 |
| Max. Negotiated Rate |
$1,348.00 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Aetna Managed Medicare |
$94.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$219.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$168.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$161.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.59
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.75
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$219.05
|
| Rate for Payer: Quartz Medicare Advantage |
$202.20
|
| Rate for Payer: The Alliance Commercial |
$1,348.00
|
| Rate for Payer: United Healthcare PPO |
$252.75
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
Ethanol Level
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
633725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Aetna Commercial |
$331.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$331.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.40
|
| Rate for Payer: Health EOS Commercial |
$317.59
|
| Rate for Payer: HFN Commercial |
$331.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Preferred Network Access Commercial |
$331.55
|
| Rate for Payer: Quartz Beloit One Network |
$153.56
|
| Rate for Payer: Quartz Commercial |
$198.93
|
| Rate for Payer: The Alliance Commercial |
$174.50
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Ethanol Level
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
633725
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.01 |
| Max. Negotiated Rate |
$321.08 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$209.40
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Ethanol Level (Tox Scr)
|
Facility
|
OP
|
$358.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
4494624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.24 |
| Max. Negotiated Rate |
$1,432.00 |
| Rate for Payer: Aetna Commercial |
$322.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.88
|
| Rate for Payer: Aetna Managed Medicare |
$100.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$232.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$179.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.74
|
| Rate for Payer: Cash Price |
$107.40
|
| Rate for Payer: Cigna Commercial |
$329.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.34
|
| Rate for Payer: Health EOS Commercial |
$318.62
|
| Rate for Payer: HFN Commercial |
$329.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.50
|
| Rate for Payer: Multiplan Commercial |
$286.40
|
| Rate for Payer: NAPHCARE Commercial |
$214.80
|
| Rate for Payer: Preferred Network Access Commercial |
$329.36
|
| Rate for Payer: Quartz Beloit One Network |
$175.42
|
| Rate for Payer: Quartz Commercial |
$232.70
|
| Rate for Payer: Quartz Medicare Advantage |
$214.80
|
| Rate for Payer: The Alliance Commercial |
$1,432.00
|
| Rate for Payer: United Healthcare PPO |
$268.50
|
| Rate for Payer: WEA Trust Commercial |
$196.90
|
| Rate for Payer: WPS Commercial |
$265.17
|
|
