|
Fructose, Semen
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
5528670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.19 |
| Max. Negotiated Rate |
$218.15 |
| Rate for Payer: Aetna Commercial |
$213.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.67
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$218.15
|
| Rate for Payer: Health EOS Commercial |
$211.04
|
| Rate for Payer: HFN Commercial |
$218.15
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: Preferred Network Access Commercial |
$218.15
|
| Rate for Payer: Quartz Beloit One Network |
$116.19
|
| Rate for Payer: Quartz Commercial |
$142.27
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: WPS Commercial |
$175.63
|
|
|
Fructose, Semen
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
5528670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$225.26 |
| Rate for Payer: Aetna Commercial |
$225.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.92
|
| Rate for Payer: Aetna Managed Medicare |
$18.03
|
| Rate for Payer: Anthem Medicare Advantage |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.03
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$225.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.03
|
| Rate for Payer: Health EOS Commercial |
$215.78
|
| Rate for Payer: HFN Commercial |
$225.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.03
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: NAPHCARE Commercial |
$27.05
|
| Rate for Payer: Preferred Network Access Commercial |
$225.26
|
| Rate for Payer: Quartz Beloit One Network |
$104.33
|
| Rate for Payer: Quartz Commercial |
$135.16
|
| Rate for Payer: Quartz Medicare Advantage |
$18.03
|
| Rate for Payer: The Alliance Commercial |
$71.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.03
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: WPS Commercial |
$79.35
|
|
|
Fructose, Semen
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 82757
|
| Hospital Charge Code |
5528670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.03 |
| Max. Negotiated Rate |
$218.15 |
| Rate for Payer: Aetna Commercial |
$213.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.92
|
| Rate for Payer: Aetna Managed Medicare |
$18.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.94
|
| Rate for Payer: Anthem Medicare Advantage |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.03
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$218.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.03
|
| Rate for Payer: Health EOS Commercial |
$211.04
|
| Rate for Payer: HFN Commercial |
$218.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.03
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: NAPHCARE Commercial |
$27.05
|
| Rate for Payer: Preferred Network Access Commercial |
$218.15
|
| Rate for Payer: Quartz Beloit One Network |
$116.19
|
| Rate for Payer: Quartz Commercial |
$154.13
|
| Rate for Payer: Quartz Medicare Advantage |
$18.03
|
| Rate for Payer: The Alliance Commercial |
$72.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.03
|
| Rate for Payer: United Healthcare PPO |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: Wellcare Medicare |
$18.03
|
| Rate for Payer: WPS Commercial |
$175.63
|
|
|
Frz Plasma CPD
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052865
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.57 |
| Max. Negotiated Rate |
$354.27 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$88.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.72
|
| Rate for Payer: Anthem Medicare Advantage |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.57
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$88.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$88.57
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$88.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$132.85
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$88.57
|
| Rate for Payer: The Alliance Commercial |
$354.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.57
|
| Rate for Payer: United Healthcare PPO |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: Wellcare Medicare |
$88.57
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Frz Plasma CPD
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052865
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$222.14
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
FSH and LH, Pediatrics
|
Professional
|
Both
|
$106.69
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
4253737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$105.41 |
| Rate for Payer: Aetna Commercial |
$105.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.42
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Medicare Advantage |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.32
|
| Rate for Payer: Cash Price |
$32.01
|
| Rate for Payer: Cash Price |
$32.01
|
| Rate for Payer: Cigna Commercial |
$105.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$100.97
|
| Rate for Payer: HFN Commercial |
$105.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$88.77
|
| Rate for Payer: NAPHCARE Commercial |
$28.98
|
| Rate for Payer: Preferred Network Access Commercial |
$105.41
|
| Rate for Payer: Quartz Beloit One Network |
$48.82
|
| Rate for Payer: Quartz Commercial |
$63.25
|
| Rate for Payer: Quartz Medicare Advantage |
$19.32
|
| Rate for Payer: The Alliance Commercial |
