|
Aluminum Level 24 Hour Urine
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
977863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$25.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.30
|
| Rate for Payer: Anthem Medicaid |
$26.33
|
| Rate for Payer: Anthem Medicare Advantage |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.48
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.33
|
| Rate for Payer: Dean Health Medicaid |
$26.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.48
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.48
|
| Rate for Payer: Managed Health Services Medicaid |
$27.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.48
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$38.22
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.33
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$25.48
|
| Rate for Payer: The Alliance Commercial |
$504.00
|
| Rate for Payer: United Healthcare Medicaid |
$26.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.48
|
| Rate for Payer: United Healthcare PPO |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$25.48
|
| Rate for Payer: WMAP Medicaid |
$26.33
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Alveolar Lavage - Bronchoscopy Charge
|
Facility
OP
|
$4,066.00
|
|
|
Service Code
|
CPT 31624
|
| Hospital Charge Code |
2990183
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.59 |
| Max. Negotiated Rate |
$6,240.63 |
| Rate for Payer: Aetna Commercial |
$3,659.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,496.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cigna Commercial |
$3,740.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Health EOS Commercial |
$3,618.74
|
| Rate for Payer: HFN Commercial |
$3,740.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: Multiplan Commercial |
$3,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,740.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.34
|
| Rate for Payer: Quartz Commercial |
$2,642.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$5,242.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$2,236.30
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
| Rate for Payer: WPS Commercial |
$3,011.69
|
|
|
Alveolar Lavage - Bronchoscopy Charge
|
Facility
IP
|
$4,066.00
|
|
|
Service Code
|
CPT 31624
|
| Hospital Charge Code |
2990183
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,992.34 |
| Max. Negotiated Rate |
$3,740.72 |
| Rate for Payer: Aetna Commercial |
$3,659.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,154.98
|
| Rate for Payer: Cash Price |
$1,219.80
|
| Rate for Payer: Cigna Commercial |
$3,740.72
|
| Rate for Payer: Health EOS Commercial |
$3,618.74
|
| Rate for Payer: HFN Commercial |
$3,740.72
|
| Rate for Payer: Multiplan Commercial |
$3,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,439.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,740.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,992.34
|
| Rate for Payer: Quartz Commercial |
$2,439.60
|
| Rate for Payer: WEA Trust Commercial |
$2,236.30
|
| Rate for Payer: WPS Commercial |
$3,011.69
|
|
|
ALVEOLECTOMY & ALVEOLOPLASTY
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959784
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
ALVEOLECTOMY & ALVEOLOPLASTY
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959784
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
AMBU BAG RESUSCITATOR INFANT-2YR. AMBU 540216030
|
Facility
OP
|
$409.00
|
|
| Hospital Charge Code |
2963016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$114.52 |
| Max. Negotiated Rate |
$1,636.00 |
| Rate for Payer: Aetna Commercial |
$368.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.74
|
| Rate for Payer: Aetna Managed Medicare |
$114.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$265.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$204.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.77
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$376.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.88
|
| Rate for Payer: Health EOS Commercial |
$364.01
|
| Rate for Payer: HFN Commercial |
$376.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$306.75
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: NAPHCARE Commercial |
$245.40
|
| Rate for Payer: Preferred Network Access Commercial |
$376.28
|
| Rate for Payer: Quartz Beloit One Network |
$200.41
|
| Rate for Payer: Quartz Commercial |
$265.85
|
| Rate for Payer: Quartz Medicare Advantage |
$245.40
|
| Rate for Payer: The Alliance Commercial |
$1,636.00
|
| Rate for Payer: WEA Trust Commercial |
$224.95
|
| Rate for Payer: WPS Commercial |
$302.95
|
|
|
AMBU BAG RESUSCITATOR INFANT-2YR. AMBU 540216030
|
Facility
IP
|
$409.00
|
|
| Hospital Charge Code |
2963016
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$200.41 |
| Max. Negotiated Rate |
$376.28 |
| Rate for Payer: Aetna Commercial |
$368.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.77
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$376.28
|
| Rate for Payer: Health EOS Commercial |
$364.01
|
| Rate for Payer: HFN Commercial |
$376.28
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: NAPHCARE Commercial |
$245.40
|
| Rate for Payer: Preferred Network Access Commercial |
$376.28
|
| Rate for Payer: Quartz Beloit One Network |
$200.41
|
| Rate for Payer: Quartz Commercial |
$245.40
|
| Rate for Payer: WEA Trust Commercial |
$224.95
|
| Rate for Payer: WPS Commercial |
$302.95
|
|
|
Ambulatory Recovery 4/Hours
|
Facility
IP
|
$309.00
|
|
| Hospital Charge Code |
3052553
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$151.41 |
| Max. Negotiated Rate |
$284.28 |
| Rate for Payer: Aetna Commercial |
$278.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.77
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$284.28
|
| Rate for Payer: Health EOS Commercial |
$275.01
|
| Rate for Payer: HFN Commercial |
$284.28
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: NAPHCARE Commercial |
$185.40
|
| Rate for Payer: Preferred Network Access Commercial |
$284.28
|
| Rate for Payer: Quartz Beloit One Network |
$151.41
|
| Rate for Payer: Quartz Commercial |
$185.40
|
| Rate for Payer: WEA Trust Commercial |
$169.95
|
| Rate for Payer: WPS Commercial |
$228.88
|
|
|
Ambulatory Recovery 4/Hours
|
Facility
OP
|
$309.00
|
|
| Hospital Charge Code |
3052553
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$86.52 |
| Max. Negotiated Rate |
$1,236.00 |
| Rate for Payer: Aetna Commercial |
