|
Fungus Culture Blood
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
979911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.38 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$89.86
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
Fungus Culture Blood
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
979911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$21.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.32
|
| Rate for Payer: Anthem Medicare Advantage |
$21.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.28
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.28
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.28
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$31.92
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: Quartz Medicare Advantage |
$21.28
|
| Rate for Payer: The Alliance Commercial |
$85.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.28
|
| Rate for Payer: United Healthcare PPO |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: Wellcare Medicare |
$21.28
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
Furosemide JW Waste Charge per 20 mg
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J1940 JW
|
| Hospital Charge Code |
5266672
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Furosemide JW Waste Charge per 20 mg
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J1940 JW
|
| Hospital Charge Code |
5266672
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.84
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$1.58
|
|
|
Furosemide JW Waste Charge per 20 mg
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J1940 JW
|
| Hospital Charge Code |
5266672
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.63 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.63
|
| Rate for Payer: Health EOS Commercial |
$8.52
|
| Rate for Payer: HFN Commercial |
$8.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.16
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.89
|
| Rate for Payer: Quartz Beloit One Network |
$4.12
|
| Rate for Payer: Quartz Commercial |
$5.34
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$1.58
|
|
|
FUSION OF BIG TOE JOINT 28750
|
Professional
|
Both
|
$2,522.00
|
|
|
Service Code
|
CPT 28750
|
| Hospital Charge Code |
3014279
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$278.69 |
| Max. Negotiated Rate |
$2,491.74 |
| Rate for Payer: Aetna Commercial |
$2,491.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,255.68
|
| Rate for Payer: Aetna Managed Medicare |
$520.47
|
| Rate for Payer: Anthem Medicare Advantage |
$520.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$520.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$520.47
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cigna Commercial |
$2,491.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$520.47
|
| Rate for Payer: Health EOS Commercial |
$2,386.82
|
| Rate for Payer: HFN Commercial |
$2,491.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,025.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,025.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$520.47
|
| Rate for Payer: Multiplan Commercial |
$2,098.30
|
| Rate for Payer: NAPHCARE Commercial |
$780.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,491.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.07
|
| Rate for Payer: Quartz Commercial |
$1,495.04
|
| Rate for Payer: Quartz Medicare Advantage |
$520.47
|
| Rate for Payer: The Alliance Commercial |
$2,211.99
|
| Rate for Payer: United Healthcare Medicaid |
$278.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$520.47
|
| Rate for Payer: WEA Trust Commercial |
$1,442.58
|
| Rate for Payer: WPS Commercial |
$2,342.11
|
|
|
FUSION OF BIG TOE JOINT 28755
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
CPT 28755
|
| Hospital Charge Code |
3014280
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$2,050.54 |
| Rate for Payer: Aetna Commercial |
$1,783.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$455.68
|
| Rate for Payer: Anthem Medicare Advantage |
$455.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$455.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$455.68
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,783.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.68
|
| Rate for Payer: Health EOS Commercial |
$1,708.25
|
| Rate for Payer: HFN Commercial |
$1,783.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,169.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,169.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$455.68
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$683.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.34
|
| Rate for Payer: Quartz Beloit One Network |
$825.97
|
| Rate for Payer: Quartz Commercial |
$1,070.00
|
| Rate for Payer: Quartz Medicare Advantage |
$455.68
|
| Rate for Payer: The Alliance Commercial |
$1,936.62
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$455.68
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$2,050.54
|
|
|
FUSION OF BIG TOE JOINT 28760
|
Professional
|
Both
|
$3,085.00
|
|
|
Service Code
|
CPT 28760
|
| Hospital Charge Code |
3014281
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$3,047.98 |
| Rate for Payer: Aetna Commercial |
$3,047.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,759.22
|
| Rate for Payer: Aetna Managed Medicare |
$524.07
|
| Rate for Payer: Anthem Medicare Advantage |
$524.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$524.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$524.07
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$3,047.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.07
|
| Rate for Payer: Health EOS Commercial |
$2,919.64
|
| Rate for Payer: HFN Commercial |
$3,047.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,991.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,991.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$524.07
|
| Rate for Payer: Multiplan Commercial |
$2,566.72
|
| Rate for Payer: NAPHCARE Commercial |
$786.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,047.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,411.70
|
| Rate for Payer: Quartz Commercial |
$1,828.79
|
| Rate for Payer: Quartz Medicare Advantage |
$524.07
|
| Rate for Payer: The Alliance Commercial |
$2,227.28
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$524.07
|
| Rate for Payer: WEA Trust Commercial |
$1,764.62
|
| Rate for Payer: WPS Commercial |
