|
Impression casting ft S0395
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
HCPCS S0395
|
| Hospital Charge Code |
3133687
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
IMRT Radiotherapy Plan
|
Facility
|
OP
|
$11,981.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
3040380
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,369.56 |
| Max. Negotiated Rate |
$11,022.52 |
| Rate for Payer: Aetna Commercial |
$10,782.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,303.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,369.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,135.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,108.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,903.25
|
| Rate for Payer: Anthem Medicare Advantage |
$1,369.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,349.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,369.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,369.56
|
| Rate for Payer: Cash Price |
$3,594.30
|
| Rate for Payer: Cash Price |
$3,594.30
|
| Rate for Payer: Cigna Commercial |
$11,022.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,369.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,704.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,369.56
|
| Rate for Payer: Health EOS Commercial |
$10,663.09
|
| Rate for Payer: HFN Commercial |
$11,022.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,094.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,369.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,369.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,369.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,369.56
|
| Rate for Payer: Multiplan Commercial |
$9,584.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,054.34
|
| Rate for Payer: Preferred Network Access Commercial |
$11,022.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,870.69
|
| Rate for Payer: Quartz Commercial |
$7,787.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,369.56
|
| Rate for Payer: The Alliance Commercial |
$5,478.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,369.56
|
| Rate for Payer: United Healthcare PPO |
$8,985.75
|
| Rate for Payer: WEA Trust Commercial |
$6,589.55
|
| Rate for Payer: Wellcare Medicare |
$1,369.56
|
| Rate for Payer: WPS Commercial |
$8,874.33
|
|
|
IMRT Radiotherapy Plan
|
Facility
|
IP
|
$11,981.00
|
|
|
Service Code
|
CPT 77301
|
| Hospital Charge Code |
3040380
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,870.69 |
| Max. Negotiated Rate |
$11,022.52 |
| Rate for Payer: Aetna Commercial |
$10,782.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,303.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,349.93
|
| Rate for Payer: Cash Price |
$3,594.30
|
| Rate for Payer: Cigna Commercial |
$11,022.52
|
| Rate for Payer: Health EOS Commercial |
$10,663.09
|
| Rate for Payer: HFN Commercial |
$11,022.52
|
| Rate for Payer: Multiplan Commercial |
$9,584.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,188.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11,022.52
|
| Rate for Payer: Quartz Beloit One Network |
$5,870.69
|
| Rate for Payer: Quartz Commercial |
$7,188.60
|
| Rate for Payer: WEA Trust Commercial |
$6,589.55
|
| Rate for Payer: WPS Commercial |
$8,874.33
|
|
|
IMRT Treatment Complex (all other areas)
|
Facility
|
IP
|
$5,709.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
3040396
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,797.41 |
| Max. Negotiated Rate |
$5,252.28 |
| Rate for Payer: Aetna Commercial |
$5,138.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,909.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,025.77
|
| Rate for Payer: Cash Price |
$1,712.70
|
| Rate for Payer: Cigna Commercial |
$5,252.28
|
| Rate for Payer: Health EOS Commercial |
$5,081.01
|
| Rate for Payer: HFN Commercial |
$5,252.28
|
| Rate for Payer: Multiplan Commercial |
$4,567.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,425.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,252.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,797.41
|
| Rate for Payer: Quartz Commercial |
$3,425.40
|
| Rate for Payer: WEA Trust Commercial |
$3,139.95
|
| Rate for Payer: WPS Commercial |
$4,228.66
|
|
|
IMRT Treatment Complex (all other areas)
|
Facility
|
OP
|
$5,709.00
|
|
|
Service Code
|
CPT 77386
|
| Hospital Charge Code |
3040396
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$581.84 |
| Max. Negotiated Rate |
$5,252.28 |
| Rate for Payer: Aetna Commercial |
$5,138.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,909.74
|
| Rate for Payer: Aetna Managed Medicare |
$581.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,181.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,745.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,658.24
|
| Rate for Payer: Anthem Medicare Advantage |
$581.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,025.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$581.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$581.84
|
| Rate for Payer: Cash Price |
$1,712.70
|
| Rate for Payer: Cash Price |
$1,712.70
|
| Rate for Payer: Cigna Commercial |
$5,252.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$581.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,194.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$581.84
