|
Lynch Syndrome Panel
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
CPT 81295
|
| Hospital Charge Code |
5542683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$305.68 |
| Max. Negotiated Rate |
$1,746.66 |
| Rate for Payer: Aetna Commercial |
$659.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Aetna Managed Medicare |
$396.97
|
| Rate for Payer: Anthem Medicare Advantage |
$396.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$396.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$396.97
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$659.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$347.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.97
|
| Rate for Payer: Health EOS Commercial |
$632.20
|
| Rate for Payer: HFN Commercial |
$659.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,401.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,401.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$396.97
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: NAPHCARE Commercial |
$595.45
|
| Rate for Payer: Preferred Network Access Commercial |
$659.98
|
| Rate for Payer: Quartz Beloit One Network |
$305.68
|
| Rate for Payer: Quartz Commercial |
$395.99
|
| Rate for Payer: Quartz Medicare Advantage |
$396.97
|
| Rate for Payer: The Alliance Commercial |
$1,568.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$396.97
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: WPS Commercial |
$1,746.66
|
|
|
LYNX WHFO (RIGHT/LARGE)
|
Facility
|
IP
|
$924.00
|
|
| Hospital Charge Code |
2971862
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$470.87 |
| Max. Negotiated Rate |
$884.08 |
| Rate for Payer: Aetna Commercial |
$864.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$826.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.31
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$884.08
|
| Rate for Payer: Health EOS Commercial |
$855.25
|
| Rate for Payer: HFN Commercial |
$884.08
|
| Rate for Payer: Multiplan Commercial |
$768.77
|
| Rate for Payer: Preferred Network Access Commercial |
$884.08
|
| Rate for Payer: Quartz Beloit One Network |
$470.87
|
| Rate for Payer: Quartz Commercial |
$576.58
|
| Rate for Payer: WEA Trust Commercial |
$528.53
|
| Rate for Payer: WPS Commercial |
$711.76
|
|
|
LYNX WHFO (RIGHT/LARGE)
|
Facility
|
OP
|
$924.00
|
|
| Hospital Charge Code |
2971862
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$269.07 |
| Max. Negotiated Rate |
$884.08 |
| Rate for Payer: Aetna Commercial |
$864.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$826.43
|
| Rate for Payer: Aetna Managed Medicare |
$269.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$624.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$480.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.31
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$884.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$537.77
|
| Rate for Payer: Health EOS Commercial |
$855.25
|
| Rate for Payer: HFN Commercial |
$884.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$720.72
|
| Rate for Payer: Multiplan Commercial |
$768.77
|
| Rate for Payer: NAPHCARE Commercial |
$576.58
|
| Rate for Payer: Preferred Network Access Commercial |
$884.08
|
| Rate for Payer: Quartz Beloit One Network |
$470.87
|
| Rate for Payer: Quartz Commercial |
$624.62
|
| Rate for Payer: Quartz Medicare Advantage |
$576.58
|
| Rate for Payer: The Alliance Commercial |
$480.48
|
| Rate for Payer: WEA Trust Commercial |
$528.53
|
| Rate for Payer: WPS Commercial |
$711.76
|
|
|
Lysis intranasal synechia
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 30560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$567.58 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Managed Medicare |
$567.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$567.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$567.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$567.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$567.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,111.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$567.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$567.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$567.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$567.58
|
| Rate for Payer: NAPHCARE Commercial |
$851.37
|
| Rate for Payer: Quartz Medicare Advantage |
$567.58
|
| Rate for Payer: The Alliance Commercial |
$2,270.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$567.58
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$567.58
|
|
|
LYSIS INTRANASAL SYNECHIA 30560
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
5581934
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$1,751.72 |
| Rate for Payer: Aetna Commercial |
