|
.Hepatitis C RNA w/Rfx NS5a Drug Resist
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5246606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$668.36 |
| Max. Negotiated Rate |
$1,443.05 |
| Rate for Payer: Aetna Commercial |
$1,443.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.34
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,443.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$759.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.40
|
| Rate for Payer: Health EOS Commercial |
$1,382.29
|
| Rate for Payer: HFN Commercial |
$1,443.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$908.80
|
| Rate for Payer: Multiplan Commercial |
$1,215.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,443.05
|
| Rate for Payer: Quartz Beloit One Network |
$668.36
|
| Rate for Payer: Quartz Commercial |
$865.83
|
| Rate for Payer: The Alliance Commercial |
$759.50
|
| Rate for Payer: WEA Trust Commercial |
$835.45
|
| Rate for Payer: WPS Commercial |
$1,125.12
|
|
|
.Hepatitis C RNA w/Rfx NS5a Drug Resist
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5246606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$744.31 |
| Max. Negotiated Rate |
$1,397.48 |
| Rate for Payer: Aetna Commercial |
$1,367.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.07
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,397.48
|
| Rate for Payer: Health EOS Commercial |
$1,351.91
|
| Rate for Payer: HFN Commercial |
$1,397.48
|
| Rate for Payer: Multiplan Commercial |
$1,215.20
|
| Rate for Payer: NAPHCARE Commercial |
$911.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.48
|
| Rate for Payer: Quartz Beloit One Network |
$744.31
|
| Rate for Payer: Quartz Commercial |
$911.40
|
| Rate for Payer: WEA Trust Commercial |
$835.45
|
| Rate for Payer: WPS Commercial |
$1,125.12
|
|
|
.Hepatitis C Viral RNA Genotype, LIPA
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4494993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$1,029.80 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Aetna Managed Medicare |
$257.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$965.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$427.37
|
| Rate for Payer: Anthem Medicaid |
$266.02
|
| Rate for Payer: Anthem Medicare Advantage |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$257.45
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$257.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$266.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.46
|
| Rate for Payer: Dean Health Medicaid |
$266.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$257.45
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$266.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$257.45
|
| Rate for Payer: Managed Health Services Medicaid |
$276.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$257.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$257.45
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$266.02
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$163.15
|
| Rate for Payer: Quartz Medicare Advantage |
$257.45
|
| Rate for Payer: The Alliance Commercial |
$1,029.80
|
| Rate for Payer: United Healthcare Medicaid |
$266.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare PPO |
$188.25
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: Wellcare Medicare |
$257.45
|
| Rate for Payer: WMAP Medicaid |
$266.02
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
.Hepatitis C Viral RNA Genotype, LIPA
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4494993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$230.92 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$150.60
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
.Hepatitis C Viral RNA Genotype, LIPA
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4494993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.44 |
| Max. Negotiated Rate |
$908.80 |
| Rate for Payer: Aetna Commercial |
$238.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$238.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.60
|
| Rate for Payer: Health EOS Commercial |
$228.41
|
| Rate for Payer: HFN Commercial |
$238.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$908.80
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: Preferred Network Access Commercial |
$238.45
|
| Rate for Payer: Quartz Beloit One Network |
$110.44
|
| Rate for Payer: Quartz Commercial |
$143.07
|
| Rate for Payer: The Alliance Commercial |
$125.50
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
Hepatitis D Antibody IgM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
977973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.16 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.49
|
| Rate for Payer: Anthem Medicaid |
$17.73
|
| Rate for Payer: Anthem Medicare Advantage |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.16
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.28
|
| Rate for Payer: Dean Health Medicaid |
$17.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.16
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.16
|
| Rate for Payer: Managed Health Services Medicaid |
$18.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.74
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.73
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$188.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.16
|
| Rate for Payer: The Alliance Commercial |
$68.64
|
| Rate for Payer: United Healthcare Medicaid |
$17.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.16
|
| Rate for Payer: United Healthcare PPO |
$217.50
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: Wellcare Medicare |
$17.16
|
| Rate for Payer: WMAP Medicaid |
$17.73
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
Hepatitis D Antibody IgM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
977973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
Hepatitis D Antibody IgM
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
977973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.57 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$275.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.00
|
| Rate for Payer: Health EOS Commercial |
$263.90
|
| Rate for Payer: HFN Commercial |
$275.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.57
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Preferred Network Access Commercial |
$275.50
|
| Rate for Payer: Quartz Beloit One Network |
$127.60
|
| Rate for Payer: Quartz Commercial |
$165.30
|
| Rate for Payer: The Alliance Commercial |
$145.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
Hepatitis E Antibody, IgG & IgM
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1039149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Hepatitis E Antibody, IgG & IgM
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1039149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$211.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$211.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.80
|
| Rate for Payer: Health EOS Commercial |
$202.93
|
| Rate for Payer: HFN Commercial |
$211.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Preferred Network Access Commercial |
$211.85
|
| Rate for Payer: Quartz Beloit One Network |
$98.12
|
| Rate for Payer: Quartz Commercial |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$111.50
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Hepatitis E Antibody, IgG & IgM
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1039149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Hepatitis E IgM Antibody
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2942913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Hepatitis E IgM Antibody
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2942913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$209.25
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Hepatitis E IgM Antibody