$2,358.30
|
|
|
FUSION OF TOES 28280
|
Professional
|
Both
|
$1,484.00
|
|
|
Service Code
|
CPT 28280
|
| Hospital Charge Code |
3014228
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,466.19 |
| Rate for Payer: Aetna Commercial |
$1,466.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Aetna Managed Medicare |
$316.19
|
| Rate for Payer: Anthem Medicare Advantage |
$316.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$316.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$316.19
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,466.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.19
|
| Rate for Payer: Health EOS Commercial |
$1,404.46
|
| Rate for Payer: HFN Commercial |
$1,466.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,213.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,213.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$316.19
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: NAPHCARE Commercial |
$474.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,466.19
|
| Rate for Payer: Quartz Beloit One Network |
$679.08
|
| Rate for Payer: Quartz Commercial |
$879.72
|
| Rate for Payer: Quartz Medicare Advantage |
$316.19
|
| Rate for Payer: The Alliance Commercial |
$1,343.81
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$316.19
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,422.86
|
|
|
FUSION PLATE MPJ MED. LT
|
Facility
|
OP
|
$8,940.00
|
|
| Hospital Charge Code |
2964737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,603.33 |
| Max. Negotiated Rate |
$8,553.79 |
| Rate for Payer: Aetna Commercial |
$8,367.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,995.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,603.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,043.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,648.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,462.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,927.73
|
| Rate for Payer: Cash Price |
$2,682.00
|
| Rate for Payer: Cigna Commercial |
$8,553.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,203.08
|
| Rate for Payer: Health EOS Commercial |
$8,274.86
|
| Rate for Payer: HFN Commercial |
$8,553.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,973.20
|
| Rate for Payer: Multiplan Commercial |
$7,438.08
|
| Rate for Payer: NAPHCARE Commercial |
$5,578.56
|
| Rate for Payer: Preferred Network Access Commercial |
$8,553.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,555.82
|
| Rate for Payer: Quartz Commercial |
$6,043.44
|
| Rate for Payer: Quartz Medicare Advantage |
$5,578.56
|
| Rate for Payer: The Alliance Commercial |
$4,648.80
|
| Rate for Payer: WEA Trust Commercial |
$5,113.68
|
| Rate for Payer: WPS Commercial |
$6,886.48
|
|
|
FUSION PLATE MPJ MED. LT
|
Facility
|
IP
|
$8,940.00
|
|
| Hospital Charge Code |
2964737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,555.82 |
| Max. Negotiated Rate |
$8,553.79 |
| Rate for Payer: Aetna Commercial |
$8,367.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,995.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,927.73
|
| Rate for Payer: Cash Price |
$2,682.00
|
| Rate for Payer: Cigna Commercial |
$8,553.79
|
| Rate for Payer: Health EOS Commercial |
$8,274.86
|
| Rate for Payer: HFN Commercial |
$8,553.79
|
| Rate for Payer: Multiplan Commercial |
$7,438.08
|
| Rate for Payer: Preferred Network Access Commercial |
$8,553.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,555.82
|
| Rate for Payer: Quartz Commercial |
$5,578.56
|
| Rate for Payer: WEA Trust Commercial |
$5,113.68
|
| Rate for Payer: WPS Commercial |
$6,886.48
|
|
|
G0416 Prostate Histology
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
4510700
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$295.03 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.03
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$399.52
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$460.98
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
G0416 Prostate Histology
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
4510700
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$565.47 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$368.78
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
Gabapentin Level
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
977954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$322.09 |
| Rate for Payer: Aetna Commercial |
$322.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Aetna Managed Medicare |
$22.54
|
| Rate for Payer: Anthem Medicare Advantage |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.54
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$322.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$169.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.54
|
| Rate for Payer: Health EOS Commercial |
$308.53
|
| Rate for Payer: HFN Commercial |
$322.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.54
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: NAPHCARE Commercial |
$33.81
|
| Rate for Payer: Preferred Network Access Commercial |
$322.09
|
| Rate for Payer: Quartz Beloit One Network |
$149.18
|
| Rate for Payer: Quartz Commercial |
$193.25
|
| Rate for Payer: Quartz Medicare Advantage |
$22.54
|
| Rate for Payer: The Alliance Commercial |
$89.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.54
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: WPS Commercial |
$99.16
|
|
|
Gabapentin Level
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
977954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.13 |
| Max. Negotiated Rate |
$311.92 |
| Rate for Payer: Aetna Commercial |
$305.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.69
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$311.92
|
| Rate for Payer: Health EOS Commercial |
$301.75
|
| Rate for Payer: HFN Commercial |
$311.92
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: Preferred Network Access Commercial |
$311.92
|
| Rate for Payer: Quartz Beloit One Network |
$166.13
|
| Rate for Payer: Quartz Commercial |
$203.42
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: WPS Commercial |
$251.12
|
|
|
Gabapentin Level
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
977954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$311.92 |
| Rate for Payer: Aetna Commercial |
$305.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Aetna Managed Medicare |