$1,751.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,585.77
|
| Rate for Payer: Aetna Managed Medicare |
$136.68
|
| Rate for Payer: Anthem Medicare Advantage |
$136.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.68
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cigna Commercial |
$1,751.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.68
|
| Rate for Payer: Health EOS Commercial |
$1,677.97
|
| Rate for Payer: HFN Commercial |
$1,751.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$516.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$516.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.68
|
| Rate for Payer: Multiplan Commercial |
$1,475.14
|
| Rate for Payer: NAPHCARE Commercial |
$205.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.72
|
| Rate for Payer: Quartz Beloit One Network |
$811.32
|
| Rate for Payer: Quartz Commercial |
$1,051.03
|
| Rate for Payer: Quartz Medicare Advantage |
$136.68
|
| Rate for Payer: The Alliance Commercial |
$580.88
|
| Rate for Payer: United Healthcare Medicaid |
$18.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.68
|
| Rate for Payer: WEA Trust Commercial |
$1,014.16
|
| Rate for Payer: WPS Commercial |
$615.05
|
|
|
Lysis of cells
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2776832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.50
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$38.06
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$38.06
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: United Healthcare PPO |
$47.58
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Lysis of cells
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2776832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Lysis of cells
|
Professional
|
Both
|
$61.00
|
|
| Hospital Charge Code |
2776832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.91 |
| Max. Negotiated Rate |
$60.27 |
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$60.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.06
|
| Rate for Payer: Health EOS Commercial |
$57.73
|
| Rate for Payer: HFN Commercial |
$60.27
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$60.27
|
| Rate for Payer: Quartz Beloit One Network |
$27.91
|
| Rate for Payer: Quartz Commercial |
$36.16
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
Lysis or excision of penile post-circumcision adhesions
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 54162
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
LYSIS PENIL CIRCUMIC LESION 54162
|
Professional
|
Both
|
$1,389.00
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
3015025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.29 |
| Max. Negotiated Rate |
$1,372.33 |
| Rate for Payer: Aetna Commercial |
$1,372.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,242.32
|
| Rate for Payer: Aetna Managed Medicare |
$178.94
|
| Rate for Payer: Anthem Medicare Advantage |
$178.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$178.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$178.94
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cigna Commercial |
$1,372.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.94
|
| Rate for Payer: Health EOS Commercial |
$1,314.55
|
| Rate for Payer: HFN Commercial |
$1,372.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$695.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$695.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$178.94
|
| Rate for Payer: Multiplan Commercial |
$1,155.65
|
| Rate for Payer: NAPHCARE Commercial |
$268.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,372.33
|
| Rate for Payer: Quartz Beloit One Network |
$635.61
|
| Rate for Payer: Quartz Commercial |
$823.40
|
| Rate for Payer: Quartz Medicare Advantage |
$178.94
|
| Rate for Payer: The Alliance Commercial |
$760.51
|
| Rate for Payer: United Healthcare Medicaid |
$90.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$178.94
|
| Rate for Payer: WEA Trust Commercial |
$794.51
|
| Rate for Payer: WPS Commercial |
$805.24
|
|
|
MA Breast Ndl Loc Placement Left
|
Facility
|
IP
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,276.04 |
| Max. Negotiated Rate |
$2,395.83 |
| Rate for Payer: Aetna Commercial |
$2,343.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,239.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,380.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,395.83
|
| Rate for Payer: Health EOS Commercial |
$2,317.70
|
| Rate for Payer: HFN Commercial |
$2,395.83
|
| Rate for Payer: Multiplan Commercial |
$2,083.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,395.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,276.04
|
| Rate for Payer: Quartz Commercial |
$1,562.50
|
| Rate for Payer: WEA Trust Commercial |
