|
Leukotriene E4, Urine
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5841646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$1,017.52 |
| Rate for Payer: Aetna Commercial |
$995.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$951.16
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$586.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$1,017.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.92
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$984.34
|
| Rate for Payer: HFN Commercial |
$1,017.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$884.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,017.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$541.94
|
| Rate for Payer: Quartz Commercial |
$718.90
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$829.50
|
| Rate for Payer: WEA Trust Commercial |
$608.30
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$819.21
|
|
|
Leuprolide acetate /3.75 mg J1950 man
|
Professional
|
Both
|
$2,412.00
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
3373657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,061.28 |
| Max. Negotiated Rate |
$3,940.30 |
| Rate for Payer: Aetna Commercial |
$2,291.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,074.32
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,291.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,564.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,576.12
|
| Rate for Payer: Health EOS Commercial |
$2,194.92
|
| Rate for Payer: HFN Commercial |
$2,291.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,851.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,851.28
|
| Rate for Payer: Multiplan Commercial |
$1,929.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,291.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,061.28
|
| Rate for Payer: Quartz Commercial |
$1,374.84
|
| Rate for Payer: The Alliance Commercial |
$1,206.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,564.60
|
| Rate for Payer: WEA Trust Commercial |
$1,326.60
|
| Rate for Payer: WPS Commercial |
$3,940.30
|
|
|
Leuprolide acetate /3.75 mg J1950 man
|
Facility
|
IP
|
$2,412.00
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
3373657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,181.88 |
| Max. Negotiated Rate |
$2,219.04 |
| Rate for Payer: Aetna Commercial |
$2,170.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,074.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.36
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,219.04
|
| Rate for Payer: Health EOS Commercial |
$2,146.68
|
| Rate for Payer: HFN Commercial |
$2,219.04
|
| Rate for Payer: Multiplan Commercial |
$1,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,447.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.88
|
| Rate for Payer: Quartz Commercial |
$1,447.20
|
| Rate for Payer: WEA Trust Commercial |
$1,326.60
|
| Rate for Payer: WPS Commercial |
$1,786.57
|
|
|
Leuprolide acetate /3.75 mg J1950 man
|
Facility
|
OP
|
$2,412.00
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
3373657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,157.76 |
| Max. Negotiated Rate |
$6,258.42 |
| Rate for Payer: Aetna Commercial |
$2,170.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,074.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,564.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,567.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,206.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,157.76
|
| Rate for Payer: Anthem Medicare Advantage |
$1,564.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,278.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,564.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,564.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,219.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,564.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,085.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,564.60
|
| Rate for Payer: Health EOS Commercial |
$2,146.68
|
| Rate for Payer: HFN Commercial |
$2,219.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,820.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,564.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,564.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,564.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,564.60
|
| Rate for Payer: Multiplan Commercial |
$1,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,346.91
|
| Rate for Payer: Preferred Network Access Commercial |
$2,219.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,181.88
|
| Rate for Payer: Quartz Commercial |
$1,567.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,564.60
|
| Rate for Payer: The Alliance Commercial |
$6,258.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,564.60
|
| Rate for Payer: WEA Trust Commercial |
$1,326.60
|
| Rate for Payer: Wellcare Medicare |
$1,564.60
|
| Rate for Payer: WPS Commercial |
$3,940.30
|
|
|
Leuprolide acetate suspnsion 7.5 mg J9217 mans
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
3369607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$725.21 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Aetna Managed Medicare |
$181.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.84
|
| Rate for Payer: Anthem Medicare Advantage |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.30
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.30
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$674.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.30
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$271.95
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$248.95
|
| Rate for Payer: Quartz Medicare Advantage |
$181.30
|
| Rate for Payer: The Alliance Commercial |
$725.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: Wellcare Medicare |
$181.30
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Leuprolide acetate suspnsion 7.5 mg J9217 mans
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
3369607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$168.52 |
| Max. Negotiated Rate |
$464.16 |
| Rate for Payer: Aetna Commercial |
$363.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$363.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.66
|
| Rate for Payer: Health EOS Commercial |
$348.53
|
| Rate for Payer: HFN Commercial |
$363.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.94
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Preferred Network Access Commercial |
$363.85
|
| Rate for Payer: Quartz Beloit One Network |
$168.52
|
| Rate for Payer: Quartz Commercial |
$218.31
|
| Rate for Payer: The Alliance Commercial |
$191.50
|
| Rate for Payer: United Healthcare Medicaid |
$181.30
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$464.16
|
|
|
Leuprolide acetate suspnsion 7.5 mg J9217 mans
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