$76.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.32
|
| Rate for Payer: WEA Trust Commercial |
$61.03
|
| Rate for Payer: WPS Commercial |
$85.02
|
|
|
FSH and LH, Pediatrics
|
Facility
|
OP
|
$106.69
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
4253737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$102.08 |
| Rate for Payer: Aetna Commercial |
$99.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.42
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.08
|
| Rate for Payer: Anthem Medicare Advantage |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.32
|
| Rate for Payer: Cash Price |
$32.01
|
| Rate for Payer: Cash Price |
$32.01
|
| Rate for Payer: Cigna Commercial |
$102.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$98.75
|
| Rate for Payer: HFN Commercial |
$102.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$88.77
|
| Rate for Payer: NAPHCARE Commercial |
$28.98
|
| Rate for Payer: Preferred Network Access Commercial |
$102.08
|
| Rate for Payer: Quartz Beloit One Network |
$54.37
|
| Rate for Payer: Quartz Commercial |
$72.12
|
| Rate for Payer: Quartz Medicare Advantage |
$19.32
|
| Rate for Payer: The Alliance Commercial |
$77.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.32
|
| Rate for Payer: United Healthcare PPO |
$83.22
|
| Rate for Payer: WEA Trust Commercial |
$61.03
|
| Rate for Payer: Wellcare Medicare |
$19.32
|
| Rate for Payer: WPS Commercial |
$82.18
|
|
|
FSH and LH, Pediatrics
|
Facility
|
IP
|
$106.69
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
4253737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.37 |
| Max. Negotiated Rate |
$102.08 |
| Rate for Payer: Aetna Commercial |
$99.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.81
|
| Rate for Payer: Cash Price |
$32.01
|
| Rate for Payer: Cigna Commercial |
$102.08
|
| Rate for Payer: Health EOS Commercial |
$98.75
|
| Rate for Payer: HFN Commercial |
$102.08
|
| Rate for Payer: Multiplan Commercial |
$88.77
|
| Rate for Payer: Preferred Network Access Commercial |
$102.08
|
| Rate for Payer: Quartz Beloit One Network |
$54.37
|
| Rate for Payer: Quartz Commercial |
$66.57
|
| Rate for Payer: WEA Trust Commercial |
$61.03
|
| Rate for Payer: WPS Commercial |
$82.18
|
|
|
FSH Pediatrics
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
4253746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Aetna Commercial |
$88.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Medicare Advantage |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.32
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$88.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$85.18
|
| Rate for Payer: HFN Commercial |
$88.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$28.98
|
| Rate for Payer: Preferred Network Access Commercial |
$88.92
|
| Rate for Payer: Quartz Beloit One Network |
$41.18
|
| Rate for Payer: Quartz Commercial |
$53.35
|
| Rate for Payer: Quartz Medicare Advantage |
$19.32
|
| Rate for Payer: The Alliance Commercial |
$76.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.32
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$85.02
|
|
|
FSH Pediatrics
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
4253746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
FSH Pediatrics
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 83001
|
| Hospital Charge Code |
4253746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.08
|
| Rate for Payer: Anthem Medicare Advantage |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.32
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$28.98
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$60.84
|
| Rate for Payer: Quartz Medicare Advantage |
$19.32
|
| Rate for Payer: The Alliance Commercial |
$77.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.32
|
| Rate for Payer: United Healthcare PPO |
$70.20
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: Wellcare Medicare |
$19.32
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
Ft arch suprt premold longit L3040
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
3133557
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$13.73
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
Ft arch suprt premold longit L3040
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
3133557
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.80
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: NAPHCARE Commercial |
$13.73
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$14.87
|
| Rate for Payer: Quartz Medicare Advantage |
$13.73
|
| Rate for Payer: The Alliance Commercial |
$240.61
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
Ft arch suprt premold longit L3040
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
3133557
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$173.46 |
| Rate for Payer: Aetna Commercial |
$21.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Aetna Managed Medicare |
$60.15
|
| Rate for Payer: Anthem Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.15
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.15
|
| Rate for Payer: Health EOS Commercial |
$20.82
|
| Rate for Payer: HFN Commercial |
$21.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: NAPHCARE Commercial |
$90.23
|
| Rate for Payer: Preferred Network Access Commercial |
$21.74
|
| Rate for Payer: Quartz Beloit One Network |
$10.07
|
| Rate for Payer: Quartz Commercial |
