|
GLENOSPHERE & LOCKING CAPS (2) EQUINOXE REVERSE SHOULDER 320-06-42
|
Facility
|
IP
|
$6,138.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240163
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,007.62 |
| Max. Negotiated Rate |
$5,646.96 |
| Rate for Payer: Aetna Commercial |
$5,524.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,278.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,253.14
|
| Rate for Payer: Cash Price |
$1,841.40
|
| Rate for Payer: Cigna Commercial |
$5,646.96
|
| Rate for Payer: Health EOS Commercial |
$5,462.82
|
| Rate for Payer: HFN Commercial |
$5,646.96
|
| Rate for Payer: Multiplan Commercial |
$4,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,682.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,646.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,007.62
|
| Rate for Payer: Quartz Commercial |
$3,682.80
|
| Rate for Payer: WEA Trust Commercial |
$3,375.90
|
| Rate for Payer: WPS Commercial |
$4,546.42
|
|
|
GLENOSPHERE REVERS UNI 36 +2.5 AR-9504S-INF
|
Facility
|
IP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,473.30 |
| Max. Negotiated Rate |
$10,276.40 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$6,702.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
GLENOSPHERE REVERS UNI 36 +2.5 AR-9504S-INF
|
Facility
|
OP
|
$11,170.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4240358
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,127.60 |
| Max. Negotiated Rate |
$44,680.00 |
| Rate for Payer: Aetna Commercial |
$10,053.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,606.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,127.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,260.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,585.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,361.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,920.10
|
| Rate for Payer: Cash Price |
$3,351.00
|
| Rate for Payer: Cigna Commercial |
$10,276.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,250.73
|
| Rate for Payer: Health EOS Commercial |
$9,941.30
|
| Rate for Payer: HFN Commercial |
$10,276.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,377.50
|
| Rate for Payer: Multiplan Commercial |
$8,936.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,702.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,276.40
|
| Rate for Payer: Quartz Beloit One Network |
$5,473.30
|
| Rate for Payer: Quartz Commercial |
$7,260.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,702.00
|
| Rate for Payer: The Alliance Commercial |
$44,680.00
|
| Rate for Payer: WEA Trust Commercial |
$6,143.50
|
| Rate for Payer: WPS Commercial |
$8,273.62
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 33 / 24 AR-9564-2433
|
Facility
|
OP
|
$10,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6214986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,043.32 |
| Max. Negotiated Rate |
$43,476.00 |
| Rate for Payer: Aetna Commercial |
$9,782.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,347.34
|
| Rate for Payer: Aetna Managed Medicare |
$3,043.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,064.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,434.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,217.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,760.57
|
| Rate for Payer: Cash Price |
$3,260.70
|
| Rate for Payer: Cigna Commercial |
$9,999.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,082.29
|
| Rate for Payer: Health EOS Commercial |
$9,673.41
|
| Rate for Payer: HFN Commercial |
$9,999.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,151.75
|
| Rate for Payer: Multiplan Commercial |
$8,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,521.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,999.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,325.81
|
| Rate for Payer: Quartz Commercial |
$7,064.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,521.40
|
| Rate for Payer: The Alliance Commercial |
$43,476.00
|
| Rate for Payer: WEA Trust Commercial |
$5,977.95
|
| Rate for Payer: WPS Commercial |
$8,050.67
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 33 / 24 AR-9564-2433
|
Facility
|
IP
|
$10,869.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6214986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,325.81 |
| Max. Negotiated Rate |
$9,999.48 |
| Rate for Payer: Aetna Commercial |
$9,782.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,347.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,760.57
|
| Rate for Payer: Cash Price |
$3,260.70
|
| Rate for Payer: Cigna Commercial |
$9,999.48
|
| Rate for Payer: Health EOS Commercial |
$9,673.41
|
| Rate for Payer: HFN Commercial |
$9,999.48
|
| Rate for Payer: Multiplan Commercial |
$8,695.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,521.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,999.48
|
| Rate for Payer: Quartz Beloit One Network |
$5,325.81
|
| Rate for Payer: Quartz Commercial |
$6,521.40
|
| Rate for Payer: WEA Trust Commercial |
$5,977.95
|
| Rate for Payer: WPS Commercial |
$8,050.67
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 33 +4 LAT / 24 AR-9564-2433-LAT
|
Facility
|
OP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,425.52 |
| Max. Negotiated Rate |
$48,936.00 |
| Rate for Payer: Aetna Commercial |
$11,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,521.24
|
| Rate for Payer: Aetna Managed Medicare |
$3,425.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,952.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,872.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,484.02
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,255.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,846.15
|
| Rate for Payer: Health EOS Commercial |
$10,888.26
|
| Rate for Payer: HFN Commercial |
$11,255.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,175.50
|
| Rate for Payer: Multiplan Commercial |
