|
Level 5 New - 99205
|
Facility
|
IP
|
$727.00
|
|
| Hospital Charge Code |
5516701
|
| Min. Negotiated Rate |
$356.23 |
| Max. Negotiated Rate |
$668.84 |
| Rate for Payer: Aetna Commercial |
$654.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$625.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.31
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cigna Commercial |
$668.84
|
| Rate for Payer: Health EOS Commercial |
$647.03
|
| Rate for Payer: HFN Commercial |
$668.84
|
| Rate for Payer: Multiplan Commercial |
$581.60
|
| Rate for Payer: NAPHCARE Commercial |
$436.20
|
| Rate for Payer: Preferred Network Access Commercial |
$668.84
|
| Rate for Payer: Quartz Beloit One Network |
$356.23
|
| Rate for Payer: Quartz Commercial |
$436.20
|
| Rate for Payer: WEA Trust Commercial |
$399.85
|
| Rate for Payer: WPS Commercial |
$538.49
|
|
|
Level 5 New - 99205
|
Facility
|
OP
|
$727.00
|
|
| Hospital Charge Code |
5516701
|
| Min. Negotiated Rate |
$203.56 |
| Max. Negotiated Rate |
$2,908.00 |
| Rate for Payer: Aetna Commercial |
$654.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$625.22
|
| Rate for Payer: Aetna Managed Medicare |
$203.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$472.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$363.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$348.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$385.31
|
| Rate for Payer: Cash Price |
$218.10
|
| Rate for Payer: Cigna Commercial |
$668.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.83
|
| Rate for Payer: Health EOS Commercial |
$647.03
|
| Rate for Payer: HFN Commercial |
$668.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$545.25
|
| Rate for Payer: Multiplan Commercial |
$581.60
|
| Rate for Payer: NAPHCARE Commercial |
$436.20
|
| Rate for Payer: Preferred Network Access Commercial |
$668.84
|
| Rate for Payer: Quartz Beloit One Network |
$356.23
|
| Rate for Payer: Quartz Commercial |
$472.55
|
| Rate for Payer: Quartz Medicare Advantage |
$436.20
|
| Rate for Payer: The Alliance Commercial |
$2,908.00
|
| Rate for Payer: WEA Trust Commercial |
$399.85
|
| Rate for Payer: WPS Commercial |
$538.49
|
|
|
Level 6 - Labor Level
|
Facility
|
OP
|
$15,062.00
|
|
| Hospital Charge Code |
3003930
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$4,217.36 |
| Max. Negotiated Rate |
$60,248.00 |
| Rate for Payer: Aetna Commercial |
$13,555.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,953.32
|
| Rate for Payer: Aetna Managed Medicare |
$4,217.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,790.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,531.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,229.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,982.86
|
| Rate for Payer: Cash Price |
$4,518.60
|
| Rate for Payer: Cigna Commercial |
$13,857.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,428.70
|
| Rate for Payer: Health EOS Commercial |
$13,405.18
|
| Rate for Payer: HFN Commercial |
$13,857.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,296.50
|
| Rate for Payer: Multiplan Commercial |
$12,049.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,037.20
|
| Rate for Payer: Preferred Network Access Commercial |
$13,857.04
|
| Rate for Payer: Quartz Beloit One Network |
$7,380.38
|
| Rate for Payer: Quartz Commercial |
$9,790.30
|
| Rate for Payer: Quartz Medicare Advantage |
$9,037.20
|
| Rate for Payer: The Alliance Commercial |
$60,248.00
|
| Rate for Payer: United Healthcare PPO |
$11,296.50
|
| Rate for Payer: WEA Trust Commercial |
$8,284.10
|
| Rate for Payer: WPS Commercial |
$11,156.42
|
|
|
Level 6 - Labor Level
|
Facility
|
IP
|
$15,062.00
|
|
| Hospital Charge Code |
3003930
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$7,380.38 |
| Max. Negotiated Rate |
$13,857.04 |
| Rate for Payer: Aetna Commercial |
$13,555.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,953.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,982.86
|
| Rate for Payer: Cash Price |
$4,518.60
|
| Rate for Payer: Cigna Commercial |
$13,857.04
|
| Rate for Payer: Health EOS Commercial |
$13,405.18
|
| Rate for Payer: HFN Commercial |
$13,857.04
|
| Rate for Payer: Multiplan Commercial |
$12,049.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,037.20
|
| Rate for Payer: Preferred Network Access Commercial |
$13,857.04
|
| Rate for Payer: Quartz Beloit One Network |
$7,380.38
|
| Rate for Payer: Quartz Commercial |
$9,037.20
|
| Rate for Payer: WEA Trust Commercial |
$8,284.10
|
| Rate for Payer: WPS Commercial |
$11,156.42
|
|
|
Level I
|
Facility
|
OP
|
$3,566.00
|
|
| Hospital Charge Code |
3000366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$14,264.00 |
| Rate for Payer: Aetna Commercial |
$3,209.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,066.76
|
| Rate for Payer: Aetna Managed Medicare |
$998.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,317.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,783.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,711.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,889.98
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$3,280.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,995.53
|
| Rate for Payer: Health EOS Commercial |
$3,173.74
|
| Rate for Payer: HFN Commercial |
$3,280.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,674.50