|
| Rate for Payer: Health EOS Commercial |
$5,081.01
|
| Rate for Payer: HFN Commercial |
$5,252.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,164.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$581.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$581.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$581.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$581.84
|
| Rate for Payer: Multiplan Commercial |
$4,567.20
|
| Rate for Payer: NAPHCARE Commercial |
$872.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,252.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,797.41
|
| Rate for Payer: Quartz Commercial |
$3,710.85
|
| Rate for Payer: Quartz Medicare Advantage |
$581.84
|
| Rate for Payer: The Alliance Commercial |
$2,327.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.84
|
| Rate for Payer: United Healthcare PPO |
$4,281.75
|
| Rate for Payer: WEA Trust Commercial |
$3,139.95
|
| Rate for Payer: Wellcare Medicare |
$581.84
|
| Rate for Payer: WPS Commercial |
$4,228.66
|
|
|
IMRT Treatment Simplex (Breast & Prostate)
|
Facility
|
IP
|
$6,079.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
3040408
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$2,978.71 |
| Max. Negotiated Rate |
$5,592.68 |
| Rate for Payer: Aetna Commercial |
$5,471.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,227.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,221.87
|
| Rate for Payer: Cash Price |
$1,823.70
|
| Rate for Payer: Cigna Commercial |
$5,592.68
|
| Rate for Payer: Health EOS Commercial |
$5,410.31
|
| Rate for Payer: HFN Commercial |
$5,592.68
|
| Rate for Payer: Multiplan Commercial |
$4,863.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,647.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,592.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,978.71
|
| Rate for Payer: Quartz Commercial |
$3,647.40
|
| Rate for Payer: WEA Trust Commercial |
$3,343.45
|
| Rate for Payer: WPS Commercial |
$4,502.72
|
|
|
IMRT Treatment Simplex (Breast & Prostate)
|
Facility
|
OP
|
$6,079.00
|
|
|
Service Code
|
CPT 77385
|
| Hospital Charge Code |
3040408
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$581.84 |
| Max. Negotiated Rate |
$5,592.68 |
| Rate for Payer: Aetna Commercial |
$5,471.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,227.94
|
| Rate for Payer: Aetna Managed Medicare |
$581.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,181.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,745.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,658.24
|
| Rate for Payer: Anthem Medicare Advantage |
$581.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,221.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$581.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$581.84
|
| Rate for Payer: Cash Price |
$1,823.70
|
| Rate for Payer: Cash Price |
$1,823.70
|
| Rate for Payer: Cigna Commercial |
$5,592.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$581.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,401.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$581.84
|
| Rate for Payer: Health EOS Commercial |
$5,410.31
|
| Rate for Payer: HFN Commercial |
$5,592.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,164.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$581.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$581.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$581.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$581.84
|
| Rate for Payer: Multiplan Commercial |
$4,863.20
|
| Rate for Payer: NAPHCARE Commercial |
$872.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,592.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,978.71
|
| Rate for Payer: Quartz Commercial |
$3,951.35
|
| Rate for Payer: Quartz Medicare Advantage |
$581.84
|
| Rate for Payer: The Alliance Commercial |
$2,327.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$581.84
|
| Rate for Payer: United Healthcare PPO |
$4,559.25
|
| Rate for Payer: WEA Trust Commercial |
$3,343.45
|
| Rate for Payer: Wellcare Medicare |
$581.84
|
| Rate for Payer: WPS Commercial |
$4,502.72
|
|
|
IM/Subsq Injection
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
3040225
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
|
IM/Subsq Injection
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
3040225
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.04
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| 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 |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| 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 |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| 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 |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| 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 |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
IM/Subsq Injection - 96372
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
5516709
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
|
IM/Subsq Injection - 96372
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 96372
|
| Hospital Charge Code |
5516709
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.04
