|
Glucose, Synovial Fluid
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Glucose, Synovial Fluid
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$3.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.52
|
| Rate for Payer: Anthem Medicaid |
$4.06
|
| Rate for Payer: Anthem Medicare Advantage |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.93
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.79
|
| Rate for Payer: Dean Health Medicaid |
$4.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.93
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.93
|
| Rate for Payer: Managed Health Services Medicaid |
$4.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.90
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.06
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3.93
|
| Rate for Payer: The Alliance Commercial |
$15.72
|
| Rate for Payer: United Healthcare Medicaid |
$4.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: Wellcare Medicare |
$3.93
|
| Rate for Payer: WMAP Medicaid |
$4.06
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Glucose Tolerance 1 Hour
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
633597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.40
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.77
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: The Alliance Commercial |
$52.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Glucose Tolerance 1 Hour
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
633597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Glucose Tolerance 1 Hour
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
633597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$4.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.88
|
| Rate for Payer: Anthem Medicaid |
$4.91
|
| Rate for Payer: Anthem Medicare Advantage |
$4.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.75
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Dean Health Medicaid |
$4.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.75
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.75
|
| Rate for Payer: Managed Health Services Medicaid |
$5.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.12
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.91
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$4.75
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.75
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$4.75
|
| Rate for Payer: WMAP Medicaid |
$4.91
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Glutamic Acid Decarboxylase-65 Antibody
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
1039113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$513.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$513.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.00
|
| Rate for Payer: Health EOS Commercial |
$491.40
|
| Rate for Payer: HFN Commercial |
$513.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.95
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$513.00
|
| Rate for Payer: Quartz Beloit One Network |
$237.60
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
Glutamic Acid Decarboxylase-65 Antibody
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
1039113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$264.60 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$324.00
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
Glutamic Acid Decarboxylase-65 Antibody
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
1039113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$496.80 |
| Rate for Payer: Aetna Commercial |
$486.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.40
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.54
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$496.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.18
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$480.60
|
| Rate for Payer: HFN Commercial |
$496.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$432.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$496.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$264.60
|
| Rate for Payer: Quartz Commercial |
$351.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$73.60
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare PPO |
$405.00
|
| Rate for Payer: WEA Trust Commercial |
$297.00
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$399.98
|
|
|
GOLD PROBE BICAP 10FR M00560100
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.20 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Aetna Managed Medicare |
$683.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.42
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,586.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.00
|
| Rate for Payer: The Alliance Commercial |
$9,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
GOLD PROBE BICAP 10FR M00560100
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$2,244.80 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
GOLD PROBE BICAP 7FR M00560070
|
Facility
|
IP
|
$2,534.00
|
|
| Hospital Charge Code |
2973011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,241.66 |
| Max. Negotiated Rate |
$2,331.28 |
| Rate for Payer: Aetna Commercial |
$2,280.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,179.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,343.02
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cigna Commercial |
$2,331.28
|
| Rate for Payer: Health EOS Commercial |
$2,255.26
|
| Rate for Payer: HFN Commercial |
$2,331.28
|
| Rate for Payer: Multiplan Commercial |
$2,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,520.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,331.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,241.66
|
| Rate for Payer: Quartz Commercial |
$1,520.40
|
| Rate for Payer: WEA Trust Commercial |
$1,393.70
|
| Rate for Payer: WPS Commercial |
$1,876.93
|
|
|
GOLD PROBE BICAP 7FR M00560070
|
Facility
|
OP
|
$2,534.00
|
|
| Hospital Charge Code |
2973011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$709.52 |
| Max. Negotiated Rate |
$10,136.00 |
| Rate for Payer: Aetna Commercial |
$2,280.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,179.24
|
| Rate for Payer: Aetna Managed Medicare |
$709.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,647.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,267.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,343.02
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cigna Commercial |
$2,331.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,418.03
|
| Rate for Payer: Health EOS Commercial |
$2,255.26
|
| Rate for Payer: HFN Commercial |
$2,331.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,900.50
|
| Rate for Payer: Multiplan Commercial |
$2,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,520.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,331.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,241.66
|
| Rate for Payer: Quartz Commercial |
$1,647.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,520.40
|
| Rate for Payer: The Alliance Commercial |
$10,136.00
|
| Rate for Payer: WEA Trust Commercial |
$1,393.70
|
| Rate for Payer: WPS Commercial |
$1,876.93
|
|
|
Golimumab Level
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5502668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$272.44 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$333.60
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
Golimumab Level
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5502668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$528.20 |
| Rate for Payer: Aetna Commercial |