|
| Rate for Payer: Multiplan Commercial |
$2,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,280.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,747.34
|
| Rate for Payer: Quartz Commercial |
$2,317.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,139.60
|
| Rate for Payer: The Alliance Commercial |
$14,264.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,961.30
|
| Rate for Payer: WPS Commercial |
$2,641.34
|
|
|
Level I
|
Facility
|
IP
|
$3,566.00
|
|
| Hospital Charge Code |
3000366
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$1,747.34 |
| Max. Negotiated Rate |
$3,280.72 |
| Rate for Payer: Aetna Commercial |
$3,209.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,066.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,889.98
|
| Rate for Payer: Cash Price |
$1,069.80
|
| Rate for Payer: Cigna Commercial |
$3,280.72
|
| Rate for Payer: Health EOS Commercial |
$3,173.74
|
| Rate for Payer: HFN Commercial |
$3,280.72
|
| Rate for Payer: Multiplan Commercial |
$2,852.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,139.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,280.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,747.34
|
| Rate for Payer: Quartz Commercial |
$2,139.60
|
| Rate for Payer: WEA Trust Commercial |
$1,961.30
|
| Rate for Payer: WPS Commercial |
$2,641.34
|
|
|
Level III
|
Facility
|
IP
|
$2,005.00
|
|
| Hospital Charge Code |
5104609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$982.45 |
| Max. Negotiated Rate |
$1,844.60 |
| Rate for Payer: Aetna Commercial |
$1,804.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,724.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.65
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,844.60
|
| Rate for Payer: Health EOS Commercial |
$1,784.45
|
| Rate for Payer: HFN Commercial |
$1,844.60
|
| Rate for Payer: Multiplan Commercial |
$1,604.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,203.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,844.60
|
| Rate for Payer: Quartz Beloit One Network |
$982.45
|
| Rate for Payer: Quartz Commercial |
$1,203.00
|
| Rate for Payer: WEA Trust Commercial |
$1,102.75
|
| Rate for Payer: WPS Commercial |
$1,485.10
|
|
|
Level III
|
Facility
|
OP
|
$2,005.00
|
|
| Hospital Charge Code |
5104609
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,020.00 |
| Rate for Payer: Aetna Commercial |
$1,804.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,724.30
|
| Rate for Payer: Aetna Managed Medicare |
$561.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,303.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,002.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$962.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,062.65
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cash Price |
$601.50
|
| Rate for Payer: Cigna Commercial |
$1,844.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,122.00
|
| Rate for Payer: Health EOS Commercial |
$1,784.45
|
| Rate for Payer: HFN Commercial |
$1,844.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.75
|
| Rate for Payer: Multiplan Commercial |
$1,604.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,203.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,844.60
|
| Rate for Payer: Quartz Beloit One Network |
$982.45
|
| Rate for Payer: Quartz Commercial |
$1,303.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,203.00
|
| Rate for Payer: The Alliance Commercial |
$8,020.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,102.75
|
| Rate for Payer: WPS Commercial |
$1,485.10
|
|
|
Levetiracetam Level
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
978008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$13.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.00
|
| Rate for Payer: Anthem Medicaid |
$13.69
|
| Rate for Payer: Anthem Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Dean Health Medicaid |
$13.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.25
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.25
|
| Rate for Payer: Managed Health Services Medicaid |
$14.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.88
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.69
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$13.25
|
| Rate for Payer: The Alliance Commercial |
$53.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$13.25
|
| Rate for Payer: WMAP Medicaid |
$13.69
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Levetiracetam Level
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
978008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.00
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: HFN Commercial |
$213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.77
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: The Alliance Commercial |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Levetiracetam Level
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 80177
|
| Hospital Charge Code |
978008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Levonorgestrel iu contracept J7298
|
Professional
|
Both
|
$1,710.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
4605888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$752.40 |
| Max. Negotiated Rate |
$1,624.50 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,470.60
|
| Rate for Payer: Anthem Commercial |
$999.28