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| 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 |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| 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 |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| 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 |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| 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 |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
In-111 Oxyquinoline(WBC labeling)
|
Facility
|
IP
|
$11,190.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
1486828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5,483.10 |
| Max. Negotiated Rate |
$10,294.80 |
| Rate for Payer: Aetna Commercial |
$10,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,623.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,930.70
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cigna Commercial |
$10,294.80
|
| Rate for Payer: Health EOS Commercial |
$9,959.10
|
| Rate for Payer: HFN Commercial |
$10,294.80
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,294.80
|
| Rate for Payer: Quartz Beloit One Network |
$5,483.10
|
| Rate for Payer: Quartz Commercial |
$6,714.00
|
| Rate for Payer: WEA Trust Commercial |
$6,154.50
|
| Rate for Payer: WPS Commercial |
$8,288.43
|
|
|
In-111 Oxyquinoline(WBC labeling)
|
Facility
|
OP
|
$11,190.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
1486828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,133.20 |
| Max. Negotiated Rate |
$44,760.00 |
| Rate for Payer: Aetna Commercial |
$10,071.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,623.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,133.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,273.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,595.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,371.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,930.70
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cigna Commercial |
$10,294.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,261.92
|
| Rate for Payer: Health EOS Commercial |
$9,959.10
|
| Rate for Payer: HFN Commercial |
$10,294.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,392.50
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,714.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,294.80
|
| Rate for Payer: Quartz Beloit One Network |
$5,483.10
|
| Rate for Payer: Quartz Commercial |
$7,273.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,714.00
|
| Rate for Payer: The Alliance Commercial |
$44,760.00
|
| Rate for Payer: WEA Trust Commercial |
$6,154.50
|
| Rate for Payer: WPS Commercial |
$8,288.43
|
|
|
In-111 Oxyquinoline(WBC labeling)
|
Professional
|
Both
|
$11,190.00
|
|
|
Service Code
|
HCPCS A9570
|
| Hospital Charge Code |
1486828
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,923.60 |
| Max. Negotiated Rate |
$10,630.50 |
| Rate for Payer: Aetna Commercial |
$10,630.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,623.40
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cash Price |
$3,357.00
|
| Rate for Payer: Cigna Commercial |
$10,630.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,595.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,714.00
|
| Rate for Payer: Health EOS Commercial |
$10,182.90
|
| Rate for Payer: HFN Commercial |
$10,630.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,265.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,265.59
|
| Rate for Payer: Multiplan Commercial |
$8,952.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,630.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,923.60
|
| Rate for Payer: Quartz Commercial |
$6,378.30
|
| Rate for Payer: The Alliance Commercial |
$5,595.00
|
| Rate for Payer: WEA Trust Commercial |
$6,154.50
|
| Rate for Payer: WPS Commercial |
$8,288.43
|
|
|
In-111 Pentetreotide(Octreoscan)
|
Professional
|
Both
|
$5,883.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
1486842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,588.52 |
| Max. Negotiated Rate |
$9,944.35 |
| Rate for Payer: Aetna Commercial |
$5,588.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,059.38
|
| Rate for Payer: Cash Price |
$1,764.90
|
| Rate for Payer: Cash Price |
$1,764.90
|
| Rate for Payer: Cigna Commercial |
$5,588.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,941.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,529.80
|
| Rate for Payer: Health EOS Commercial |
$5,353.53
|
| Rate for Payer: HFN Commercial |
$5,588.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,944.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,944.35
|
| Rate for Payer: Multiplan Commercial |
$4,706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,588.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,588.52
|
| Rate for Payer: Quartz Commercial |
$3,353.31
|
| Rate for Payer: The Alliance Commercial |
$2,941.50
|
| Rate for Payer: WEA Trust Commercial |
$3,235.65
|
| Rate for Payer: WPS Commercial |
$4,357.54
|
|
|
In-111 Pentetreotide(Octreoscan)
|
Facility
|
IP
|
$5,883.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
1486842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,882.67 |
| Max. Negotiated Rate |
$5,412.36 |
| Rate for Payer: Aetna Commercial |