$278.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.74
|
| Rate for Payer: Aetna Managed Medicare |
$86.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$154.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.77
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$284.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.92
|
| Rate for Payer: Health EOS Commercial |
$275.01
|
| Rate for Payer: HFN Commercial |
$284.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.75
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: NAPHCARE Commercial |
$185.40
|
| Rate for Payer: Preferred Network Access Commercial |
$284.28
|
| Rate for Payer: Quartz Beloit One Network |
$151.41
|
| Rate for Payer: Quartz Commercial |
$200.85
|
| Rate for Payer: Quartz Medicare Advantage |
$185.40
|
| Rate for Payer: The Alliance Commercial |
$1,236.00
|
| Rate for Payer: WEA Trust Commercial |
$169.95
|
| Rate for Payer: WPS Commercial |
$228.88
|
|
|
Ambulatory Recovery Charge
|
Facility
OP
|
$1,317.00
|
|
| Hospital Charge Code |
3243537
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$368.76 |
| Max. Negotiated Rate |
$5,268.00 |
| Rate for Payer: Aetna Commercial |
$1,185.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,132.62
|
| Rate for Payer: Aetna Managed Medicare |
$368.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$856.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$658.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$632.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$698.01
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Cigna Commercial |
$1,211.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.99
|
| Rate for Payer: Health EOS Commercial |
$1,172.13
|
| Rate for Payer: HFN Commercial |
$1,211.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$987.75
|
| Rate for Payer: Multiplan Commercial |
$1,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$790.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,211.64
|
| Rate for Payer: Quartz Beloit One Network |
$645.33
|
| Rate for Payer: Quartz Commercial |
$856.05
|
| Rate for Payer: Quartz Medicare Advantage |
$790.20
|
| Rate for Payer: The Alliance Commercial |
$5,268.00
|
| Rate for Payer: WEA Trust Commercial |
$724.35
|
| Rate for Payer: WPS Commercial |
$975.50
|
|
|
Ambulatory Recovery Charge
|
Facility
IP
|
$1,317.00
|
|
| Hospital Charge Code |
3243537
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$645.33 |
| Max. Negotiated Rate |
$1,211.64 |
| Rate for Payer: Aetna Commercial |
$1,185.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$698.01
|
| Rate for Payer: Cash Price |
$395.10
|
| Rate for Payer: Cigna Commercial |
$1,211.64
|
| Rate for Payer: Health EOS Commercial |
$1,172.13
|
| Rate for Payer: HFN Commercial |
$1,211.64
|
| Rate for Payer: Multiplan Commercial |
$1,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$790.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,211.64
|
| Rate for Payer: Quartz Beloit One Network |
$645.33
|
| Rate for Payer: Quartz Commercial |
$790.20
|
| Rate for Payer: WEA Trust Commercial |
$724.35
|
| Rate for Payer: WPS Commercial |
$975.50
|
|
|
Ambulatory Recovery Charge-Ped
|
Facility
OP
|
$1,315.00
|
|
| Hospital Charge Code |
3243534
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$368.20 |
| Max. Negotiated Rate |
$5,260.00 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,130.90
|
| Rate for Payer: Aetna Managed Medicare |
$368.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$854.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$657.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$735.87
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$986.25
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$854.75
|
| Rate for Payer: Quartz Medicare Advantage |
$789.00
|
| Rate for Payer: The Alliance Commercial |
$5,260.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
Ambulatory Recovery Charge-Ped
|
Facility
IP
|
$1,315.00
|
|
| Hospital Charge Code |
3243534
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$644.35 |
| Max. Negotiated Rate |
$1,209.80 |
| Rate for Payer: Aetna Commercial |
$1,183.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$696.95
|
| Rate for Payer: Cash Price |
$394.50
|
| Rate for Payer: Cigna Commercial |
$1,209.80
|
| Rate for Payer: Health EOS Commercial |
$1,170.35
|
| Rate for Payer: HFN Commercial |
$1,209.80
|
| Rate for Payer: Multiplan Commercial |
$1,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$789.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,209.80
|
| Rate for Payer: Quartz Beloit One Network |
$644.35
|
| Rate for Payer: Quartz Commercial |
$789.00
|
| Rate for Payer: WEA Trust Commercial |
$723.25
|
| Rate for Payer: WPS Commercial |
$974.02
|
|
|
Ambulatory Recovery-Minor
|
Facility
OP
|
$234.00
|
|
| Hospital Charge Code |
3243536
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$65.52 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$65.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$112.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.50
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$140.40
|
| Rate for Payer: The Alliance Commercial |
$936.00
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Ambulatory Recovery-Minor
|
Facility
IP
|
$234.00
|
|
| Hospital Charge Code |
3243536
|
|
Hospital Revenue Code
|
710
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$140.40
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Ambulatory surgical boot eac L3260
|
Professional
|
$72.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
3133577
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.20
|
| Rate for Payer: Health EOS Commercial |
$65.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.92
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$68.40
|
| Rate for Payer: Quartz Beloit One Network |
$31.68
|
| Rate for Payer: Quartz Commercial |
$41.04
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Ambulatory surgical boot eac L3260
|
Facility
IP
|
$72.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
3133577
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Ambulatory surgical boot eac L3260
|
Facility
OP
|
$72.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
3133577
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.00
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.20
|
| Rate for Payer: The Alliance Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Amikacin
|
Facility
OP
|
$331.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