$1,432.29
|
| Rate for Payer: WPS Commercial |
$1,928.83
|
|
|
MA Breast Ndl Loc Placement Left
|
Professional
|
Both
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$2,473.95 |
| Rate for Payer: Aetna Commercial |
$2,473.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,239.58
|
| Rate for Payer: Aetna Managed Medicare |
$81.42
|
| Rate for Payer: Anthem Medicare Advantage |
$81.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.42
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,473.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.42
|
| Rate for Payer: Health EOS Commercial |
$2,369.79
|
| Rate for Payer: HFN Commercial |
$2,473.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$349.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.42
|
| Rate for Payer: Multiplan Commercial |
$2,083.33
|
| Rate for Payer: NAPHCARE Commercial |
$122.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,145.83
|
| Rate for Payer: Quartz Commercial |
$1,484.37
|
| Rate for Payer: Quartz Medicare Advantage |
$81.42
|
| Rate for Payer: The Alliance Commercial |
$346.04
|
| Rate for Payer: United Healthcare Medicaid |
$78.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.42
|
| Rate for Payer: WEA Trust Commercial |
$1,432.29
|
| Rate for Payer: WPS Commercial |
$366.40
|
|
|
MA Breast Ndl Loc Placement Left
|
Facility
|
OP
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$2,343.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,239.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,692.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,302.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,250.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,380.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,395.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$2,317.70
|
| Rate for Payer: HFN Commercial |
$2,395.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: Multiplan Commercial |
$2,083.33
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,395.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,276.04
|
| Rate for Payer: Quartz Commercial |
$1,692.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,432.29
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$1,928.83
|
|
|
MA Breast Ndl Loc Placement Right
|
Facility
|
OP
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$2,343.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,239.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,692.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,302.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,250.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,380.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,395.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$2,317.70
|
| Rate for Payer: HFN Commercial |
$2,395.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: Multiplan Commercial |
$2,083.33
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,395.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,276.04
|
| Rate for Payer: Quartz Commercial |
$1,692.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,432.29
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$1,928.83
|
|
|
MA Breast Ndl Loc Placement Right
|
Facility
|
OP
|
$1,508.00
|
|
| Hospital Charge Code |
3072759
|
| Min. Negotiated Rate |
$439.13 |
| Max. Negotiated Rate |
$1,442.85 |
| Rate for Payer: Aetna Commercial |
$1,411.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,348.76
|
| Rate for Payer: Aetna Managed Medicare |
$439.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,019.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$784.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$752.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$831.21
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,442.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$877.66
|
| Rate for Payer: Health EOS Commercial |
$1,395.80
|
| Rate for Payer: HFN Commercial |
$1,442.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,176.24
|
| Rate for Payer: Multiplan Commercial |
$1,254.66
|
| Rate for Payer: NAPHCARE Commercial |
$940.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,442.85
|
| Rate for Payer: Quartz Beloit One Network |
$768.48
|
| Rate for Payer: Quartz Commercial |
$1,019.41
|
| Rate for Payer: Quartz Medicare Advantage |
$940.99
|
| Rate for Payer: The Alliance Commercial |
$784.16
|
| Rate for Payer: WEA Trust Commercial |
$862.58
|
| Rate for Payer: WPS Commercial |
$1,161.61
|
|
|
MA Breast Ndl Loc Placement Right
|
Professional
|
Both
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$78.92 |
| Max. Negotiated Rate |
$2,473.95 |
| Rate for Payer: Aetna Commercial |
$2,473.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,239.58