$5,294.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,059.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,117.99
|
| Rate for Payer: Cash Price |
$1,764.90
|
| Rate for Payer: Cigna Commercial |
$5,412.36
|
| Rate for Payer: Health EOS Commercial |
$5,235.87
|
| Rate for Payer: HFN Commercial |
$5,412.36
|
| Rate for Payer: Multiplan Commercial |
$4,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,412.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,882.67
|
| Rate for Payer: Quartz Commercial |
$3,529.80
|
| Rate for Payer: WEA Trust Commercial |
$3,235.65
|
| Rate for Payer: WPS Commercial |
$4,357.54
|
|
|
In-111 Pentetreotide(Octreoscan)
|
Facility
|
OP
|
$5,883.00
|
|
|
Service Code
|
HCPCS A9572
|
| Hospital Charge Code |
1486842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,647.24 |
| Max. Negotiated Rate |
$23,532.00 |
| Rate for Payer: Aetna Commercial |
$5,294.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,059.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,647.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,823.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,941.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,823.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,117.99
|
| Rate for Payer: Cash Price |
$1,764.90
|
| Rate for Payer: Cigna Commercial |
$5,412.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,292.13
|
| Rate for Payer: Health EOS Commercial |
$5,235.87
|
| Rate for Payer: HFN Commercial |
$5,412.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,412.25
|
| Rate for Payer: Multiplan Commercial |
$4,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,529.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,412.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,882.67
|
| Rate for Payer: Quartz Commercial |
$3,823.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,529.80
|
| Rate for Payer: The Alliance Commercial |
$23,532.00
|
| Rate for Payer: WEA Trust Commercial |
$3,235.65
|
| Rate for Payer: WPS Commercial |
$4,357.54
|
|
|
In-111 Satumomab pendetide
|
Professional
|
Both
|
$6,376.00
|
|
|
Service Code
|
HCPCS A4642
|
| Hospital Charge Code |
1486844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,148.48 |
| Max. Negotiated Rate |
$6,057.20 |
| Rate for Payer: Aetna Commercial |
$6,057.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,483.36
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cigna Commercial |
$6,057.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,188.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,825.60
|
| Rate for Payer: Health EOS Commercial |
$5,802.16
|
| Rate for Payer: HFN Commercial |
$6,057.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,148.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,148.48
|
| Rate for Payer: Multiplan Commercial |
$5,100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,057.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,805.44
|
| Rate for Payer: Quartz Commercial |
$3,634.32
|
| Rate for Payer: The Alliance Commercial |
$3,188.00
|
| Rate for Payer: WEA Trust Commercial |
$3,506.80
|
| Rate for Payer: WPS Commercial |
$4,722.70
|
|
|
In-111 Satumomab pendetide
|
Facility
|
OP
|
$6,376.00
|
|
|
Service Code
|
HCPCS A4642
|
| Hospital Charge Code |
1486844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,785.28 |
| Max. Negotiated Rate |
$25,504.00 |
| Rate for Payer: Aetna Commercial |
$5,738.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,483.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,785.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,144.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,188.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,060.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,379.28
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cigna Commercial |
$5,865.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,568.01
|
| Rate for Payer: Health EOS Commercial |
$5,674.64
|
| Rate for Payer: HFN Commercial |
$5,865.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,782.00
|
| Rate for Payer: Multiplan Commercial |
$5,100.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,825.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,865.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,124.24
|
| Rate for Payer: Quartz Commercial |
$4,144.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,825.60
|
| Rate for Payer: The Alliance Commercial |
$25,504.00
|
| Rate for Payer: WEA Trust Commercial |
$3,506.80
|
| Rate for Payer: WPS Commercial |
$4,722.70
|
|
|
In-111 Satumomab pendetide
|
Facility
|
IP
|
$6,376.00
|
|
|
Service Code
|
HCPCS A4642
|
| Hospital Charge Code |
1486844
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,124.24 |
| Max. Negotiated Rate |
$5,865.92 |
| Rate for Payer: Aetna Commercial |
$5,738.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,483.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,379.28
|
| Rate for Payer: Cash Price |
$1,912.80
|
| Rate for Payer: Cigna Commercial |
$5,865.92
|
| Rate for Payer: Health EOS Commercial |
$5,674.64
|
| Rate for Payer: HFN Commercial |
$5,865.92
|
| Rate for Payer: Multiplan Commercial |