$9,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,255.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.66
|
| Rate for Payer: Quartz Commercial |
$7,952.10
|
| Rate for Payer: Quartz Medicare Advantage |
$7,340.40
|
| Rate for Payer: The Alliance Commercial |
$48,936.00
|
| Rate for Payer: WEA Trust Commercial |
$6,728.70
|
| Rate for Payer: WPS Commercial |
$9,061.72
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 33 +4 LAT / 24 AR-9564-2433-LAT
|
Facility
|
IP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5496691
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,994.66 |
| Max. Negotiated Rate |
$11,255.28 |
| Rate for Payer: Aetna Commercial |
$11,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,521.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,484.02
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,255.28
|
| Rate for Payer: Health EOS Commercial |
$10,888.26
|
| Rate for Payer: HFN Commercial |
$11,255.28
|
| Rate for Payer: Multiplan Commercial |
$9,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,255.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.66
|
| Rate for Payer: Quartz Commercial |
$7,340.40
|
| Rate for Payer: WEA Trust Commercial |
$6,728.70
|
| Rate for Payer: WPS Commercial |
$9,061.72
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 36 +4 LAT / 24 AR-9564-2436-LAT
|
Facility
|
OP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,425.52 |
| Max. Negotiated Rate |
$48,936.00 |
| Rate for Payer: Aetna Commercial |
$11,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,521.24
|
| Rate for Payer: Aetna Managed Medicare |
$3,425.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,952.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,872.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,484.02
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,255.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,846.15
|
| Rate for Payer: Health EOS Commercial |
$10,888.26
|
| Rate for Payer: HFN Commercial |
$11,255.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,175.50
|
| Rate for Payer: Multiplan Commercial |
$9,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,255.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.66
|
| Rate for Payer: Quartz Commercial |
$7,952.10
|
| Rate for Payer: Quartz Medicare Advantage |
$7,340.40
|
| Rate for Payer: The Alliance Commercial |
$48,936.00
|
| Rate for Payer: WEA Trust Commercial |
$6,728.70
|
| Rate for Payer: WPS Commercial |
$9,061.72
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 36 +4 LAT / 24 AR-9564-2436-LAT
|
Facility
|
IP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563496
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,994.66 |
| Max. Negotiated Rate |
$11,255.28 |
| Rate for Payer: Aetna Commercial |
$11,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,521.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,484.02
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,255.28
|
| Rate for Payer: Health EOS Commercial |
$10,888.26
|
| Rate for Payer: HFN Commercial |
$11,255.28
|
| Rate for Payer: Multiplan Commercial |
$9,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,255.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.66
|
| Rate for Payer: Quartz Commercial |
$7,340.40
|
| Rate for Payer: WEA Trust Commercial |
$6,728.70
|
| Rate for Payer: WPS Commercial |
$9,061.72
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 39 +4 LAT / 24 AR-9564-2439-LAT
|
Facility
|
OP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,425.52 |
| Max. Negotiated Rate |
$48,936.00 |
| Rate for Payer: Aetna Commercial |
$11,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,521.24
|
| Rate for Payer: Aetna Managed Medicare |
$3,425.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,952.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,872.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,484.02
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,255.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,846.15
|
| Rate for Payer: Health EOS Commercial |
$10,888.26
|
| Rate for Payer: HFN Commercial |
$11,255.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,175.50
|
| Rate for Payer: Multiplan Commercial |
$9,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,255.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.66
|
| Rate for Payer: Quartz Commercial |
$7,952.10
|
| Rate for Payer: Quartz Medicare Advantage |
$7,340.40
|
| Rate for Payer: The Alliance Commercial |
$48,936.00
|
| Rate for Payer: WEA Trust Commercial |
$6,728.70
|
| Rate for Payer: WPS Commercial |
$9,061.72
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 39 +4 LAT / 24 AR-9564-2439-LAT
|
Facility
|
IP
|
$12,234.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5490708
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,994.66 |
| Max. Negotiated Rate |
$11,255.28 |
| Rate for Payer: Aetna Commercial |
$11,010.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,521.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,484.02
|
| Rate for Payer: Cash Price |
$3,670.20
|
| Rate for Payer: Cigna Commercial |
$11,255.28
|
| Rate for Payer: Health EOS Commercial |
$10,888.26
|
| Rate for Payer: HFN Commercial |
$11,255.28
|
| Rate for Payer: Multiplan Commercial |
$9,787.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,340.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,255.28
|
| Rate for Payer: Quartz Beloit One Network |
$5,994.66
|
| Rate for Payer: Quartz Commercial |
$7,340.40
|
| Rate for Payer: WEA Trust Commercial |
$6,728.70
|
| Rate for Payer: WPS Commercial |
$9,061.72
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 39 +4 LAT / 28 AR-9564-2839-LAT
|
Facility
|
OP
|
$11,763.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,293.64 |
| Max. Negotiated Rate |
$47,052.00 |
| Rate for Payer: Aetna Commercial |
$10,586.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,116.18
|
| Rate for Payer: Aetna Managed Medicare |