3369607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.67 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$229.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$229.80
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
Leustatin 100 mg Charge
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
2958946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$41.49 |
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.60
|
| Rate for Payer: Health EOS Commercial |
$33.67
|
| Rate for Payer: HFN Commercial |
$35.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.65
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Preferred Network Access Commercial |
$35.15
|
| Rate for Payer: Quartz Beloit One Network |
$16.28
|
| Rate for Payer: Quartz Commercial |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$18.50
|
| Rate for Payer: United Healthcare Medicaid |
$15.77
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$41.49
|
|
|
Leustatin 100 mg Charge
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
2958946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$34.04 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.61
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$34.04
|
| Rate for Payer: Health EOS Commercial |
$32.93
|
| Rate for Payer: HFN Commercial |
$34.04
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.20
|
| Rate for Payer: Preferred Network Access Commercial |
$34.04
|
| Rate for Payer: Quartz Beloit One Network |
$18.13
|
| Rate for Payer: Quartz Commercial |
$22.20
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
Leustatin 100 mg Charge
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
HCPCS J9065
|
| Hospital Charge Code |
2958946
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.77 |
| Max. Negotiated Rate |
$63.09 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Aetna Managed Medicare |
$15.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.76
|
| Rate for Payer: Anthem Medicare Advantage |
$15.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.77
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$34.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.77
|
| Rate for Payer: Health EOS Commercial |
$32.93
|
| Rate for Payer: HFN Commercial |
$34.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.77
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: NAPHCARE Commercial |
$23.66
|
| Rate for Payer: Preferred Network Access Commercial |
$34.04
|
| Rate for Payer: Quartz Beloit One Network |
$18.13
|
| Rate for Payer: Quartz Commercial |
$24.05
|
| Rate for Payer: Quartz Medicare Advantage |
$15.77
|
| Rate for Payer: The Alliance Commercial |
$63.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.77
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: Wellcare Medicare |
$15.77
|
| Rate for Payer: WPS Commercial |
$41.49
|
|
|
LEVEEN SHUNT
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960373
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| 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
|
|
|
LEVEEN SHUNT
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960373
|
|
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
|
|
|
Level 1 - 99281
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
5516683
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$186.69 |
| Max. Negotiated Rate |
$350.52 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$228.60
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$228.60
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
Level 1 - 99281
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 99281
|
| Hospital Charge Code |
5516683
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$87.75 |
| Max. Negotiated Rate |
$641.00 |
| Rate for Payer: Aetna Commercial |
$342.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$327.66
|
| Rate for Payer: Aetna Managed Medicare |
$87.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$641.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$436.00
|
| Rate for Payer: Anthem Medicare Advantage |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$201.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$87.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$87.75
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$350.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$87.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$87.75
|
| Rate for Payer: Health EOS Commercial |
$339.09
|
| Rate for Payer: HFN Commercial |
$350.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$326.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$87.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$87.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$87.75
|
| Rate for Payer: Multiplan Commercial |
$304.80
|
| Rate for Payer: NAPHCARE Commercial |
$131.62
|
| Rate for Payer: Preferred Network Access Commercial |
$350.52
|
| Rate for Payer: Quartz Beloit One Network |
$186.69
|
| Rate for Payer: Quartz Commercial |
$247.65
|
| Rate for Payer: Quartz Medicare Advantage |
$87.75
|
| Rate for Payer: The Alliance Commercial |
$351.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$87.75
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$209.55
|
| Rate for Payer: Wellcare Medicare |
$87.75
|
| Rate for Payer: WPS Commercial |
$282.21
|
|
|
Level 1 Est - 99211
|
Facility
|
OP
|
$165.00
|
|
| Hospital Charge Code |
5516694
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$660.00 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Aetna Managed Medicare |
$46.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$107.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.33
|
| Rate for Payer: Health EOS Commercial |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.75
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$99.00
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$107.25
|
| Rate for Payer: Quartz Medicare Advantage |
$99.00
|
| Rate for Payer: The Alliance Commercial |
$660.00
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
Level 1 Est - 99211
|
Facility
|
IP
|
$165.00
|
|
| Hospital Charge Code |
5516694
|
| Min. Negotiated Rate |
$80.85 |
| Max. Negotiated Rate |
$151.80 |
| Rate for Payer: Aetna Commercial |
$148.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.45
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$151.80
|
| Rate for Payer: Health EOS Commercial |
$146.85
|
| Rate for Payer: HFN Commercial |
$151.80
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: NAPHCARE Commercial |
$99.00
|
| Rate for Payer: Preferred Network Access Commercial |
$151.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.85
|
| Rate for Payer: Quartz Commercial |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
Level 1 IV Fluid Warmer
|
Facility
|
IP
|
$187.00
|
|
| Hospital Charge Code |
3101757
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Level 1 IV Fluid Warmer
|
Facility
|
OP
|
$187.00
|
|
| Hospital Charge Code |
3101757