$5,100.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,825.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,865.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,124.24
|
| Rate for Payer: Quartz Commercial |
$3,825.60
|
| Rate for Payer: WEA Trust Commercial |
$3,506.80
|
| Rate for Payer: WPS Commercial |
$4,722.70
|
|
|
INBORN AND OTHER DISORDERS OF METABOLISM
|
Facility
|
IP
|
$34,970.00
|
|
|
Service Code
|
MSDRG 642
|
| Min. Negotiated Rate |
$12,579.11 |
| Max. Negotiated Rate |
$34,970.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,579.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,274.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,905.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,861.40
|
| Rate for Payer: Anthem Medicare Advantage |
$12,579.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,579.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,579.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,579.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,047.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,579.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,414.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,579.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,579.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,579.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,579.11
|
| Rate for Payer: NAPHCARE Commercial |
$18,868.66
|
| Rate for Payer: Quartz Medicare Advantage |
$12,579.11
|
| Rate for Payer: The Alliance Commercial |
$34,970.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,579.11
|
| Rate for Payer: United Healthcare PPO |
$19,785.40
|
| Rate for Payer: Wellcare Medicare |
$12,579.11
|
|
|
INCISE EXTERNAL HEMORRHOID 46083
|
Professional
|
Both
|
$428.00
|
|
|
Service Code
|
CPT 46083
|
| Hospital Charge Code |
3014825
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$406.60 |
| Rate for Payer: Aetna Commercial |
$406.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.08
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cash Price |
$128.40
|
| Rate for Payer: Cigna Commercial |
$406.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.80
|
| Rate for Payer: Health EOS Commercial |
$389.48
|
| Rate for Payer: HFN Commercial |
$406.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$363.27
|
| Rate for Payer: Multiplan Commercial |
$342.40
|
| Rate for Payer: Preferred Network Access Commercial |
$406.60
|
| Rate for Payer: Quartz Beloit One Network |
$188.32
|
| Rate for Payer: Quartz Commercial |
$243.96
|
| Rate for Payer: The Alliance Commercial |
$214.00
|
| Rate for Payer: United Healthcare Medicaid |
$82.56
|
| Rate for Payer: WEA Trust Commercial |
$235.40
|
| Rate for Payer: WPS Commercial |
$317.02
|
|
|
INCISE FINGER TENDON SHEATH 26055
|
Professional
|
Both
|
$1,493.00
|
|
|
Service Code
|
CPT 26055
|
| Hospital Charge Code |
3013931
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.31 |
| Max. Negotiated Rate |
$1,418.35 |
| Rate for Payer: Aetna Commercial |
$1,418.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,418.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.80
|
| Rate for Payer: Health EOS Commercial |
$1,358.63
|
| Rate for Payer: HFN Commercial |
$1,418.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$976.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$976.22
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.35
|
| Rate for Payer: Quartz Beloit One Network |
$656.92
|
| Rate for Payer: Quartz Commercial |
$851.01
|
| Rate for Payer: The Alliance Commercial |
$746.50
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
INCISE INNER EAR 69801
|
Professional
|
Both
|
$2,298.00
|
|
|
Service Code
|
CPT 69801
|
| Hospital Charge Code |
3015282
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$409.76 |
| Max. Negotiated Rate |
$2,183.10 |
| Rate for Payer: Aetna Commercial |
$2,183.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.28
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cash Price |
$689.40
|
| Rate for Payer: Cigna Commercial |
$2,183.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,506.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,378.80
|
| Rate for Payer: Health EOS Commercial |
$2,091.18
|
| Rate for Payer: HFN Commercial |
$2,183.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$409.76
|
| Rate for Payer: Multiplan Commercial |
$1,838.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,183.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,011.12
|
| Rate for Payer: Quartz Commercial |
$1,309.86
|
| Rate for Payer: The Alliance Commercial |
$1,149.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,506.67
|
| Rate for Payer: WEA Trust Commercial |
$1,263.90
|
| Rate for Payer: WPS Commercial |
$1,702.13
|
|
|
INCISIONAL BIOPSY OF SKIN (EG, WEDGE) (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 11106
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$620.77 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$620.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.77
|
| Rate for Payer: NAPHCARE Commercial |
$931.16
|
| Rate for Payer: Quartz Medicare Advantage |
$620.77
|
| Rate for Payer: The Alliance Commercial |
$2,483.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.77
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$620.77
|
|