$3,293.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,645.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,881.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,646.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,234.39
|
| Rate for Payer: Cash Price |
$3,528.90
|
| Rate for Payer: Cigna Commercial |
$10,821.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,582.57
|
| Rate for Payer: Health EOS Commercial |
$10,469.07
|
| Rate for Payer: HFN Commercial |
$10,821.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,822.25
|
| Rate for Payer: Multiplan Commercial |
$9,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$7,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,821.96
|
| Rate for Payer: Quartz Beloit One Network |
$5,763.87
|
| Rate for Payer: Quartz Commercial |
$7,645.95
|
| Rate for Payer: Quartz Medicare Advantage |
$7,057.80
|
| Rate for Payer: The Alliance Commercial |
$47,052.00
|
| Rate for Payer: WEA Trust Commercial |
$6,469.65
|
| Rate for Payer: WPS Commercial |
$8,712.85
|
|
|
GLENOSPHERE UNIVERS REVERS MODULAR 39 +4 LAT / 28 AR-9564-2839-LAT
|
Facility
|
IP
|
$11,763.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729755
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,763.87 |
| Max. Negotiated Rate |
$10,821.96 |
| Rate for Payer: Aetna Commercial |
$10,586.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,116.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,234.39
|
| Rate for Payer: Cash Price |
$3,528.90
|
| Rate for Payer: Cigna Commercial |
$10,821.96
|
| Rate for Payer: Health EOS Commercial |
$10,469.07
|
| Rate for Payer: HFN Commercial |
$10,821.96
|
| Rate for Payer: Multiplan Commercial |
$9,410.40
|
| Rate for Payer: NAPHCARE Commercial |
$7,057.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,821.96
|
| Rate for Payer: Quartz Beloit One Network |
$5,763.87
|
| Rate for Payer: Quartz Commercial |
$7,057.80
|
| Rate for Payer: WEA Trust Commercial |
$6,469.65
|
| Rate for Payer: WPS Commercial |
$8,712.85
|
|
|
Gliadin Ab
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.42 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$34.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$34.80
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
Gliadin Ab
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$53.36 |
| Rate for Payer: Aetna Commercial |
$52.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$53.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.46
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$51.62
|
| Rate for Payer: HFN Commercial |
$53.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$53.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$28.42
|
| Rate for Payer: Quartz Commercial |
$37.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$43.50
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
Gliadin Ab
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.52 |
| Max. Negotiated Rate |
$55.10 |
| Rate for Payer: Aetna Commercial |
$55.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.88
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.80
|
| Rate for Payer: Health EOS Commercial |
$52.78
|
| Rate for Payer: HFN Commercial |
$55.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$46.40
|
| Rate for Payer: Preferred Network Access Commercial |
$55.10
|
| Rate for Payer: Quartz Beloit One Network |
$25.52
|
| Rate for Payer: Quartz Commercial |
$33.06
|
| Rate for Payer: The Alliance Commercial |
$29.00
|
| Rate for Payer: WEA Trust Commercial |
$31.90
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
Gliadin Antibody
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
977955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.10
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$102.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Gliadin Antibody
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
977955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.13
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$110.50
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$127.50
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Gliadin Antibody
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
977955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$161.50 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.00
|
| Rate for Payer: Health EOS Commercial |
$154.70
|
| Rate for Payer: HFN Commercial |
$161.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.50
|
| Rate for Payer: Quartz Beloit One Network |
$74.80
|
| Rate for Payer: Quartz Commercial |
$96.90
|
| Rate for Payer: The Alliance Commercial |
$85.00
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Gliadin Antibody IgG
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5156617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Gliadin Antibody IgG
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5156617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$46.12 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.75
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Gliadin Antibody IgG
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5156617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$40.70 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: HFN Commercial |
$19.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$19.95
|
| Rate for Payer: Quartz Beloit One Network |
$9.24
|
| Rate for Payer: Quartz Commercial |
$11.97
|
| Rate for Payer: The Alliance Commercial |
$10.50
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Gliadin IgA Antibody
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: HFN Commercial |
$168.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Gliadin IgA Antibody
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Gliadin IgA Antibody
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.05
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$132.75
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
