|
Inj Hip Arthrogram
|
Facility
|
IP
|
$861.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
3072738
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$438.77 |
| Max. Negotiated Rate |
$823.80 |
| Rate for Payer: Aetna Commercial |
$805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.58
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$823.80
|
| Rate for Payer: Health EOS Commercial |
$796.94
|
| Rate for Payer: HFN Commercial |
$823.80
|
| Rate for Payer: Multiplan Commercial |
$716.35
|
| Rate for Payer: Preferred Network Access Commercial |
$823.80
|
| Rate for Payer: Quartz Beloit One Network |
$438.77
|
| Rate for Payer: Quartz Commercial |
$537.26
|
| Rate for Payer: WEA Trust Commercial |
$492.49
|
| Rate for Payer: WPS Commercial |
$663.23
|
|
|
Inj Hip Arthrogram
|
Facility
|
OP
|
$861.00
|
|
|
Service Code
|
CPT 27093
|
| Hospital Charge Code |
3072738
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$224.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.08
|
| Rate for Payer: Aetna Managed Medicare |
$250.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$582.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$429.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.58
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$823.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$796.94
|
| Rate for Payer: HFN Commercial |
$823.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.58
|
| Rate for Payer: Multiplan Commercial |
$716.35
|
| Rate for Payer: NAPHCARE Commercial |
$537.26
|
| Rate for Payer: Preferred Network Access Commercial |
$823.80
|
| Rate for Payer: Quartz Beloit One Network |
$438.77
|
| Rate for Payer: Quartz Commercial |
$582.04
|
| Rate for Payer: Quartz Medicare Advantage |
$537.26
|
| Rate for Payer: The Alliance Commercial |
$224.14
|
| Rate for Payer: WEA Trust Commercial |
$492.49
|
| Rate for Payer: WPS Commercial |
$663.23
|
|
|
Inj Hysterosalpingogram
|
Professional
|
Both
|
$1,233.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
3072745
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$50.00 |
| Max. Negotiated Rate |
$1,218.20 |
| Rate for Payer: Aetna Commercial |
$1,218.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.80
|
| Rate for Payer: Aetna Managed Medicare |
$50.00
|
| Rate for Payer: Anthem Medicare Advantage |
$50.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.00
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,218.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.00
|
| Rate for Payer: Health EOS Commercial |
$1,166.91
|
| Rate for Payer: HFN Commercial |
$1,218.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.00
|
| Rate for Payer: Multiplan Commercial |
$1,025.86
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.20
|
| Rate for Payer: Quartz Beloit One Network |
$564.22
|
| Rate for Payer: Quartz Commercial |
$730.92
|
| Rate for Payer: Quartz Medicare Advantage |
$50.00
|
| Rate for Payer: The Alliance Commercial |
$212.51
|
| Rate for Payer: United Healthcare Medicaid |
$116.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.00
|
| Rate for Payer: WEA Trust Commercial |
$705.28
|
| Rate for Payer: WPS Commercial |
$225.01
|
|
|
Inj Hysterosalpingogram
|
Facility
|
IP
|
$1,233.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
3072745
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$628.34 |
| Max. Negotiated Rate |
$1,179.73 |
| Rate for Payer: Aetna Commercial |
$1,154.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.63
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,179.73
|
| Rate for Payer: Health EOS Commercial |
$1,141.26
|
| Rate for Payer: HFN Commercial |
$1,179.73
|
| Rate for Payer: Multiplan Commercial |
$1,025.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.73
|
| Rate for Payer: Quartz Beloit One Network |
$628.34
|
| Rate for Payer: Quartz Commercial |
$769.39
|
| Rate for Payer: WEA Trust Commercial |
$705.28
|
| Rate for Payer: WPS Commercial |
$949.78
|
|
|
Inj Hysterosalpingogram
|
Facility
|
OP
|
$1,233.00
|
|
|
Service Code
|
CPT 58340
|
| Hospital Charge Code |
3072745
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$200.01 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,154.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.80
|
| Rate for Payer: Aetna Managed Medicare |
$359.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$833.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$615.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.63
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cash Price |
$369.90
|
| Rate for Payer: Cigna Commercial |
$1,179.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,141.26
|
| Rate for Payer: HFN Commercial |
$1,179.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$961.74
|
| Rate for Payer: Multiplan Commercial |
$1,025.86
|
| Rate for Payer: NAPHCARE Commercial |
$769.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.73
|
