|
Ganglioside GM-1 Antibody IgG & IgM
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
1039122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.20
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: HFN Commercial |
$77.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: The Alliance Commercial |
$41.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Ganglioside GM-1 IgM Antibody
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942900
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Ganglioside GM-1 IgM Antibody
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942900
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Ganglioside GM-1 IgM Antibody
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942900
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.20
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: HFN Commercial |
$96.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: The Alliance Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Ganglioside GQ1b Antibody IgG
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5582228
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.21
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$122.25
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Ganglioside GQ1b Antibody IgG
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5582228
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna Commercial |
$154.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$154.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.80
|
| Rate for Payer: Health EOS Commercial |
$148.33
|
| Rate for Payer: HFN Commercial |
$154.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Preferred Network Access Commercial |
$154.85
|
| Rate for Payer: Quartz Beloit One Network |
$71.72
|
| Rate for Payer: Quartz Commercial |
$92.91
|
| Rate for Payer: The Alliance Commercial |
$81.50
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Ganglioside GQ1b Antibody IgG
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5582228
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
GARMENT CODE: LE - CHEVRON
|
Facility
|
IP
|
$4,271.00
|
|
| Hospital Charge Code |
2974160
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,092.79 |
| Max. Negotiated Rate |
$3,929.32 |
| Rate for Payer: Aetna Commercial |
$3,843.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.63
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$3,929.32
|
| Rate for Payer: Health EOS Commercial |
$3,801.19
|
| Rate for Payer: HFN Commercial |
$3,929.32
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.79
|
| Rate for Payer: Quartz Commercial |
$2,562.60
|
| Rate for Payer: WEA Trust Commercial |
$2,349.05
|
| Rate for Payer: WPS Commercial |
$3,163.53
|
|
|
GARMENT CODE: LE - CHEVRON
|
Facility
|
OP
|
$4,271.00
|
|
| Hospital Charge Code |
2974160
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,195.88 |
| Max. Negotiated Rate |
$17,084.00 |
| Rate for Payer: Aetna Commercial |
$3,843.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,673.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,195.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,776.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,050.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,263.63
|
| Rate for Payer: Cash Price |
$1,281.30
|
| Rate for Payer: Cigna Commercial |
$3,929.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,390.05
|
| Rate for Payer: Health EOS Commercial |
$3,801.19
|
| Rate for Payer: HFN Commercial |
$3,929.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,203.25
|
| Rate for Payer: Multiplan Commercial |
$3,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,562.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,929.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,092.79
|
| Rate for Payer: Quartz Commercial |
$2,776.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,562.60
|
| Rate for Payer: The Alliance Commercial |
$17,084.00
|
| Rate for Payer: WEA Trust Commercial |
$2,349.05
|
| Rate for Payer: WPS Commercial |
$3,163.53
|
|
|
GARMENT TOES TO MID THIGH #LE-AF-C
|
Facility
|
OP
|
$5,186.00
|
|
| Hospital Charge Code |
2973567
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,452.08 |
| Max. Negotiated Rate |
$20,744.00 |
| Rate for Payer: Aetna Commercial |
$4,667.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,459.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,370.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,593.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,489.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,748.58
|
| Rate for Payer: Cash Price |
$1,555.80
|
| Rate for Payer: Cigna Commercial |
$4,771.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,902.09
|
| Rate for Payer: Health EOS Commercial |
$4,615.54
|
| Rate for Payer: HFN Commercial |
$4,771.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,889.50
|
| Rate for Payer: Multiplan Commercial |
$4,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,771.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.14
|
| Rate for Payer: Quartz Commercial |
$3,370.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,111.60
|
| Rate for Payer: The Alliance Commercial |
$20,744.00
|
| Rate for Payer: WEA Trust Commercial |
$2,852.30
|
| Rate for Payer: WPS Commercial |
$3,841.27
|
|
|
GARMENT TOES TO MID THIGH #LE-AF-C
|
Facility
|
IP
|
$5,186.00
|
|
| Hospital Charge Code |
2973567
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,541.14 |
| Max. Negotiated Rate |
$4,771.12 |
| Rate for Payer: Aetna Commercial |
$4,667.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,459.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,748.58
|
| Rate for Payer: Cash Price |
$1,555.80
|
| Rate for Payer: Cigna Commercial |
$4,771.12
|
| Rate for Payer: Health EOS Commercial |
$4,615.54
|
| Rate for Payer: HFN Commercial |
$4,771.12
|
| Rate for Payer: Multiplan Commercial |
$4,148.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,771.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.14
|
| Rate for Payer: Quartz Commercial |
$3,111.60
|
| Rate for Payer: WEA Trust Commercial |
$2,852.30
|
| Rate for Payer: WPS Commercial |
$3,841.27
|
|
|
Gast Occult Bld
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
633787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.26 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$5.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.83
|
| Rate for Payer: Anthem Medicaid |
$4.26
|
| Rate for Payer: Anthem Medicare Advantage |
$5.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.32
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Dean Health Medicaid |
$4.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.32
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.32
|
| Rate for Payer: Managed Health Services Medicaid |
$4.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.32
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.98
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.26
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5.32
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicaid |
$4.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.32
|
| Rate for Payer: United Healthcare PPO |
$60.75
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: Wellcare Medicare |
$5.32
|
| Rate for Payer: WMAP Medicaid |
$4.26
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
Gast Occult Bld
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
633787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
Gast Occult Bld
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
633787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna Commercial |
$76.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$76.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.60