3595599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$1,324.00 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.66
|
| Rate for Payer: Aetna Managed Medicare |
$15.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.03
|
| Rate for Payer: Anthem Medicaid |
$15.58
|
| Rate for Payer: Anthem Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.08
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$304.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.58
|
| Rate for Payer: Dean Health Medicaid |
$15.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.08
|
| Rate for Payer: Health EOS Commercial |
$294.59
|
| Rate for Payer: HFN Commercial |
$304.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.08
|
| Rate for Payer: Managed Health Services Medicaid |
$16.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: NAPHCARE Commercial |
$22.62
|
| Rate for Payer: Preferred Network Access Commercial |
$304.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.58
|
| Rate for Payer: Quartz Beloit One Network |
$162.19
|
| Rate for Payer: Quartz Commercial |
$215.15
|
| Rate for Payer: Quartz Medicare Advantage |
$15.08
|
| Rate for Payer: The Alliance Commercial |
$1,324.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare PPO |
$248.25
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
| Rate for Payer: WMAP Medicaid |
$15.58
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Amikacin
|
Facility
IP
|
$331.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
3595599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.19 |
| Max. Negotiated Rate |
$304.52 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.43
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$304.52
|
| Rate for Payer: Health EOS Commercial |
$294.59
|
| Rate for Payer: HFN Commercial |
$304.52
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: NAPHCARE Commercial |
$198.60
|
| Rate for Payer: Preferred Network Access Commercial |
$304.52
|
| Rate for Payer: Quartz Beloit One Network |
$162.19
|
| Rate for Payer: Quartz Commercial |
$198.60
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Amikacin
|
Professional
|
$331.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
3595599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna Commercial |
$314.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.66
|
| Rate for Payer: Aetna Managed Medicare |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.08
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$314.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.08
|
| Rate for Payer: Health EOS Commercial |
$301.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Preferred Network Access Commercial |
$314.45
|
| Rate for Payer: Quartz Beloit One Network |
$145.64
|
| Rate for Payer: Quartz Commercial |
$188.67
|
| Rate for Payer: Quartz Medicare Advantage |
$15.08
|
| Rate for Payer: The Alliance Commercial |
$59.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: WPS Commercial |
$66.35
|
|
|
Amikacin Level Peak
|
Facility
IP
|
$219.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
633646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$201.48 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$131.40
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$131.40
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
Amikacin Level Peak
|
Professional
|
$219.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
633646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Aetna Commercial |
$208.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Aetna Managed Medicare |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.08
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$208.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.08
|
| Rate for Payer: Health EOS Commercial |
$199.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.05
|
| Rate for Payer: Quartz Beloit One Network |
$96.36
|
| Rate for Payer: Quartz Commercial |
$124.83
|
| Rate for Payer: Quartz Medicare Advantage |
$15.08
|
| Rate for Payer: The Alliance Commercial |
$59.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$66.35
|
|
|
Amikacin Level Peak
|
Facility
OP
|
$219.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
633646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$876.00 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Aetna Managed Medicare |
$15.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.03
|
| Rate for Payer: Anthem Medicaid |
$15.58
|
| Rate for Payer: Anthem Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.08
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.58
|
| Rate for Payer: Dean Health Medicaid |
$15.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.08
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.08
|
| Rate for Payer: Managed Health Services Medicaid |
$16.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.62
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.58
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$142.35
|
| Rate for Payer: Quartz Medicare Advantage |
$15.08
|
| Rate for Payer: The Alliance Commercial |
$876.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare PPO |
$164.25
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
| Rate for Payer: WMAP Medicaid |
$15.58
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
Amikacin Level Trough
|
Facility
OP
|
$219.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
633647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$876.00 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Aetna Managed Medicare |
$15.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.03
|
| Rate for Payer: Anthem Medicaid |
$15.58
|
| Rate for Payer: Anthem Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.08
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.58
|
| Rate for Payer: Dean Health Medicaid |
$15.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.08
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.08
|
| Rate for Payer: Managed Health Services Medicaid |
$16.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.62
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.58
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$142.35
|
| Rate for Payer: Quartz Medicare Advantage |
$15.08
|
| Rate for Payer: The Alliance Commercial |
$876.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare PPO |
$164.25
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
| Rate for Payer: WMAP Medicaid |
$15.58
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