| Rate for Payer: Quartz Beloit One Network |
$628.34
|
| Rate for Payer: Quartz Commercial |
$833.51
|
| Rate for Payer: Quartz Medicare Advantage |
$769.39
|
| Rate for Payer: The Alliance Commercial |
$200.01
|
| Rate for Payer: WEA Trust Commercial |
$705.28
|
| Rate for Payer: WPS Commercial |
$949.78
|
|
|
Inj Knee Arthrogram
|
Facility
|
OP
|
$1,047.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
3072739
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$132.91 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$979.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$936.44
|
| Rate for Payer: Aetna Managed Medicare |
$304.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$707.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$522.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.11
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna Commercial |
$1,001.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$969.10
|
| Rate for Payer: HFN Commercial |
$1,001.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$816.66
|
| Rate for Payer: Multiplan Commercial |
$871.10
|
| Rate for Payer: NAPHCARE Commercial |
$653.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,001.77
|
| Rate for Payer: Quartz Beloit One Network |
$533.55
|
| Rate for Payer: Quartz Commercial |
$707.77
|
| Rate for Payer: Quartz Medicare Advantage |
$653.33
|
| Rate for Payer: The Alliance Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$598.88
|
| Rate for Payer: WPS Commercial |
$806.50
|
|
|
Inj Knee Arthrogram
|
Facility
|
IP
|
$1,047.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
3072739
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$533.55 |
| Max. Negotiated Rate |
$1,001.77 |
| Rate for Payer: Aetna Commercial |
$979.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$936.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$577.11
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna Commercial |
$1,001.77
|
| Rate for Payer: Health EOS Commercial |
$969.10
|
| Rate for Payer: HFN Commercial |
$1,001.77
|
| Rate for Payer: Multiplan Commercial |
$871.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,001.77
|
| Rate for Payer: Quartz Beloit One Network |
$533.55
|
| Rate for Payer: Quartz Commercial |
$653.33
|
| Rate for Payer: WEA Trust Commercial |
$598.88
|
| Rate for Payer: WPS Commercial |
$806.50
|
|
|
Inj Knee Arthrogram
|
Professional
|
Both
|
$1,047.00
|
|
|
Service Code
|
CPT 27369
|
| Hospital Charge Code |
3072739
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$33.23 |
| Max. Negotiated Rate |
$1,034.44 |
| Rate for Payer: Aetna Commercial |
$1,034.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$936.44
|
| Rate for Payer: Aetna Managed Medicare |
$33.23
|
| Rate for Payer: Anthem Medicare Advantage |
$33.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.23
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cash Price |
$314.10
|
| Rate for Payer: Cigna Commercial |
$1,034.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.23
|
| Rate for Payer: Health EOS Commercial |
$990.88
|
| Rate for Payer: HFN Commercial |
$1,034.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.23
|
| Rate for Payer: Multiplan Commercial |
$871.10
|
| Rate for Payer: NAPHCARE Commercial |
$49.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,034.44
|
| Rate for Payer: Quartz Beloit One Network |
$479.11
|
| Rate for Payer: Quartz Commercial |
$620.66
|
| Rate for Payer: Quartz Medicare Advantage |
$33.23
|
| Rate for Payer: The Alliance Commercial |
$141.22
|
| Rate for Payer: United Healthcare Medicaid |
$115.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.23
|
| Rate for Payer: WEA Trust Commercial |
$598.88
|
| Rate for Payer: WPS Commercial |
$149.53
|
|
|
Inj Major Joint or Bursa 20610 - Admin Injection Major Joint or Bursa Charge
|
Facility
|
IP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3023774
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$311.88 |
| Max. Negotiated Rate |
$585.56 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$547.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$337.33
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$585.56
|
| Rate for Payer: Health EOS Commercial |
$566.47
|
| Rate for Payer: HFN Commercial |
$585.56
|
| Rate for Payer: Multiplan Commercial |
$509.18
|
| Rate for Payer: Preferred Network Access Commercial |
$585.56
|
| Rate for Payer: Quartz Beloit One Network |
$311.88
|
| Rate for Payer: Quartz Commercial |
$381.89
|
| Rate for Payer: WEA Trust Commercial |
$350.06
|
| Rate for Payer: WPS Commercial |
$471.42
|
|
|
Inj Major Joint or Bursa 20610 - Admin Injection Major Joint or Bursa Charge
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3023774
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$37.79 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$37.79
|
| Rate for Payer: Anthem Medicare Advantage |
$37.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.79