|
| Rate for Payer: Health EOS Commercial |
$73.71
|
| Rate for Payer: HFN Commercial |
$76.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.95
|
| Rate for Payer: Quartz Beloit One Network |
$35.64
|
| Rate for Payer: Quartz Commercial |
$46.17
|
| Rate for Payer: The Alliance Commercial |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
GASTRECTOMY/GASTRIC RESECTION
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2960083
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,344.84 |
| Max. Negotiated Rate |
$19,212.00 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,344.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,121.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,401.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,305.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,602.25
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$3,121.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,881.80
|
| Rate for Payer: The Alliance Commercial |
$19,212.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
GASTRECTOMY/GASTRIC RESECTION
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2960083
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,353.47 |
| Max. Negotiated Rate |
$4,418.76 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$2,881.80
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
GASTRIC BAND ADJUSTMENT
|
Facility
|
OP
|
$3,784.00
|
|
| Hospital Charge Code |
2959781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,059.52 |
| Max. Negotiated Rate |
$15,136.00 |
| Rate for Payer: Aetna Commercial |
$3,405.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,254.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,059.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,459.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,892.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,816.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,005.52
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,481.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,117.53
|
| Rate for Payer: Health EOS Commercial |
$3,367.76
|
| Rate for Payer: HFN Commercial |
$3,481.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,838.00
|
| Rate for Payer: Multiplan Commercial |
$3,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,481.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.16
|
| Rate for Payer: Quartz Commercial |
$2,459.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,270.40
|
| Rate for Payer: The Alliance Commercial |
$15,136.00
|
| Rate for Payer: WEA Trust Commercial |
$2,081.20
|
| Rate for Payer: WPS Commercial |
$2,802.81
|
|
|
GASTRIC BAND ADJUSTMENT
|
Facility
|
IP
|
$3,784.00
|
|
| Hospital Charge Code |
2959781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,854.16 |
| Max. Negotiated Rate |
$3,481.28 |
| Rate for Payer: Aetna Commercial |
$3,405.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,254.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,005.52
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,481.28
|
| Rate for Payer: Health EOS Commercial |
$3,367.76
|
| Rate for Payer: HFN Commercial |
$3,481.28
|
| Rate for Payer: Multiplan Commercial |
$3,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,481.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.16
|
| Rate for Payer: Quartz Commercial |
$2,270.40
|
| Rate for Payer: WEA Trust Commercial |
$2,081.20
|
| Rate for Payer: WPS Commercial |
$2,802.81
|
|
|
Gastric Lavage - Gastric Tube Activity
|
Facility
|
OP
|
$1,135.00
|
|
| Hospital Charge Code |
3000257
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$317.80 |
| Max. Negotiated Rate |
$4,540.00 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Aetna Managed Medicare |
$317.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$737.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$544.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.15
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$851.25
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$737.75
|
| Rate for Payer: Quartz Medicare Advantage |
$681.00
|
| Rate for Payer: The Alliance Commercial |
$4,540.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
Gastric Lavage - Gastric Tube Activity
|
Facility
|
IP
|
$1,135.00
|
|
| Hospital Charge Code |
3000257
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
Gastrin Level
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
633734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.23 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$296.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$296.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.20
|
| Rate for Payer: Health EOS Commercial |
$283.92
|
| Rate for Payer: HFN Commercial |
$296.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.23
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$296.40
|
| Rate for Payer: Quartz Beloit One Network |
$137.28
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
Gastrin Level
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
633734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.63 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$17.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.27
|
| Rate for Payer: Anthem Medicaid |
$18.22
|
| Rate for Payer: Anthem Medicare Advantage |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.63
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Dean Health Medicaid |
$18.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.63
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.63
|
| Rate for Payer: Managed Health Services Medicaid |
$18.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.63
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.44
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.22
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17.63
|
| Rate for Payer: The Alliance Commercial |
$70.52
|
| Rate for Payer: United Healthcare Medicaid |
$18.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.63
|
| Rate for Payer: United Healthcare PPO |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: Wellcare Medicare |
$17.63
|
| Rate for Payer: WMAP Medicaid |
$18.22
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
Gastrin Level
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
633734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 27687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH CC
|
Facility
|
IP
|
$26,476.00
|
|
|
Service Code
|
MSDRG 378
|
| Min. Negotiated Rate |
$9,523.64 |
| Max. Negotiated Rate |
$26,476.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,523.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,560.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,759.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,972.44
|
| Rate for Payer: Anthem Medicare Advantage |
$9,523.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,523.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,523.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,523.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,620.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,523.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,184.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,523.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,523.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,523.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,523.64
|
| Rate for Payer: NAPHCARE Commercial |
$14,285.46
|
| Rate for Payer: Quartz Medicare Advantage |
$9,523.64
|
| Rate for Payer: The Alliance Commercial |
$26,476.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,523.64
|
| Rate for Payer: United Healthcare PPO |
$14,935.07
|
| Rate for Payer: Wellcare Medicare |
$9,523.64
|
|
