|
Herpesvirus 6 Antibodies (IgG, IgM)
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075328
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$60.84
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Herpesvirus 6 IgG
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Herpesvirus 6 IgG
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$77.06 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$77.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$73.82
|
| Rate for Payer: HFN Commercial |
$77.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$77.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.69
|
| Rate for Payer: Quartz Commercial |
$46.24
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Herpesvirus 6 IgG
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$60.84
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Herpesvirus Interpretation
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Herpesvirus Interpretation
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$77.06 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$77.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$73.82
|
| Rate for Payer: HFN Commercial |
$77.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$77.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.69
|
| Rate for Payer: Quartz Commercial |
$46.24
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Herpesvirus Interpretation
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
4075379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$60.84
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Heterophile Antibodies Screening POC
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 86308
|
| Hospital Charge Code |
2580840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$140.30 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$140.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$140.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$140.30
|
| Rate for Payer: Quartz Beloit One Network |
$64.98
|
| Rate for Payer: Quartz Commercial |
$84.18
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
Hexagonal Phase Confirmation
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
1039156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$215.38 |
| Rate for Payer: Aetna Commercial |
$215.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$18.70
|
| Rate for Payer: Anthem Medicare Advantage |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.70
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$215.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.70
|
| Rate for Payer: Health EOS Commercial |
$206.32
|
| Rate for Payer: HFN Commercial |
$215.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.70
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$28.05
|
| Rate for Payer: Preferred Network Access Commercial |
$215.38
|
| Rate for Payer: Quartz Beloit One Network |
$99.76
|
| Rate for Payer: Quartz Commercial |
$129.23
|
| Rate for Payer: Quartz Medicare Advantage |
$18.70
|
| Rate for Payer: The Alliance Commercial |
$73.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.70
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$82.28
|
|
|
Hexagonal Phase Confirmation
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
1039156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Hexagonal Phase Confirmation
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 85598
|
| Hospital Charge Code |
1039156
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$18.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.04
|
| Rate for Payer: Anthem Medicare Advantage |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.70
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.70
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.70
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$28.05
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$18.70
|
| Rate for Payer: The Alliance Commercial |
$74.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.70
|
| Rate for Payer: United Healthcare PPO |
$170.04
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: Wellcare Medicare |
$18.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
HFO nontorsion joint, prefab L3929
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
4506604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
HFO nontorsion joint, prefab L3929
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
4506604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$424.99 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$83.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$424.99
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
HFO nontorsion joint, prefab L3929
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
HCPCS L3929
|
| Hospital Charge Code |
4506604
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.25 |
| Max. Negotiated Rate |
$306.32 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$106.25
|
| Rate for Payer: Anthem Medicare Advantage |
$106.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.25
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.25
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$306.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$306.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.25
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$159.37
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$106.25
|
| Rate for Payer: The Alliance Commercial |
$292.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.25
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$185.93
|
|
|
HFO without joints pre ots L3924
|
Professional
|
Both
|
$260.00
|
|
|
Service Code
|
HCPCS L3924
|
| Hospital Charge Code |
4520628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.36 |
| Max. Negotiated Rate |
$323.98 |
| Rate for Payer: Aetna Commercial |
$256.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$112.36
|
| Rate for Payer: Anthem Medicare Advantage |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.36
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$256.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.36
|
| Rate for Payer: Health EOS Commercial |
$246.06
|
| Rate for Payer: HFN Commercial |
$256.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.36
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$168.54
|
| Rate for Payer: Preferred Network Access Commercial |
$256.88
|
| Rate for Payer: Quartz Beloit One Network |
$118.98
|
| Rate for Payer: Quartz Commercial |
$154.13
|
| Rate for Payer: Quartz Medicare Advantage |
$112.36
|
| Rate for Payer: The Alliance Commercial |
$308.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.36
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$196.63
|
|
|
HFO without joints pre ots L3924
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS L3924
|
| Hospital Charge Code |
4520628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.87 |
| Max. Negotiated Rate |
$449.45 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$75.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.32
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$162.24
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| Rate for Payer: Quartz Medicare Advantage |
$162.24
|
| Rate for Payer: The Alliance Commercial |
$449.45
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
HFO without joints pre ots L3924
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS L3924
|
| Hospital Charge Code |
4520628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
HFO w/o joints PF L3923
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
HCPCS L3923
|
| Hospital Charge Code |
4578709
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
HFO w/o joints PF L3923
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS L3923
|
| Hospital Charge Code |
4578709
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$323.98 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$112.36
|
| Rate for Payer: Anthem Medicare Advantage |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.36
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$119.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.36
|
| Rate for Payer: Health EOS Commercial |
$114.51
|
| Rate for Payer: HFN Commercial |
$119.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.36
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$168.54
|
| Rate for Payer: Preferred Network Access Commercial |
$119.55
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$71.73
|
| Rate for Payer: Quartz Medicare Advantage |
$112.36
|
| Rate for Payer: The Alliance Commercial |
$308.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.36
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$196.63
|
|
|
HFO w/o joints PF L3923
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
HCPCS L3923
|
| Hospital Charge Code |
4578709
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$28.87 |
| Max. Negotiated Rate |
$449.45 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$449.45
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Hib PRP-OMP 90647
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
5586187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.73 |
| Max. Negotiated Rate |
$121.52 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.75
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: The Alliance Commercial |
$63.96
|
| Rate for Payer: United Healthcare Medicaid |
$32.73
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Hib PRP-OMP 90647
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
5586187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$76.75
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Hib PRP-OMP 90647
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
5586187
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$35.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.59
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.94
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$76.75
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$83.15
|
| Rate for Payer: Quartz Medicare Advantage |
$76.75
|
| Rate for Payer: The Alliance Commercial |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Hib PRP-OMP 90647 VFC Charge
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
5586166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$46.95 |
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$20.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.00
|
| Rate for Payer: Health EOS Commercial |
$19.71
|
| Rate for Payer: HFN Commercial |
$20.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: Preferred Network Access Commercial |
$20.58
|
| Rate for Payer: Quartz Beloit One Network |
$9.53
|
| Rate for Payer: Quartz Commercial |
$12.35
|
| Rate for Payer: The Alliance Commercial |
$10.83
|
| Rate for Payer: United Healthcare Medicaid |
$32.73
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
Hib PRP-OMP 90647 VFC Charge
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90647
|
| Hospital Charge Code |
5586166
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.48
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.93
|
| Rate for Payer: Health EOS Commercial |
$19.28
|
| Rate for Payer: HFN Commercial |
$19.93
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: Preferred Network Access Commercial |
$19.93
|
| Rate for Payer: Quartz Beloit One Network |
$10.61
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