$13.04
|
| Rate for Payer: Quartz Medicare Advantage |
$60.15
|
| Rate for Payer: The Alliance Commercial |
$165.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.15
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$105.27
|
|
|
Ft insert ucb berkeley shell L3000
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
HCPCS L3000
|
| Hospital Charge Code |
3133692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.20 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Aetna Commercial |
$263.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.89
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$268.86
|
| Rate for Payer: Health EOS Commercial |
$260.09
|
| Rate for Payer: HFN Commercial |
$268.86
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: Preferred Network Access Commercial |
$268.86
|
| Rate for Payer: Quartz Beloit One Network |
$143.20
|
| Rate for Payer: Quartz Commercial |
$175.34
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: WPS Commercial |
$216.45
|
|
|
Ft insert ucb berkeley shell L3000
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
HCPCS L3000
|
| Hospital Charge Code |
3133692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.59 |
| Max. Negotiated Rate |
$1,157.68 |
| Rate for Payer: Aetna Commercial |
$277.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Aetna Managed Medicare |
$401.50
|
| Rate for Payer: Anthem Medicare Advantage |
$401.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$401.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$401.50
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$277.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$401.50
|
| Rate for Payer: Health EOS Commercial |
$265.94
|
| Rate for Payer: HFN Commercial |
$277.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,157.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,157.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$401.50
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: NAPHCARE Commercial |
$602.25
|
| Rate for Payer: Preferred Network Access Commercial |
$277.63
|
| Rate for Payer: Quartz Beloit One Network |
$128.59
|
| Rate for Payer: Quartz Commercial |
$166.58
|
| Rate for Payer: Quartz Medicare Advantage |
$401.50
|
| Rate for Payer: The Alliance Commercial |
$1,104.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$401.50
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: WPS Commercial |
$702.63
|
|
|
Ft insert ucb berkeley shell L3000
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
HCPCS L3000
|
| Hospital Charge Code |
3133692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$1,606.01 |
| Rate for Payer: Aetna Commercial |
$263.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Aetna Managed Medicare |
$81.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.89
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$268.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.54
|
| Rate for Payer: Health EOS Commercial |
$260.09
|
| Rate for Payer: HFN Commercial |
$268.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.18
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: NAPHCARE Commercial |
$175.34
|
| Rate for Payer: Preferred Network Access Commercial |
$268.86
|
| Rate for Payer: Quartz Beloit One Network |
$143.20
|
| Rate for Payer: Quartz Commercial |
$189.96
|
| Rate for Payer: Quartz Medicare Advantage |
$175.34
|
| Rate for Payer: The Alliance Commercial |
$1,606.01
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: WPS Commercial |
$216.45
|
|
|
FULKERSON/TIBIAL OSTEOTOMY
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
4524687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
FULKERSON/TIBIAL OSTEOTOMY
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
4524687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
Full Assess and Care Planning Cognitive Impairment 99483
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
CPT 99483
|
| Hospital Charge Code |
5344633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$106.91 |
| Max. Negotiated Rate |
$812.32 |
| Rate for Payer: Aetna Commercial |
$794.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.35
|
| Rate for Payer: Aetna Managed Medicare |
$106.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$441.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.82
|
| Rate for Payer: Anthem Medicare Advantage |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.91
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$812.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$106.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$106.91
|
| Rate for Payer: Health EOS Commercial |
$785.83
|
| Rate for Payer: HFN Commercial |
$812.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$397.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$106.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$106.91
|
| Rate for Payer: Multiplan Commercial |
$706.37
|
| Rate for Payer: NAPHCARE Commercial |
$160.37
|
| Rate for Payer: Preferred Network Access Commercial |
$812.32
|
| Rate for Payer: Quartz Beloit One Network |
$432.65
|
| Rate for Payer: Quartz Commercial |
$573.92
|
| Rate for Payer: Quartz Medicare Advantage |
$106.91
|
| Rate for Payer: The Alliance Commercial |
$427.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.91
|
| Rate for Payer: WEA Trust Commercial |
$485.63
|
| Rate for Payer: Wellcare Medicare |