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.79
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$156.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.79
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$56.69
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$37.79
|
| Rate for Payer: The Alliance Commercial |
$160.62
|
| Rate for Payer: United Healthcare Medicaid |
$67.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.79
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$170.07
|
|
|
Inj Major Joint or Bursa 20610 - Admin Injection Major Joint or Bursa Charge
|
Facility
|
OP
|
$612.00
|
|
|
Service Code
|
CPT 20610
|
| Hospital Charge Code |
3023774
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$305.51 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$547.37
|
| Rate for Payer: Aetna Managed Medicare |
$323.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$413.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$318.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$305.51
|
| Rate for Payer: Anthem Medicare Advantage |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$337.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$323.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$323.03
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$585.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$323.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$323.03
|
| Rate for Payer: Health EOS Commercial |
$566.47
|
| Rate for Payer: HFN Commercial |
$585.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,201.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$323.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$323.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$323.03
|
| Rate for Payer: Multiplan Commercial |
$509.18
|
| Rate for Payer: NAPHCARE Commercial |
$484.55
|
| Rate for Payer: Preferred Network Access Commercial |
$585.56
|
| Rate for Payer: Quartz Beloit One Network |
$311.88
|
| Rate for Payer: Quartz Commercial |
$413.71
|
| Rate for Payer: Quartz Medicare Advantage |
$323.03
|
| Rate for Payer: The Alliance Commercial |
$1,292.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$323.03
|
| Rate for Payer: United Healthcare PPO |
$477.36
|
| Rate for Payer: WEA Trust Commercial |
$350.06
|
| Rate for Payer: Wellcare Medicare |
$323.03
|
| Rate for Payer: WPS Commercial |
$471.42
|
|
|
Inj, Medroxyprogesterone Acetate, 1 MG J1050
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
3397519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.59 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.25
|
| Rate for Payer: Health EOS Commercial |
$1.89
|
| Rate for Payer: HFN Commercial |
$1.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.86
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.98
|
| Rate for Payer: Quartz Beloit One Network |
$0.92
|
| Rate for Payer: Quartz Commercial |
$1.19
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: United Healthcare Medicaid |
$0.59
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Inj, Medroxyprogesterone Acetate, 1 MG J1050
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
3397519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Inj, Medroxyprogesterone Acetate, 1 MG J1050
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS J1050
|
| Hospital Charge Code |
3397519
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Inj Myleogram
|
Facility
|
IP
|
$1,743.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
3072746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$888.23 |
| Max. Negotiated Rate |
$1,667.70 |
| Rate for Payer: Aetna Commercial |
$1,631.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.74
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,667.70
|
| Rate for Payer: Health EOS Commercial |
$1,613.32
|
| Rate for Payer: HFN Commercial |
$1,667.70
|
| Rate for Payer: Multiplan Commercial |
$1,450.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.70
|
| Rate for Payer: Quartz Beloit One Network |
$888.23
|
| Rate for Payer: Quartz Commercial |
$1,087.63
|
| Rate for Payer: WEA Trust Commercial |
$997.00
|
| Rate for Payer: WPS Commercial |
$1,342.63
|
|
|
Inj Myleogram
|
Professional
|
Both
|
$1,743.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
3072746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$70.13 |
| Max. Negotiated Rate |
$1,722.08 |
| Rate for Payer: Aetna Commercial |
$1,722.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.94
|
| Rate for Payer: Aetna Managed Medicare |
$70.13
|
| Rate for Payer: Anthem Medicare Advantage |
$70.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.13
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,722.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.13
|
| Rate for Payer: Health EOS Commercial |
$1,649.58
|
| Rate for Payer: HFN Commercial |