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$1,624.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,156.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.00
|
| Rate for Payer: Health EOS Commercial |
$1,556.10
|
| Rate for Payer: HFN Commercial |
$1,624.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,495.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,495.42
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,624.50
|
| Rate for Payer: Quartz Beloit One Network |
$752.40
|
| Rate for Payer: Quartz Commercial |
$974.70
|
| Rate for Payer: The Alliance Commercial |
$855.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,156.79
|
| Rate for Payer: WEA Trust Commercial |
$940.50
|
| Rate for Payer: WPS Commercial |
$1,266.60
|
|
|
Levonorgestrel iu contracept J7298
|
Facility
|
IP
|
$1,710.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
4605888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$837.90 |
| Max. Negotiated Rate |
$1,573.20 |
| Rate for Payer: Aetna Commercial |
$1,539.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,470.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.30
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$1,573.20
|
| Rate for Payer: Health EOS Commercial |
$1,521.90
|
| Rate for Payer: HFN Commercial |
$1,573.20
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,026.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,573.20
|
| Rate for Payer: Quartz Beloit One Network |
$837.90
|
| Rate for Payer: Quartz Commercial |
$1,026.00
|
| Rate for Payer: WEA Trust Commercial |
$940.50
|
| Rate for Payer: WPS Commercial |
$1,266.60
|
|
|
Levonorgestrel iu contracept J7298
|
Facility
|
OP
|
$1,710.00
|
|
|
Service Code
|
HCPCS J7298
|
| Hospital Charge Code |
4605888
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$478.80 |
| Max. Negotiated Rate |
$6,840.00 |
| Rate for Payer: Aetna Commercial |
$1,539.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,470.60
|
| Rate for Payer: Aetna Managed Medicare |
$478.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,111.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$855.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$820.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$906.30
|
| Rate for Payer: Cash Price |
$513.00
|
| Rate for Payer: Cigna Commercial |
$1,573.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$956.92
|
| Rate for Payer: Health EOS Commercial |
$1,521.90
|
| Rate for Payer: HFN Commercial |
$1,573.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,282.50
|
| Rate for Payer: Multiplan Commercial |
$1,368.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,026.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,573.20
|
| Rate for Payer: Quartz Beloit One Network |
$837.90
|
| Rate for Payer: Quartz Commercial |
$1,111.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,026.00
|
| Rate for Payer: The Alliance Commercial |
$6,840.00
|
| Rate for Payer: WEA Trust Commercial |
$940.50
|
| Rate for Payer: WPS Commercial |
$1,266.60
|
|
|
Levonorgestrel-releasing intrauterine contraceptive system J7296
|
Facility
|
IP
|
$2,521.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
5366628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,235.29 |
| Max. Negotiated Rate |
$2,319.32 |
| Rate for Payer: Aetna Commercial |
$2,268.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,336.13
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,319.32
|
| Rate for Payer: Health EOS Commercial |
$2,243.69
|
| Rate for Payer: HFN Commercial |
$2,319.32
|
| Rate for Payer: Multiplan Commercial |
$2,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,512.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,319.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.29
|
| Rate for Payer: Quartz Commercial |
$1,512.60
|
| Rate for Payer: WEA Trust Commercial |
$1,386.55
|
| Rate for Payer: WPS Commercial |
$1,867.30
|
|
|
Levonorgestrel-releasing intrauterine contraceptive system J7296
|
Facility
|
OP
|
$2,521.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
5366628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$705.88 |
| Max. Negotiated Rate |
$10,084.00 |
| Rate for Payer: Aetna Commercial |
$2,268.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.06
|
| Rate for Payer: Aetna Managed Medicare |
$705.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,638.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,210.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,336.13
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,319.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,410.75
|
| Rate for Payer: Health EOS Commercial |
$2,243.69
|
| Rate for Payer: HFN Commercial |
$2,319.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,890.75
|
| Rate for Payer: Multiplan Commercial |
$2,016.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,512.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,319.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.29
|
| Rate for Payer: Quartz Commercial |
$1,638.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,512.60
|
| Rate for Payer: The Alliance Commercial |
$10,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,386.55
|
| Rate for Payer: WPS Commercial |
$1,867.30
|
|
|
Levonorgestrel-releasing intrauterine contraceptive system J7296
|
Professional
|
Both
|
$2,521.00
|
|
|