|
| Rate for Payer: Aetna Managed Medicare |
$81.42
|
| Rate for Payer: Anthem Medicare Advantage |
$81.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.42
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,473.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.42
|
| Rate for Payer: Health EOS Commercial |
$2,369.79
|
| Rate for Payer: HFN Commercial |
$2,473.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$349.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.42
|
| Rate for Payer: Multiplan Commercial |
$2,083.33
|
| Rate for Payer: NAPHCARE Commercial |
$122.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,473.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,145.83
|
| Rate for Payer: Quartz Commercial |
$1,484.37
|
| Rate for Payer: Quartz Medicare Advantage |
$81.42
|
| Rate for Payer: The Alliance Commercial |
$346.04
|
| Rate for Payer: United Healthcare Medicaid |
$78.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.42
|
| Rate for Payer: WEA Trust Commercial |
$1,432.29
|
| Rate for Payer: WPS Commercial |
$366.40
|
|
|
MA Breast Ndl Loc Placement Right
|
Facility
|
IP
|
$1,508.00
|
|
| Hospital Charge Code |
3072759
|
| Min. Negotiated Rate |
$768.48 |
| Max. Negotiated Rate |
$1,442.85 |
| Rate for Payer: Aetna Commercial |
$1,411.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,348.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$831.21
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,442.85
|
| Rate for Payer: Health EOS Commercial |
$1,395.80
|
| Rate for Payer: HFN Commercial |
$1,442.85
|
| Rate for Payer: Multiplan Commercial |
$1,254.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,442.85
|
| Rate for Payer: Quartz Beloit One Network |
$768.48
|
| Rate for Payer: Quartz Commercial |
$940.99
|
| Rate for Payer: WEA Trust Commercial |
$862.58
|
| Rate for Payer: WPS Commercial |
$1,161.61
|
|
|
MA Breast Ndl Loc Placement Right
|
Facility
|
IP
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,276.04 |
| Max. Negotiated Rate |
$2,395.83 |
| Rate for Payer: Aetna Commercial |
$2,343.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,239.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,380.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,395.83
|
| Rate for Payer: Health EOS Commercial |
$2,317.70
|
| Rate for Payer: HFN Commercial |
$2,395.83
|
| Rate for Payer: Multiplan Commercial |
$2,083.33
|
| Rate for Payer: Preferred Network Access Commercial |
$2,395.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,276.04
|
| Rate for Payer: Quartz Commercial |
$1,562.50
|
| Rate for Payer: WEA Trust Commercial |
$1,432.29
|
| Rate for Payer: WPS Commercial |
$1,928.83
|
|
|
MA Breast Ndl Loc Placement Right
|
Professional
|
Both
|
$1,508.00
|
|
| Hospital Charge Code |
3072759
|
| Min. Negotiated Rate |
$690.06 |
| Max. Negotiated Rate |
$1,489.90 |
| Rate for Payer: Aetna Commercial |
$1,489.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,348.76
|
| Rate for Payer: Cash Price |
$452.40
|
| Rate for Payer: Cigna Commercial |
$1,489.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$784.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$940.99
|
| Rate for Payer: Health EOS Commercial |
$1,427.17
|
| Rate for Payer: HFN Commercial |
$1,489.90
|
| Rate for Payer: Multiplan Commercial |
$1,254.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,489.90
|
| Rate for Payer: Quartz Beloit One Network |
$690.06
|
| Rate for Payer: Quartz Commercial |
$893.94
|
| Rate for Payer: The Alliance Commercial |
$784.16
|
| Rate for Payer: WEA Trust Commercial |
$862.58
|
| Rate for Payer: WPS Commercial |
$1,161.61
|
|
|
MA Breast Tissue Specimen Left
|
Professional
|
Both
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711761
|
| Min. Negotiated Rate |
$42.69 |
| Max. Negotiated Rate |
$376.43 |
| Rate for Payer: Aetna Commercial |
$376.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Aetna Managed Medicare |
$42.69
|
| Rate for Payer: Anthem Medicare Advantage |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.69
|
| 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 |
$376.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.69
|
| Rate for Payer: Health EOS Commercial |
$360.58
|
| Rate for Payer: HFN Commercial |
$376.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.69
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: NAPHCARE Commercial |
$64.04
|
| Rate for Payer: Preferred Network Access Commercial |
$376.43
|
| Rate for Payer: Quartz Beloit One Network |
$174.35
|
| Rate for Payer: Quartz Commercial |
$225.86
|
| Rate for Payer: Quartz Medicare Advantage |
$42.69
|
| Rate for Payer: The Alliance Commercial |
$162.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.69