$1,722.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$296.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$296.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.13
|
| Rate for Payer: Multiplan Commercial |
$1,450.18
|
| Rate for Payer: NAPHCARE Commercial |
$105.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,722.08
|
| Rate for Payer: Quartz Beloit One Network |
$797.60
|
| Rate for Payer: Quartz Commercial |
$1,033.25
|
| Rate for Payer: Quartz Medicare Advantage |
$70.13
|
| Rate for Payer: The Alliance Commercial |
$298.04
|
| Rate for Payer: United Healthcare Medicaid |
$200.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.13
|
| Rate for Payer: WEA Trust Commercial |
$997.00
|
| Rate for Payer: WPS Commercial |
$315.57
|
|
|
Inj Myleogram
|
Facility
|
OP
|
$1,743.00
|
|
|
Service Code
|
CPT 62284
|
| Hospital Charge Code |
3072746
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$280.51 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,631.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.94
|
| Rate for Payer: Aetna Managed Medicare |
$507.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,178.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$906.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$870.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.74
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cash Price |
$522.90
|
| Rate for Payer: Cigna Commercial |
$1,667.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,613.32
|
| Rate for Payer: HFN Commercial |
$1,667.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,359.54
|
| Rate for Payer: Multiplan Commercial |
$1,450.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.70
|
| Rate for Payer: Quartz Beloit One Network |
$888.23
|
| Rate for Payer: Quartz Commercial |
$1,178.27
|
| Rate for Payer: Quartz Medicare Advantage |
$1,087.63
|
| Rate for Payer: The Alliance Commercial |
$280.51
|
| Rate for Payer: WEA Trust Commercial |
$997.00
|
| Rate for Payer: WPS Commercial |
$1,342.63
|
|
|
Inj Nephrostogram
|
Professional
|
Both
|
$888.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
4406586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$877.34 |
| Rate for Payer: Aetna Commercial |
$877.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$877.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$840.40
|
| Rate for Payer: HFN Commercial |
$877.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$153.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$877.34
|
| Rate for Payer: Quartz Beloit One Network |
$406.35
|
| Rate for Payer: Quartz Commercial |
$526.41
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$155.10
|
| Rate for Payer: United Healthcare Medicaid |
$25.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$164.22
|
|
|
Inj Nephrostogram
|
Facility
|
OP
|
$888.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
4406586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$145.97 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Aetna Managed Medicare |
$258.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$600.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: NAPHCARE Commercial |
$554.11
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: Quartz Medicare Advantage |
$554.11
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
Inj Nephrostogram
|
Facility
|
IP
|
$888.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
4406586
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$452.52 |
| Max. Negotiated Rate |
$849.64 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$554.11
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
Inj paravert f inj l/s 3 lev 64495-50
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
CPT 64495 50
|
| Hospital Charge Code |
5355251
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.17 |
| Max. Negotiated Rate |
$1,380.24 |
| Rate for Payer: Aetna Commercial |
$1,380.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.48
|
| Rate for Payer: Cash Price |
$419.10
|
| Rate for Payer: Cash Price |
$419.10
|
| Rate for Payer: Cash Price |
$419.10
|
| Rate for Payer: Cigna Commercial |
$1,380.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$871.73
|
| Rate for Payer: Health EOS Commercial |
$1,322.12
|
| Rate for Payer: HFN Commercial |
$1,380.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$183.78
|
| Rate for Payer: Multiplan Commercial |
$1,162.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,380.24
|
| Rate for Payer: Quartz Beloit One Network |
$639.27
|
| Rate for Payer: Quartz Commercial |
$828.14
|
| Rate for Payer: The Alliance Commercial |
$726.44
|
| Rate for Payer: United Healthcare Medicaid |
$64.17
|
| Rate for Payer: WEA Trust Commercial |
$799.08
|
| Rate for Payer: WPS Commercial |
$1,076.11
|
|
|
Inj paravert f jnt l/s 1 lev 64493
|
Professional
|
Both
|
$1,123.00
|
|
|
Service Code
|
CPT 64493
|
| Hospital Charge Code |
3015193
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.19 |
| Max. Negotiated Rate |
$1,109.52 |
