|
MRA LE w or w/o Contrast
|
Facility
|
IP
|
$4,802.00
|
|
|
Service Code
|
CPT 73725 TC
|
| Hospital Charge Code |
4054124
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,352.98 |
| Max. Negotiated Rate |
$4,417.84 |
| Rate for Payer: Aetna Commercial |
$4,321.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.06
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,417.84
|
| Rate for Payer: Health EOS Commercial |
$4,273.78
|
| Rate for Payer: HFN Commercial |
$4,417.84
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,417.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,352.98
|
| Rate for Payer: Quartz Commercial |
$2,881.20
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Lower Ext Bilat & MRA Abd Aorta w/
|
Professional
|
Both
|
$4,802.00
|
|
| Hospital Charge Code |
1610827
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,112.88 |
| Max. Negotiated Rate |
$4,561.90 |
| Rate for Payer: Aetna Commercial |
$4,561.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,561.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,401.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,881.20
|
| Rate for Payer: Health EOS Commercial |
$4,369.82
|
| Rate for Payer: HFN Commercial |
$4,561.90
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,561.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,112.88
|
| Rate for Payer: Quartz Commercial |
$2,737.14
|
| Rate for Payer: The Alliance Commercial |
$2,401.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Lower Ext Bilat & MRA Abd Aorta w/
|
Facility
|
IP
|
$4,802.00
|
|
| Hospital Charge Code |
1610827
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,352.98 |
| Max. Negotiated Rate |
$4,417.84 |
| Rate for Payer: Aetna Commercial |
$4,321.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.06
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,417.84
|
| Rate for Payer: Health EOS Commercial |
$4,273.78
|
| Rate for Payer: HFN Commercial |
$4,417.84
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,417.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,352.98
|
| Rate for Payer: Quartz Commercial |
$2,881.20
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Lower Ext Bilat & MRA Abd Aorta w/
|
Facility
|
OP
|
$4,802.00
|
|
| Hospital Charge Code |
1610827
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,344.56 |
| Max. Negotiated Rate |
$19,208.00 |
| Rate for Payer: Aetna Commercial |
$4,321.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,344.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.06
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,417.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.20
|
| Rate for Payer: Health EOS Commercial |
$4,273.78
|
| Rate for Payer: HFN Commercial |
$4,417.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,601.50
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,417.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,352.98
|
| Rate for Payer: Quartz Commercial |
$3,121.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,881.20
|
| Rate for Payer: The Alliance Commercial |
$19,208.00
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Lower Extremity w/ Bilat
|
Facility
|
IP
|
$4,802.00
|
|
|
Service Code
|
HCPCS C8912 TC
|
| Hospital Charge Code |
3072761
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,352.98 |
| Max. Negotiated Rate |
$4,417.84 |
| Rate for Payer: Aetna Commercial |
$4,321.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.06
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,417.84
|
| Rate for Payer: Health EOS Commercial |
$4,273.78
|
| Rate for Payer: HFN Commercial |
$4,417.84
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,417.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,352.98
|
| Rate for Payer: Quartz Commercial |
$2,881.20
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Lower Extremity w/ Bilat
|
Facility
|
OP
|
$4,802.00
|
|
|
Service Code
|
HCPCS C8912 TC
|
| Hospital Charge Code |
3072761
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,417.84 |
| Rate for Payer: Aetna Commercial |
$4,321.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,417.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,273.78
|
| Rate for Payer: HFN Commercial |
$4,417.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,417.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,352.98
|
| Rate for Payer: Quartz Commercial |
$3,121.30
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Lower Extremity w/ Bilat
|
Professional
|
Both
|
$4,802.00
|
|
|
Service Code
|
HCPCS C8912 TC
|
| Hospital Charge Code |
3072761
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,112.88 |
| Max. Negotiated Rate |
$4,561.90 |
| Rate for Payer: Aetna Commercial |
$4,561.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,561.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,401.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,881.20
|
| Rate for Payer: Health EOS Commercial |
$4,369.82
|
| Rate for Payer: HFN Commercial |
$4,561.90
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,561.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,112.88
|
| Rate for Payer: Quartz Commercial |
$2,737.14
|
| Rate for Payer: The Alliance Commercial |
$2,401.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Lower Extremity w/ Left
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73725 TC,LT
|
| Hospital Charge Code |
1610838
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,283.61 |
| Max. Negotiated Rate |
$5,666.75 |
| Rate for Payer: Aetna Commercial |
$5,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,666.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.00
|
| Rate for Payer: Health EOS Commercial |
$5,428.15
|
| Rate for Payer: HFN Commercial |