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2942913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$265.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.40
|
| Rate for Payer: Health EOS Commercial |
$253.89
|
| Rate for Payer: HFN Commercial |
$265.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: Preferred Network Access Commercial |
$265.05
|
| Rate for Payer: Quartz Beloit One Network |
$122.76
|
| Rate for Payer: Quartz Commercial |
$159.03
|
| Rate for Payer: The Alliance Commercial |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Hepatitis Vaccine Supplies (Peritoneal Dialysis)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3026464
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.40 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Hepatitis Vaccine Supplies (Peritoneal Dialysis)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3026464
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$45,772.00
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$16,464.68 |
| Max. Negotiated Rate |
$45,772.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,464.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,875.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,498.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,125.38
|
| Rate for Payer: Anthem Medicare Advantage |
$16,464.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,464.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,464.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,464.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,001.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,464.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,337.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,464.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,464.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,464.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,464.68
|
| Rate for Payer: NAPHCARE Commercial |
$24,697.02
|
| Rate for Payer: Quartz Medicare Advantage |
$16,464.68
|
| Rate for Payer: The Alliance Commercial |
$45,772.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,464.68
|
| Rate for Payer: United Healthcare PPO |
$25,953.44
|
| Rate for Payer: Wellcare Medicare |
$16,464.68
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$85,417.00
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$30,725.46 |
| Max. Negotiated Rate |
$85,417.00 |
| Rate for Payer: Aetna Managed Medicare |
$30,725.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67,136.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51,459.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48,889.60
|
| Rate for Payer: Anthem Medicare Advantage |
$30,725.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30,725.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30,725.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30,725.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54,271.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30,725.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62,415.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30,725.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30,725.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30,725.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30,725.46
|
| Rate for Payer: NAPHCARE Commercial |
$46,088.19
|
| Rate for Payer: Quartz Medicare Advantage |
$30,725.46
|
| Rate for Payer: The Alliance Commercial |
$85,417.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,725.46
|
| Rate for Payer: United Healthcare PPO |
$48,591.34
|
| Rate for Payer: Wellcare Medicare |
$30,725.46
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,833.00
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$13,609.08 |
| Max. Negotiated Rate |
$37,833.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,609.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,581.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,674.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,541.98
|
| Rate for Payer: Anthem Medicare Advantage |
$13,609.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,609.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,609.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,609.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,913.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,609.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,514.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,609.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,609.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,609.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,609.08
|
| Rate for Payer: NAPHCARE Commercial |
$20,413.62
|
| Rate for Payer: Quartz Medicare Advantage |
$13,609.08
|
| Rate for Payer: The Alliance Commercial |
$37,833.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,609.08
|
| Rate for Payer: United Healthcare PPO |
$21,420.39
|
| Rate for Payer: Wellcare Medicare |
$13,609.08
|
|
|
Hep A Vaccine, Adult IM 90632
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
3382894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.28 |
| Max. Negotiated Rate |
$804.00 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Aetna Managed Medicare |
$56.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.33
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.75
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$120.60
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$130.65
|
| Rate for Payer: Quartz Medicare Advantage |
$120.60
|
| Rate for Payer: The Alliance Commercial |
$804.00
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$176.35
|
|
|
Hep A Vaccine, Adult IM 90632
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
3382894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$98.49 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$120.60
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$120.60
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
Hep A Vaccine, Adult IM 90632
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
3382894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.54 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$190.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.54
|
| Rate for Payer: Health EOS Commercial |
$182.91
|
| Rate for Payer: HFN Commercial |
$190.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.79
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$190.95
|
| Rate for Payer: Quartz Beloit One Network |
$88.44
|
| Rate for Payer: Quartz Commercial |
$114.57
|
| Rate for Payer: The Alliance Commercial |
$100.50
|
| Rate for Payer: United Healthcare Medicaid |
$94.71
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$176.35
|
|
|
Hep A Vacc, Ped/Addl, 2 Dose 90633
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
3397514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$132.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.40
|
| Rate for Payer: Health EOS Commercial |
$126.49
|
| Rate for Payer: HFN Commercial |
$132.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.38
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Preferred Network Access Commercial |
$132.05
|
| Rate for Payer: Quartz Beloit One Network |
$61.16
|
| Rate for Payer: Quartz Commercial |
$79.23
|
| Rate for Payer: The Alliance Commercial |
$69.50
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Hep A Vacc, Ped/Addl, 2 Dose 90633
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
3397514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Hep A Vacc, Ped/Addl, 2 Dose 90633
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
3397514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$556.00 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$38.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.25
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$83.40
|
| Rate for Payer: The Alliance Commercial |
$556.00
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