| Rate for Payer: Aetna Commercial |
$1,109.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,004.41
|
| Rate for Payer: Aetna Managed Medicare |
$80.19
|
| Rate for Payer: Anthem Medicare Advantage |
$80.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.19
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cash Price |
$336.90
|
| Rate for Payer: Cigna Commercial |
$1,109.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.19
|
| Rate for Payer: Health EOS Commercial |
$1,062.81
|
| Rate for Payer: HFN Commercial |
$1,109.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$317.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$317.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.19
|
| Rate for Payer: Multiplan Commercial |
$934.34
|
| Rate for Payer: NAPHCARE Commercial |
$120.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,109.52
|
| Rate for Payer: Quartz Beloit One Network |
$513.88
|
| Rate for Payer: Quartz Commercial |
$665.71
|
| Rate for Payer: Quartz Medicare Advantage |
$80.19
|
| Rate for Payer: The Alliance Commercial |
$340.83
|
| Rate for Payer: United Healthcare Medicaid |
$129.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.19
|
| Rate for Payer: WEA Trust Commercial |
$642.36
|
| Rate for Payer: WPS Commercial |
$360.87
|
|
|
Inj paravert f jnt l/s 2 lev 64494
|
Professional
|
Both
|
$687.00
|
|
|
Service Code
|
CPT 64494
|
| Hospital Charge Code |
3015194
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$678.76 |
| Rate for Payer: Aetna Commercial |
$678.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.45
|
| Rate for Payer: Aetna Managed Medicare |
$43.22
|
| Rate for Payer: Anthem Medicare Advantage |
$43.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.22
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$678.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.22
|
| Rate for Payer: Health EOS Commercial |
$650.18
|
| Rate for Payer: HFN Commercial |
$678.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.22
|
| Rate for Payer: Multiplan Commercial |
$571.58
|
| Rate for Payer: NAPHCARE Commercial |
$64.83
|
| Rate for Payer: Preferred Network Access Commercial |
$678.76
|
| Rate for Payer: Quartz Beloit One Network |
$314.37
|
| Rate for Payer: Quartz Commercial |
$407.25
|
| Rate for Payer: Quartz Medicare Advantage |
$43.22
|
| Rate for Payer: The Alliance Commercial |
$183.70
|
| Rate for Payer: United Healthcare Medicaid |
$63.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.22
|
| Rate for Payer: WEA Trust Commercial |
$392.96
|
| Rate for Payer: WPS Commercial |
$194.50
|
|
|
Inj paravert f jnt l/s 3 lev 64495
|
Professional
|
Both
|
$699.00
|
|
|
Service Code
|
CPT 64495
|
| Hospital Charge Code |
3015195
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$690.61 |
| Rate for Payer: Aetna Commercial |
$690.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$625.19
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cash Price |
$209.70
|
| Rate for Payer: Cigna Commercial |
$690.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$661.53
|
| Rate for Payer: HFN Commercial |
$690.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$183.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$581.57
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$690.61
|
| Rate for Payer: Quartz Beloit One Network |
$319.86
|
| Rate for Payer: Quartz Commercial |
$414.37
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$189.35
|
| Rate for Payer: United Healthcare Medicaid |
$64.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: WEA Trust Commercial |
$399.83
|
| Rate for Payer: WPS Commercial |
$200.49
|
|
|
Inj, Penicillin G Benz and Pen G Procaine J0558
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
4027271
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.98 |
| Max. Negotiated Rate |
$81.20 |
| Rate for Payer: Aetna Commercial |
$18.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.89
|
| Rate for Payer: Aetna Managed Medicare |
$20.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicare Advantage |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.30
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cash Price |
$6.00
|
| Rate for Payer: Cigna Commercial |
$19.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.30
|
| Rate for Payer: Health EOS Commercial |
$18.51
|
| Rate for Payer: HFN Commercial |
$19.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$16.64
|
| Rate for Payer: NAPHCARE Commercial |
$30.45
|
| Rate for Payer: Preferred Network Access Commercial |
$19.14
|
| Rate for Payer: Quartz Beloit One Network |
$10.19
|
| Rate for Payer: Quartz Commercial |
$13.52
|
| Rate for Payer: Quartz Medicare Advantage |
$20.30
|
| Rate for Payer: The Alliance Commercial |
$81.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.30
|
| Rate for Payer: WEA Trust Commercial |
$11.44
|
| Rate for Payer: Wellcare Medicare |
$20.30
|
| Rate for Payer: WPS Commercial |
$45.16
|
|