$528.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$528.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.60
|
| Rate for Payer: Health EOS Commercial |
$505.96
|
| Rate for Payer: HFN Commercial |
$528.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$528.20
|
| Rate for Payer: Quartz Beloit One Network |
$244.64
|
| Rate for Payer: Quartz Commercial |
$316.92
|
| Rate for Payer: The Alliance Commercial |
$278.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
Golimumab Level
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5502668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$511.52 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$417.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
GONIOTOMY
|
Facility
|
OP
|
$16,074.84
|
|
|
Service Code
|
CPT 65820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,018.71 |
| Max. Negotiated Rate |
$16,074.84 |
| Rate for Payer: Aetna Managed Medicare |
$4,018.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$4,018.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,018.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,018.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,018.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,018.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,949.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,018.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,018.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,018.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,018.71
|
| Rate for Payer: NAPHCARE Commercial |
$6,028.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4,018.71
|
| Rate for Payer: The Alliance Commercial |
$16,074.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,018.71
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$4,018.71
|
|
|
Goserelin Acetate Implant J9202
|
Facility
|
IP
|
$3,564.00
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
4163762
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,746.36 |
| Max. Negotiated Rate |
$3,278.88 |
| Rate for Payer: Aetna Commercial |
$3,207.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,065.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.92
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,278.88
|
| Rate for Payer: Health EOS Commercial |
$3,171.96
|
| Rate for Payer: HFN Commercial |
$3,278.88
|
| Rate for Payer: Multiplan Commercial |
$2,851.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,138.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,278.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,746.36
|
| Rate for Payer: Quartz Commercial |
$2,138.40
|
| Rate for Payer: WEA Trust Commercial |
$1,960.20
|
| Rate for Payer: WPS Commercial |
$2,639.85
|
|
|
Goserelin Acetate Implant J9202
|
Facility
|
OP
|
$3,564.00
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
4163762
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$609.01 |
| Max. Negotiated Rate |
$3,278.88 |
| Rate for Payer: Aetna Commercial |
$3,207.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,065.04
|
| Rate for Payer: Aetna Managed Medicare |
$609.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,316.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,782.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,710.72
|
| Rate for Payer: Anthem Medicare Advantage |
$609.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$609.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$609.01
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,278.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$609.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$792.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$609.01
|
| Rate for Payer: Health EOS Commercial |
$3,171.96
|
| Rate for Payer: HFN Commercial |
$3,278.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,265.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$609.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$609.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$609.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$609.01
|
| Rate for Payer: Multiplan Commercial |
$2,851.20
|
| Rate for Payer: NAPHCARE Commercial |
$913.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,278.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,746.36
|
| Rate for Payer: Quartz Commercial |
$2,316.60
|
| Rate for Payer: Quartz Medicare Advantage |
$609.01
|
| Rate for Payer: The Alliance Commercial |
$2,436.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$609.01
|
| Rate for Payer: WEA Trust Commercial |
$1,960.20
|
| Rate for Payer: Wellcare Medicare |
$609.01
|
| Rate for Payer: WPS Commercial |
$1,498.35
|
|
|
Goserelin Acetate Implant J9202
|
Professional
|
Both
|
$3,564.00
|
|
|
Service Code
|
HCPCS J9202
|
| Hospital Charge Code |
4163762
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$599.34 |
| Max. Negotiated Rate |
$3,385.80 |
| Rate for Payer: Aetna Commercial |
$3,385.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,065.04
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,385.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,782.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$599.34
|
| Rate for Payer: Health EOS Commercial |
$3,243.24
|
| Rate for Payer: HFN Commercial |
$3,385.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$785.83
|
| Rate for Payer: Multiplan Commercial |
$2,851.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,385.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,568.16
|
| Rate for Payer: Quartz Commercial |
$2,031.48
|
| Rate for Payer: The Alliance Commercial |
$1,782.00
|
| Rate for Payer: WEA Trust Commercial |
$1,960.20
|
| Rate for Payer: WPS Commercial |
$1,498.35
|
|
|
GOWN AERO CHAMBER XXL XLONG 44679
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
2963125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
GOWN AERO CHAMBER XXL XLONG 44679
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
2963125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Aetna Managed Medicare |
$50.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$117.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$90.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.73
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$117.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.00
|
| Rate for Payer: The Alliance Commercial |
$720.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
GOWN ISOLATION UNIVERSAL SIZE GOWN K-C69979
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
2969239
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.96 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$15.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.90
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$34.20
|
| Rate for Payer: The Alliance Commercial |
$228.00
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
GOWN ISOLATION UNIVERSAL SIZE GOWN K-C69979
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
2969239
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
GOWN LARGE STERILE 95111
|
Facility
|
OP
|
$90.00
|
|
| Hospital Charge Code |
2962815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.20 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$25.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.50
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$58.50
|
| Rate for Payer: Quartz Medicare Advantage |
$54.00
|
| Rate for Payer: The Alliance Commercial |
$360.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
GOWN LARGE STERILE 95111
|
Facility
|
IP
|
$90.00
|
|
| Hospital Charge Code |
2962815
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