$5,666.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,283.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,283.61
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,666.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,624.60
|
| Rate for Payer: Quartz Commercial |
$3,400.05
|
| Rate for Payer: The Alliance Commercial |
$2,982.50
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRA Lower Extremity w/ Left
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73725 TC,LT
|
| Hospital Charge Code |
1610838
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,670.20 |
| Max. Negotiated Rate |
$23,860.00 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,670.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,473.75
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,579.00
|
| Rate for Payer: The Alliance Commercial |
$23,860.00
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRA Lower Extremity w/ Left
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73725 TC,LT
|
| Hospital Charge Code |
1610838
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,922.85 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRA Lower Extremity w/ Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73725 TC,RT
|
| Hospital Charge Code |
1610840
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,670.20 |
| Max. Negotiated Rate |
$23,860.00 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Aetna Managed Medicare |
$1,670.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,338.01
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,473.75
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,877.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,579.00
|
| Rate for Payer: The Alliance Commercial |
$23,860.00
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRA Lower Extremity w/ Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73725 TC,RT
|
| Hospital Charge Code |
1610840
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,922.85 |
| Max. Negotiated Rate |
$5,487.80 |
| Rate for Payer: Aetna Commercial |
$5,368.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.45
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,487.80
|
| Rate for Payer: Health EOS Commercial |
$5,308.85
|
| Rate for Payer: HFN Commercial |
$5,487.80
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,487.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,922.85
|
| Rate for Payer: Quartz Commercial |
$3,579.00
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRA Lower Extremity w/ Right
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73725 TC,RT
|
| Hospital Charge Code |
1610840
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,283.61 |
| Max. Negotiated Rate |
$5,666.75 |
| Rate for Payer: Aetna Commercial |
$5,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,129.90
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,666.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,982.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,579.00
|
| Rate for Payer: Health EOS Commercial |
$5,428.15
|
| Rate for Payer: HFN Commercial |
$5,666.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,283.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,283.61
|
| Rate for Payer: Multiplan Commercial |
$4,772.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,666.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,624.60
|
| Rate for Payer: Quartz Commercial |
$3,400.05
|
| Rate for Payer: The Alliance Commercial |
$2,982.50
|
| Rate for Payer: WEA Trust Commercial |
$3,280.75
|
| Rate for Payer: WPS Commercial |
$4,418.28
|
|
|
MRA Lower Ext w/ Contrast
|
Professional
|
Both
|
$4,802.00
|
|
|
Service Code
|
CPT 73725 RT,TC
|
| Hospital Charge Code |
3072655
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,283.61 |
| Max. Negotiated Rate |
$4,561.90 |
| Rate for Payer: Aetna Commercial |
$4,561.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,561.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,401.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,881.20
|
| Rate for Payer: Health EOS Commercial |
$4,369.82
|
| Rate for Payer: HFN Commercial |
$4,561.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,283.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,283.61
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,561.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,112.88
|
| Rate for Payer: Quartz Commercial |
$2,737.14
|
| Rate for Payer: The Alliance Commercial |
$2,401.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Lower Ext w/ Contrast
|
Facility
|
IP
|
$4,802.00
|
|
|
Service Code
|
CPT 73725 RT,TC
|
| Hospital Charge Code |
3072655
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,352.98 |
| Max. Negotiated Rate |
$4,417.84 |
| Rate for Payer: Aetna Commercial |
$4,321.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.06
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,417.84
|
| Rate for Payer: Health EOS Commercial |
$4,273.78
|
| Rate for Payer: HFN Commercial |
$4,417.84
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,417.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,352.98
|
| Rate for Payer: Quartz Commercial |
$2,881.20
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Lower Ext w/ Contrast
|
Facility
|
OP
|
$4,802.00
|
|
|
Service Code
|
CPT 73725 RT,TC
|
| Hospital Charge Code |
3072655
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,417.84 |
| Rate for Payer: Aetna Commercial |
$4,321.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,129.72
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cash Price |
$1,440.60
|
| Rate for Payer: Cigna Commercial |
$4,417.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,273.78
|
| Rate for Payer: HFN Commercial |
