|
FIBULA BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959859
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
FIBULA, EPIPHYSIODESIS
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.80 |
| Max. Negotiated Rate |
$18,240.00 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,188.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,551.78
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,420.00
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,736.00
|
| Rate for Payer: The Alliance Commercial |
$18,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
FIBULA, EPIPHYSIODESIS
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.40 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
FIBULA OSTEOTOMY
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.40 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
FIBULA OSTEOTOMY
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.80 |
| Max. Negotiated Rate |
$18,240.00 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,188.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,551.78
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,420.00
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,736.00
|
| Rate for Payer: The Alliance Commercial |
$18,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
Fiducial Markers
|
Professional
|
Both
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5677659
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$422.23 |
| Max. Negotiated Rate |
$2,637.20 |
| Rate for Payer: Aetna Commercial |
$2,637.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.36
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,637.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$422.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,665.60
|
| Rate for Payer: Health EOS Commercial |
$2,526.16
|
| Rate for Payer: HFN Commercial |
$2,637.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$618.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$618.91
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,637.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.44
|
| Rate for Payer: Quartz Commercial |
$1,582.32
|
| Rate for Payer: The Alliance Commercial |
$1,388.00
|
| Rate for Payer: United Healthcare Medicaid |
$422.23
|
| Rate for Payer: WEA Trust Commercial |
$1,526.80
|
| Rate for Payer: WPS Commercial |
$2,056.18
|
|
|
Fiducial Markers
|
Facility
|
OP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5677659
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,360.24 |
| Max. Negotiated Rate |
$5,478.24 |
| Rate for Payer: Aetna Commercial |
$2,498.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,369.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,369.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,369.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,369.56
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,553.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,369.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,369.56
|
| Rate for Payer: Health EOS Commercial |
$2,470.64
|
| Rate for Payer: HFN Commercial |
$2,553.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,094.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,369.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,369.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,369.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,369.56
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,054.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.24
|
| Rate for Payer: Quartz Commercial |
$1,804.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,369.56
|
| Rate for Payer: The Alliance Commercial |
$5,478.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,369.56
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.80
|
| Rate for Payer: Wellcare Medicare |
$1,369.56
|
| Rate for Payer: WPS Commercial |
$2,056.18
|
|
|
Fiducial Markers
|
Facility
|
IP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5677659
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,360.24 |
| Max. Negotiated Rate |
$2,553.92 |
| Rate for Payer: Aetna Commercial |
$2,498.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.28
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,553.92
|
| Rate for Payer: Health EOS Commercial |
$2,470.64
|
| Rate for Payer: HFN Commercial |
$2,553.92
|
| Rate for Payer: Multiplan Commercial |
$2,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.24
|
| Rate for Payer: Quartz Commercial |
$1,665.60
|
| Rate for Payer: WEA Trust Commercial |
$1,526.80
|
| Rate for Payer: WPS Commercial |
$2,056.18
|
|
|
FIDUCIAL MARKER VISICOIL MRI 0.50 X 0.50CM 19G NEEDLE PLATINUM MR-050-005-1920
|
Facility
|
OP
|
$1,834.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
6178760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$513.52 |
| Max. Negotiated Rate |
$7,336.00 |
| Rate for Payer: Aetna Commercial |
$1,650.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,577.24
|
| Rate for Payer: Aetna Managed Medicare |
$513.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,192.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$917.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$880.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$972.02
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$1,687.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.31
|
| Rate for Payer: Health EOS Commercial |
$1,632.26
|
| Rate for Payer: HFN Commercial |
$1,687.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.50
|
| Rate for Payer: Multiplan Commercial |
$1,467.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,687.28
|
| Rate for Payer: Quartz Beloit One Network |
$898.66
|
| Rate for Payer: Quartz Commercial |
$1,192.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.40
|
| Rate for Payer: The Alliance Commercial |
$7,336.00
|
| Rate for Payer: WEA Trust Commercial |
$1,008.70
|
| Rate for Payer: WPS Commercial |
$1,358.44
|
|
|
FIDUCIAL MARKER VISICOIL MRI 0.50 X 0.50CM 19G NEEDLE PLATINUM MR-050-005-1920
|
Facility
|
IP
|
$1,834.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
6178760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$898.66 |
| Max. Negotiated Rate |
$1,687.28 |
| Rate for Payer: Aetna Commercial |
$1,650.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,577.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$972.02
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$1,687.28
|