Service Code
|
HCPCS J7296
|
| Hospital Charge Code |
5366628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$999.28 |
| Max. Negotiated Rate |
$2,394.95 |
| Rate for Payer: Aetna Commercial |
$2,394.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.06
|
| Rate for Payer: Anthem Commercial |
$999.28
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cash Price |
$756.30
|
| Rate for Payer: Cigna Commercial |
$2,394.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,156.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,512.60
|
| Rate for Payer: Health EOS Commercial |
$2,294.11
|
| Rate for Payer: HFN Commercial |
$2,394.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,488.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,488.13
|
| Rate for Payer: Multiplan Commercial |
$2,016.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,394.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,109.24
|
| Rate for Payer: Quartz Commercial |
$1,436.97
|
| Rate for Payer: The Alliance Commercial |
$1,260.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,156.79
|
| Rate for Payer: WEA Trust Commercial |
$1,386.55
|
| Rate for Payer: WPS Commercial |
$1,867.30
|
|
|
LHC Coronaries/BPG w/wo LV
|
Facility
|
IP
|
$21,101.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
3052499
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$10,339.49 |
| Max. Negotiated Rate |
$19,412.92 |
| Rate for Payer: Aetna Commercial |
$18,990.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,146.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,183.53
|
| Rate for Payer: Cash Price |
$6,330.30
|
| Rate for Payer: Cigna Commercial |
$19,412.92
|
| Rate for Payer: Health EOS Commercial |
$18,779.89
|
| Rate for Payer: HFN Commercial |
$19,412.92
|
| Rate for Payer: Multiplan Commercial |
$16,880.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,660.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,412.92
|
| Rate for Payer: Quartz Beloit One Network |
$10,339.49
|
| Rate for Payer: Quartz Commercial |
$12,660.60
|
| Rate for Payer: WEA Trust Commercial |
$11,605.55
|
| Rate for Payer: WPS Commercial |
$15,629.51
|
|
|
LHC Coronaries/BPG w/wo LV
|
Facility
|
OP
|
$21,101.00
|
|
|
Service Code
|
CPT 93459
|
| Hospital Charge Code |
3052499
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$19,412.92 |
| Rate for Payer: Aetna Commercial |
$18,990.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,146.86
|
| Rate for Payer: Aetna Managed Medicare |
$3,220.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,183.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,220.78
|
| Rate for Payer: Cash Price |
$6,330.30
|
| Rate for Payer: Cash Price |
$6,330.30
|
| Rate for Payer: Cash Price |
$6,330.30
|
| Rate for Payer: Cigna Commercial |
$19,412.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,220.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,220.78
|
| Rate for Payer: Health EOS Commercial |
$18,779.89
|
| Rate for Payer: HFN Commercial |
$19,412.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,981.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,220.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,220.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,220.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,220.78
|
| Rate for Payer: Multiplan Commercial |
$16,880.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$19,412.92
|
| Rate for Payer: Quartz Beloit One Network |
$10,339.49
|
| Rate for Payer: Quartz Commercial |
$13,715.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,220.78
|
| Rate for Payer: The Alliance Commercial |
$12,883.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$11,605.55
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$15,629.51
|
|
|
LHC Coronaries w/wo LV
|
Facility
|
OP
|
$19,353.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
3052498
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$17,804.76 |
| Rate for Payer: Aetna Commercial |
$17,417.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,643.58
|
| Rate for Payer: Aetna Managed Medicare |
$3,220.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,257.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,220.78
|
| Rate for Payer: Cash Price |
$5,805.90
|
| Rate for Payer: Cash Price |
$5,805.90
|
| Rate for Payer: Cash Price |
$5,805.90
|
| Rate for Payer: Cigna Commercial |
$17,804.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,220.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,220.78
|
| Rate for Payer: Health EOS Commercial |
$17,224.17
|
| Rate for Payer: HFN Commercial |
$17,804.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,981.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,220.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,220.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,220.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,220.78
|
| Rate for Payer: Multiplan Commercial |
$15,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$17,804.76
|
| Rate for Payer: Quartz Beloit One Network |
$9,482.97
|
| Rate for Payer: Quartz Commercial |
$12,579.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,220.78
|
| Rate for Payer: The Alliance Commercial |
$12,883.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$10,644.15
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$14,334.77
|
|
|