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: WPS Commercial |
$213.46
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
OP
|
$494.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
1268805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$143.85 |
| Max. Negotiated Rate |
$2,126.59 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Aetna Managed Medicare |
$143.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,126.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,701.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,616.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.51
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.32
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: NAPHCARE Commercial |
$308.26
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$333.94
|
| Rate for Payer: Quartz Medicare Advantage |
$308.26
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
MA Breast Tissue Specimen Left
|
Professional
|
Both
|
$494.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
1268805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.24 |
| Max. Negotiated Rate |
$488.07 |
| Rate for Payer: Aetna Commercial |
$488.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$488.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.26
|
| Rate for Payer: Health EOS Commercial |
$467.52
|
| Rate for Payer: HFN Commercial |
$488.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.24
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$488.07
|
| Rate for Payer: Quartz Beloit One Network |
$226.05
|
| Rate for Payer: Quartz Commercial |
$292.84
|
| Rate for Payer: The Alliance Commercial |
$256.88
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
OP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711761
|
| Min. Negotiated Rate |
$190.20 |
| Max. Negotiated Rate |
$2,300.15 |
| Rate for Payer: Aetna Commercial |
$356.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Aetna Managed Medicare |
$575.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$257.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.20
|
| Rate for Payer: Anthem Medicare Advantage |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$575.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$575.04
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$364.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$352.65
|
| Rate for Payer: HFN Commercial |
$364.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,139.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$575.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$575.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$575.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: NAPHCARE Commercial |
$862.56
|
| Rate for Payer: Preferred Network Access Commercial |
$364.54
|
| Rate for Payer: Quartz Beloit One Network |
$194.16
|
| Rate for Payer: Quartz Commercial |
$257.56
|
| Rate for Payer: Quartz Medicare Advantage |
$575.04
|
| Rate for Payer: The Alliance Commercial |
$2,300.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$575.04
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: Wellcare Medicare |
$575.04
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
IP
|
$381.00
|
|
|
Service Code
|
CPT 76098
|
| Hospital Charge Code |
711761
|
| Min. Negotiated Rate |
$194.16 |
| Max. Negotiated Rate |
$364.54 |
| Rate for Payer: Aetna Commercial |
$356.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.01
|
| Rate for Payer: Cash Price |
$114.30
|
| Rate for Payer: Cigna Commercial |
$364.54
|
| Rate for Payer: Health EOS Commercial |
$352.65
|
| Rate for Payer: HFN Commercial |
$364.54
|
| Rate for Payer: Multiplan Commercial |
$316.99
|
| Rate for Payer: Preferred Network Access Commercial |
$364.54
|
| Rate for Payer: Quartz Beloit One Network |
$194.16
|
| Rate for Payer: Quartz Commercial |
$237.74
|
| Rate for Payer: WEA Trust Commercial |
$217.93
|
| Rate for Payer: WPS Commercial |
$293.48
|
|
|
MA Breast Tissue Specimen Left
|
Facility
|
IP
|
$494.00
|
|
|
Service Code
|
CPT 76098 LT
|
| Hospital Charge Code |
1268805
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$251.74 |
| Max. Negotiated Rate |
$472.66 |
| Rate for Payer: Aetna Commercial |
$462.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.29
|
| Rate for Payer: Cash Price |
$148.20
|
| Rate for Payer: Cigna Commercial |
$472.66
|
| Rate for Payer: Health EOS Commercial |
$457.25
|
| Rate for Payer: HFN Commercial |
$472.66
|
| Rate for Payer: Multiplan Commercial |
$411.01
|
| Rate for Payer: Preferred Network Access Commercial |
$472.66
|
| Rate for Payer: Quartz Beloit One Network |
$251.74
|
| Rate for Payer: Quartz Commercial |
$308.26
|
| Rate for Payer: WEA Trust Commercial |
$282.57
|
| Rate for Payer: WPS Commercial |
$380.53
|
|