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$52.36 |
| Max. Negotiated Rate |
$748.00 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$52.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.25
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$112.20
|
| Rate for Payer: The Alliance Commercial |
$748.00
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Level 1 - Labor Level
|
Facility
|
OP
|
$1,788.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3003935
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$500.64 |
| Max. Negotiated Rate |
$7,152.00 |
| Rate for Payer: Aetna Commercial |
$1,609.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,537.68
|
| Rate for Payer: Aetna Managed Medicare |
$500.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,162.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$894.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$858.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$947.64
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna Commercial |
$1,644.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,000.56
|
| Rate for Payer: Health EOS Commercial |
$1,591.32
|
| Rate for Payer: HFN Commercial |
$1,644.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,341.00
|
| Rate for Payer: Multiplan Commercial |
$1,430.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,072.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,644.96
|
| Rate for Payer: Quartz Beloit One Network |
$876.12
|
| Rate for Payer: Quartz Commercial |
$1,162.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,072.80
|
| Rate for Payer: The Alliance Commercial |
$7,152.00
|
| Rate for Payer: United Healthcare PPO |
$1,341.00
|
| Rate for Payer: WEA Trust Commercial |
$983.40
|
| Rate for Payer: WPS Commercial |
$1,324.37
|
|
|
Level 1 - Labor Level
|
Facility
|
IP
|
$1,788.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3003935
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$876.12 |
| Max. Negotiated Rate |
$1,644.96 |
| Rate for Payer: Aetna Commercial |
$1,609.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,537.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$947.64
|
| Rate for Payer: Cash Price |
$536.40
|
| Rate for Payer: Cigna Commercial |
$1,644.96
|
| Rate for Payer: Health EOS Commercial |
$1,591.32
|
| Rate for Payer: HFN Commercial |
$1,644.96
|
| Rate for Payer: Multiplan Commercial |
$1,430.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,072.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,644.96
|
| Rate for Payer: Quartz Beloit One Network |
$876.12
|
| Rate for Payer: Quartz Commercial |
$1,072.80
|
| Rate for Payer: WEA Trust Commercial |
$983.40
|
| Rate for Payer: WPS Commercial |
$1,324.37
|
|
|
Level 2 - 99282
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
5516684
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$335.16 |
| Max. Negotiated Rate |
$629.28 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.52
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$629.28
|
| Rate for Payer: Health EOS Commercial |
$608.76
|
| Rate for Payer: HFN Commercial |
$629.28
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: NAPHCARE Commercial |
$410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$629.28
|
| Rate for Payer: Quartz Beloit One Network |
$335.16
|
| Rate for Payer: Quartz Commercial |
$410.40
|
| Rate for Payer: WEA Trust Commercial |
$376.20
|
| Rate for Payer: WPS Commercial |
$506.64
|
|
|
Level 2 - 99282
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 99282
|
| Hospital Charge Code |
5516684
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$161.65 |
| Max. Negotiated Rate |
$646.60 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.24
|
| Rate for Payer: Aetna Managed Medicare |
$161.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$641.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$459.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$436.00
|
| Rate for Payer: Anthem Medicare Advantage |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$161.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$161.65
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$629.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$161.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$161.65
|
| Rate for Payer: Health EOS Commercial |
$608.76
|
| Rate for Payer: HFN Commercial |
$629.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$601.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$161.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$161.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$161.65
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.48
|
| Rate for Payer: Preferred Network Access Commercial |
$629.28
|
| Rate for Payer: Quartz Beloit One Network |
$335.16
|
| Rate for Payer: Quartz Commercial |
$444.60
|
| Rate for Payer: Quartz Medicare Advantage |
$161.65
|
| Rate for Payer: The Alliance Commercial |
$646.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.65
|
| Rate for Payer: United Healthcare PPO |
$526.00
|
| Rate for Payer: WEA Trust Commercial |
$376.20
|
| Rate for Payer: Wellcare Medicare |
$161.65
|
| Rate for Payer: WPS Commercial |
$506.64
|
|
|
Level 2 Est - 99212
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
5516696
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
Level 2 Est - 99212
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
5516696
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.06
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
Level 2 - Labor Level
|
Facility
|
OP
|
$2,592.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3003934
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$725.76 |
| Max. Negotiated Rate |
$10,368.00 |
| Rate for Payer: Aetna Commercial |
$2,332.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.12
|
| Rate for Payer: Aetna Managed Medicare |
$725.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,684.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,296.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,244.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.76
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,384.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,450.48
|
| Rate for Payer: Health EOS Commercial |
$2,306.88
|
| Rate for Payer: HFN Commercial |
$2,384.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,944.00
|
| Rate for Payer: Multiplan Commercial |
$2,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,555.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,384.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.08
|
| Rate for Payer: Quartz Commercial |
$1,684.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,555.20
|
| Rate for Payer: The Alliance Commercial |
$10,368.00
|
| Rate for Payer: United Healthcare PPO |
$1,944.00
|
| Rate for Payer: WEA Trust Commercial |
$1,425.60
|
| Rate for Payer: WPS Commercial |
$1,919.89
|
|