LHC Coronaries w/wo LV
|
Facility
|
IP
|
$19,353.00
|
|
|
Service Code
|
CPT 93458
|
| Hospital Charge Code |
3052498
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,482.97 |
| Max. Negotiated Rate |
$17,804.76 |
| Rate for Payer: Aetna Commercial |
$17,417.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,643.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,257.09
|
| Rate for Payer: Cash Price |
$5,805.90
|
| Rate for Payer: Cigna Commercial |
$17,804.76
|
| Rate for Payer: Health EOS Commercial |
$17,224.17
|
| Rate for Payer: HFN Commercial |
$17,804.76
|
| Rate for Payer: Multiplan Commercial |
$15,482.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,611.80
|
| Rate for Payer: Preferred Network Access Commercial |
$17,804.76
|
| Rate for Payer: Quartz Beloit One Network |
$9,482.97
|
| Rate for Payer: Quartz Commercial |
$11,611.80
|
| Rate for Payer: WEA Trust Commercial |
$10,644.15
|
| Rate for Payer: WPS Commercial |
$14,334.77
|
|
|
LHC w/wo LV
|
Facility
|
IP
|
$18,729.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
3052492
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,177.21 |
| Max. Negotiated Rate |
$17,230.68 |
| Rate for Payer: Aetna Commercial |
$16,856.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,106.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,926.37
|
| Rate for Payer: Cash Price |
$5,618.70
|
| Rate for Payer: Cigna Commercial |
$17,230.68
|
| Rate for Payer: Health EOS Commercial |
$16,668.81
|
| Rate for Payer: HFN Commercial |
$17,230.68
|
| Rate for Payer: Multiplan Commercial |
$14,983.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,237.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,230.68
|
| Rate for Payer: Quartz Beloit One Network |
$9,177.21
|
| Rate for Payer: Quartz Commercial |
$11,237.40
|
| Rate for Payer: WEA Trust Commercial |
$10,300.95
|
| Rate for Payer: WPS Commercial |
$13,872.57
|
|
|
LHC w/wo LV
|
Facility
|
OP
|
$18,729.00
|
|
|
Service Code
|
CPT 93452
|
| Hospital Charge Code |
3052492
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,220.78 |
| Max. Negotiated Rate |
$17,483.00 |
| Rate for Payer: Aetna Commercial |
$16,856.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,106.94
|
| Rate for Payer: Aetna Managed Medicare |
$3,220.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,933.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,186.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,926.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,220.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,220.78
|
| Rate for Payer: Cash Price |
$5,618.70
|
| Rate for Payer: Cash Price |
$5,618.70
|
| Rate for Payer: Cash Price |
$5,618.70
|
| Rate for Payer: Cigna Commercial |
$17,230.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,220.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,480.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,220.78
|
| Rate for Payer: Health EOS Commercial |
$16,668.81
|
| Rate for Payer: HFN Commercial |
$17,230.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,981.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,220.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,220.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,220.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,220.78
|
| Rate for Payer: Multiplan Commercial |
$14,983.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,831.17
|
| Rate for Payer: Preferred Network Access Commercial |
$17,230.68
|
| Rate for Payer: Quartz Beloit One Network |
$9,177.21
|
| Rate for Payer: Quartz Commercial |
$12,173.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,220.78
|
| Rate for Payer: The Alliance Commercial |
$12,883.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,220.78
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$10,300.95
|
| Rate for Payer: Wellcare Medicare |
$3,220.78
|
| Rate for Payer: WPS Commercial |
$13,872.57
|
|
|
LH Labs, Stone Analysis
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 82360
|
| Hospital Charge Code |
4590610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
LH Labs, Stone Analysis
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 82360
|
| Hospital Charge Code |
4590610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$51.48 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$12.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.36
|
| Rate for Payer: Anthem Medicaid |
$13.30
|
| Rate for Payer: Anthem Medicare Advantage |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.87
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Dean Health Medicaid |
$13.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.87
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.87
|
| Rate for Payer: Managed Health Services Medicaid |
$13.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.87
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.30
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.30
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$12.87
|
| Rate for Payer: The Alliance Commercial |
$51.48
|
| Rate for Payer: United Healthcare Medicaid |
$13.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare PPO |
$39.75
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: Wellcare Medicare |
$12.87
|
| Rate for Payer: WMAP Medicaid |
$13.30
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