| Rate for Payer: Health EOS Commercial |
$1,632.26
|
| Rate for Payer: HFN Commercial |
$1,687.28
|
| Rate for Payer: Multiplan Commercial |
$1,467.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,687.28
|
| Rate for Payer: Quartz Beloit One Network |
$898.66
|
| Rate for Payer: Quartz Commercial |
$1,100.40
|
| Rate for Payer: WEA Trust Commercial |
$1,008.70
|
| Rate for Payer: WPS Commercial |
$1,358.44
|
|
|
Filamentous Hemagglutinin IgA
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.16 |
| 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 |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| 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
|
|
|
Filamentous Hemagglutinin IgA
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| 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 |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| 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 |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| 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 |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Filamentous Hemagglutinin IgA
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Filamentous Hemagglutinin IgG
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| 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 |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| 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 |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| 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 |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Filamentous Hemagglutinin IgG
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.16 |
| 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 |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| 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
|
|
|
Filamentous Hemagglutinin IgG
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Filgrastim 300 mcg/0.5 ml Syr (Zarxio) Q5101
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
Filgrastim 300 mcg/0.5 ml Syr (Zarxio) Q5101
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.42
|
| Rate for Payer: Anthem Medicare Advantage |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.32
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$0.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$0.32
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$0.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$0.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$0.32
|
| Rate for Payer: The Alliance Commercial |
$1.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.32
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: Wellcare Medicare |
$0.32
|
| Rate for Payer: WPS Commercial |
$1.06
|
|
|
Filgrastim 300 mcg/0.5 ml Syr (Zarxio) Q5101
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.42
|
| Rate for Payer: Health EOS Commercial |
$1.82
|
| Rate for Payer: HFN Commercial |
$1.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1.90
|
| Rate for Payer: Quartz Beloit One Network |
$0.88
|
| Rate for Payer: Quartz Commercial |
$1.14
|
| Rate for Payer: The Alliance Commercial |
$1.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.06
|
|
|
Filgrastim 480 mcg/0.8 ml Syr (Zarxio) Q5101
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.90 |
| Rate for Payer: Aetna Commercial |
$1.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.42
|
| Rate for Payer: Health EOS Commercial |
$1.82
|
| Rate for Payer: HFN Commercial |
$1.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.55
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1.90
|
| Rate for Payer: Quartz Beloit One Network |
$0.88
|
| Rate for Payer: Quartz Commercial |
$1.14
|
| Rate for Payer: The Alliance Commercial |
$1.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.32
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.06
|
|
|
Filgrastim 480 mcg/0.8 ml Syr (Zarxio) Q5101
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.32 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.42
|
| Rate for Payer: Anthem Medicare Advantage |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.32
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$0.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$0.32
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$0.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$0.32
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$0.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$0.32
|
| Rate for Payer: The Alliance Commercial |
$1.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.32
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: Wellcare Medicare |
$0.32
|
| Rate for Payer: WPS Commercial |
$1.06
|
|
|
Filgrastim 480 mcg/0.8 ml Syr (Zarxio) Q5101
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
filgrastim 480 mcg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
2958912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
filgrastim 480 mcg Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
2958912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$0.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.99
|
| Rate for Payer: Anthem Medicare Advantage |
$0.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.99
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$0.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$0.99
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$0.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$0.99
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.48
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$0.99
|
| Rate for Payer: The Alliance Commercial |
$3.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.99
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: Wellcare Medicare |
$0.99
|
| Rate for Payer: WPS Commercial |
$2.48
|
|
|
filgrastim 480 mcg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
2958912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.99 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.99
|
| Rate for Payer: Health EOS Commercial |
$6.37
|
| Rate for Payer: HFN Commercial |
$6.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.39
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6.65
|
| Rate for Payer: Quartz Beloit One Network |
$3.08
|
| Rate for Payer: Quartz Commercial |
$3.99
|
| Rate for Payer: The Alliance Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicaid |
$0.99
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$2.48
|
|