$22.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.41
|
| Rate for Payer: Anthem Medicare Advantage |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.54
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$311.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.54
|
| Rate for Payer: Health EOS Commercial |
$301.75
|
| Rate for Payer: HFN Commercial |
$311.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.54
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: NAPHCARE Commercial |
$33.81
|
| Rate for Payer: Preferred Network Access Commercial |
$311.92
|
| Rate for Payer: Quartz Beloit One Network |
$166.13
|
| Rate for Payer: Quartz Commercial |
$220.38
|
| Rate for Payer: Quartz Medicare Advantage |
$22.54
|
| Rate for Payer: The Alliance Commercial |
$90.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.54
|
| Rate for Payer: United Healthcare PPO |
$254.28
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: Wellcare Medicare |
$22.54
|
| Rate for Payer: WPS Commercial |
$251.12
|
|
|
GADS INTRODUCTORY KIT
|
Facility
|
OP
|
$1,876.00
|
|
| Hospital Charge Code |
2972752
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$546.29 |
| Max. Negotiated Rate |
$1,794.96 |
| Rate for Payer: Aetna Commercial |
$1,755.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.89
|
| Rate for Payer: Aetna Managed Medicare |
$546.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,268.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,034.05
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cigna Commercial |
$1,794.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.83
|
| Rate for Payer: Health EOS Commercial |
$1,736.43
|
| Rate for Payer: HFN Commercial |
$1,794.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,463.28
|
| Rate for Payer: Multiplan Commercial |
$1,560.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.96
|
| Rate for Payer: Quartz Beloit One Network |
$956.01
|
| Rate for Payer: Quartz Commercial |
$1,268.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.62
|
| Rate for Payer: The Alliance Commercial |
$975.52
|
| Rate for Payer: WEA Trust Commercial |
$1,073.07
|
| Rate for Payer: WPS Commercial |
$1,445.08
|
|
|
GADS INTRODUCTORY KIT
|
Facility
|
IP
|
$1,876.00
|
|
| Hospital Charge Code |
2972752
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$956.01 |
| Max. Negotiated Rate |
$1,794.96 |
| Rate for Payer: Aetna Commercial |
$1,755.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,034.05
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cigna Commercial |
$1,794.96
|
| Rate for Payer: Health EOS Commercial |
$1,736.43
|
| Rate for Payer: HFN Commercial |
$1,794.96
|
| Rate for Payer: Multiplan Commercial |
$1,560.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.96
|
| Rate for Payer: Quartz Beloit One Network |
$956.01
|
| Rate for Payer: Quartz Commercial |
$1,170.62
|
| Rate for Payer: WEA Trust Commercial |
$1,073.07
|
| Rate for Payer: WPS Commercial |
$1,445.08
|
|
|
Gait Training Charges
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
5247107
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Gait Training Charges
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
752350
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Gait Training Charges
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
752350
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$99.76 |
| Max. Negotiated Rate |
$215.38 |
| Rate for Payer: Aetna Commercial |
$215.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$215.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.03
|
| Rate for Payer: Health EOS Commercial |
$206.32
|
| Rate for Payer: HFN Commercial |
$215.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.68
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$215.38
|
| Rate for Payer: Quartz Beloit One Network |
$99.76
|
| Rate for Payer: Quartz Commercial |
$129.23
|
| Rate for Payer: The Alliance Commercial |
$113.36
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Gait Training Charges
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
5247107
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.48 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$63.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.88
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$136.03
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$136.03
|
| Rate for Payer: The Alliance Commercial |
$117.52
|
| Rate for Payer: United Healthcare PPO |
$170.04
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Gait Training Charges
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
752350
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$63.48 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$63.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.88
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$136.03
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$136.03
|
| Rate for Payer: The Alliance Commercial |
$113.36
|
| Rate for Payer: United Healthcare PPO |
$170.04
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Galactose Alpha 1, 3Galactose IgE
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
4532678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| 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 |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| 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 |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| 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 |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$211.04
|
| Rate for Payer: HFN Commercial |
$218.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| 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 |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$175.63
|
|
|
Galactose Alpha 1, 3Galactose IgE
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
4532678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| 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 |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| 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 |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$215.78
|
| Rate for Payer: HFN Commercial |
$225.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$189.70
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| 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 |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$130.42
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