$106.91
|
| Rate for Payer: WPS Commercial |
$653.98
|
|
|
Full Assess and Care Planning Cognitive Impairment 99483
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
CPT 99483
|
| Hospital Charge Code |
5344633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$432.65 |
| Max. Negotiated Rate |
$812.32 |
| Rate for Payer: Aetna Commercial |
$794.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.97
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$812.32
|
| Rate for Payer: Health EOS Commercial |
$785.83
|
| Rate for Payer: HFN Commercial |
$812.32
|
| Rate for Payer: Multiplan Commercial |
$706.37
|
| Rate for Payer: Preferred Network Access Commercial |
$812.32
|
| Rate for Payer: Quartz Beloit One Network |
$432.65
|
| Rate for Payer: Quartz Commercial |
$529.78
|
| Rate for Payer: WEA Trust Commercial |
$485.63
|
| Rate for Payer: WPS Commercial |
$653.98
|
|
|
FULL RING 140MM 4933-2-140
|
Facility
|
OP
|
$6,011.00
|
|
| Hospital Charge Code |
6001640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,750.40 |
| Max. Negotiated Rate |
$5,751.32 |
| Rate for Payer: Aetna Commercial |
$5,626.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,376.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,750.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,063.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,125.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,000.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,313.26
|
| Rate for Payer: Cash Price |
$1,803.30
|
| Rate for Payer: Cigna Commercial |
$5,751.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,498.40
|
| Rate for Payer: Health EOS Commercial |
$5,563.78
|
| Rate for Payer: HFN Commercial |
$5,751.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,688.58
|
| Rate for Payer: Multiplan Commercial |
$5,001.15
|
| Rate for Payer: NAPHCARE Commercial |
$3,750.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,751.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,063.21
|
| Rate for Payer: Quartz Commercial |
$4,063.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,750.86
|
| Rate for Payer: The Alliance Commercial |
$3,125.72
|
| Rate for Payer: WEA Trust Commercial |
$3,438.29
|
| Rate for Payer: WPS Commercial |
$4,630.27
|
|
|
FULL RING 140MM 4933-2-140
|
Facility
|
IP
|
$6,011.00
|
|
| Hospital Charge Code |
6001640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,063.21 |
| Max. Negotiated Rate |
$5,751.32 |
| Rate for Payer: Aetna Commercial |
$5,626.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,376.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,313.26
|
| Rate for Payer: Cash Price |
$1,803.30
|
| Rate for Payer: Cigna Commercial |
$5,751.32
|
| Rate for Payer: Health EOS Commercial |
$5,563.78
|
| Rate for Payer: HFN Commercial |
$5,751.32
|
| Rate for Payer: Multiplan Commercial |
$5,001.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,751.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,063.21
|
| Rate for Payer: Quartz Commercial |
$3,750.86
|
| Rate for Payer: WEA Trust Commercial |
$3,438.29
|
| Rate for Payer: WPS Commercial |
$4,630.27
|
|
|
FULL RING 155MM 4933-2-155
|
Facility
|
IP
|
$6,251.00
|
|
| Hospital Charge Code |
5611674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,185.51 |
| Max. Negotiated Rate |
$5,980.96 |
| Rate for Payer: Aetna Commercial |
$5,850.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,590.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,445.55
|
| Rate for Payer: Cash Price |
$1,875.30
|
| Rate for Payer: Cigna Commercial |
$5,980.96
|
| Rate for Payer: Health EOS Commercial |
$5,785.93
|
| Rate for Payer: HFN Commercial |
$5,980.96
|
| Rate for Payer: Multiplan Commercial |
$5,200.83
|
| Rate for Payer: Preferred Network Access Commercial |
$5,980.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,185.51
|
| Rate for Payer: Quartz Commercial |
$3,900.62
|
| Rate for Payer: WEA Trust Commercial |
$3,575.57
|
| Rate for Payer: WPS Commercial |
$4,815.15
|
|
|
FULL RING 155MM 4933-2-155
|
Facility
|
OP
|
$6,251.00
|
|
| Hospital Charge Code |
5611674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,820.29 |
| Max. Negotiated Rate |
$5,980.96 |
| Rate for Payer: Aetna Commercial |
$5,850.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,590.89
|
| Rate for Payer: Aetna Managed Medicare |
$1,820.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,225.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,250.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,120.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,445.55
|
| Rate for Payer: Cash Price |
$1,875.30
|
| Rate for Payer: Cigna Commercial |
$5,980.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,638.08
|
| Rate for Payer: Health EOS Commercial |
$5,785.93
|
| Rate for Payer: HFN Commercial |
$5,980.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,875.78
|
| Rate for Payer: Multiplan Commercial |
$5,200.83
|
| Rate for Payer: NAPHCARE Commercial |
$3,900.62
|
| Rate for Payer: Preferred Network Access Commercial |
$5,980.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,185.51
|
| Rate for Payer: Quartz Commercial |
$4,225.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,900.62
|
| Rate for Payer: The Alliance Commercial |
$3,250.52
|
| Rate for Payer: WEA Trust Commercial |
$3,575.57
|
| Rate for Payer: WPS Commercial |
$4,815.15
|
|