$4,417.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$3,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,417.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,352.98
|
| Rate for Payer: Quartz Commercial |
$3,121.30
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.10
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,556.84
|
|
|
MRA Neck/Carotids w/ Contrast
|
Facility
|
IP
|
$5,030.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
630739
|
| Min. Negotiated Rate |
$2,464.70 |
| Max. Negotiated Rate |
$4,627.60 |
| Rate for Payer: Aetna Commercial |
$4,527.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,325.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.90
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,627.60
|
| Rate for Payer: Health EOS Commercial |
$4,476.70
|
| Rate for Payer: HFN Commercial |
$4,627.60
|
| Rate for Payer: Multiplan Commercial |
$4,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,018.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,627.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.70
|
| Rate for Payer: Quartz Commercial |
$3,018.00
|
| Rate for Payer: WEA Trust Commercial |
$2,766.50
|
| Rate for Payer: WPS Commercial |
$3,725.72
|
|
|
MRA Neck/Carotids w/ Contrast
|
Facility
|
OP
|
$5,030.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
630739
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$4,627.60 |
| Rate for Payer: Aetna Commercial |
$4,527.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,325.80
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,269.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,515.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,414.40
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,627.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,814.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$4,476.70
|
| Rate for Payer: HFN Commercial |
$4,627.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,627.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.70
|
| Rate for Payer: Quartz Commercial |
$3,269.50
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: WEA Trust Commercial |
$2,766.50
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$3,725.72
|
|
|
MRA Neck/Carotids w/ Contrast
|
Professional
|
Both
|
$5,030.00
|
|
|
Service Code
|
CPT 70548
|
| Hospital Charge Code |
630739
|
| Min. Negotiated Rate |
$920.98 |
| Max. Negotiated Rate |
$4,778.50 |
| Rate for Payer: Aetna Commercial |
$4,778.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,325.80
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cash Price |
$1,509.00
|
| Rate for Payer: Cigna Commercial |
$4,778.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,515.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,018.00
|
| Rate for Payer: Health EOS Commercial |
$4,577.30
|
| Rate for Payer: HFN Commercial |
$4,778.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$920.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$920.98
|
| Rate for Payer: Multiplan Commercial |
$4,024.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,778.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,213.20
|
| Rate for Payer: Quartz Commercial |
$2,867.10
|
| Rate for Payer: The Alliance Commercial |
$2,515.00
|
| Rate for Payer: WEA Trust Commercial |
$2,766.50
|
| Rate for Payer: WPS Commercial |
$3,725.72
|
|
|
MRA Neck/Carotids w/ Contrast
|
Facility
|
OP
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
1610850
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$380.12 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$5,594.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,345.76
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,294.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cigna Commercial |
$5,718.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,478.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$5,532.24
|
| Rate for Payer: HFN Commercial |
$5,718.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$4,972.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,718.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,045.84
|
| Rate for Payer: Quartz Commercial |
$4,040.40
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,418.80
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$4,604.19
|
|
|
MRA Neck/Carotids w/ Contrast
|
Facility
|
IP
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
1610850
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$3,045.84 |
| Max. Negotiated Rate |
$5,718.72 |
| Rate for Payer: Aetna Commercial |
$5,594.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,345.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,294.48
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cigna Commercial |
$5,718.72
|
| Rate for Payer: Health EOS Commercial |
$5,532.24
|
| Rate for Payer: HFN Commercial |
$5,718.72
|
| Rate for Payer: Multiplan Commercial |
$4,972.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,718.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,045.84
|
| Rate for Payer: Quartz Commercial |
$3,729.60
|
| Rate for Payer: WEA Trust Commercial |
$3,418.80
|
| Rate for Payer: WPS Commercial |
$4,604.19
|
|
|
MRA Neck/Carotids w/ Contrast
|
Professional
|
Both
|
$6,216.00
|
|
|
Service Code
|
CPT 70548 TC
|
| Hospital Charge Code |
1610850
|
|
Hospital Revenue Code
|
615
|
| Min. Negotiated Rate |
$671.37 |
| Max. Negotiated Rate |
$5,905.20 |
| Rate for Payer: Aetna Commercial |
$5,905.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,345.76
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cash Price |
$1,864.80
|
| Rate for Payer: Cigna Commercial |
$5,905.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,108.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,729.60
|
| Rate for Payer: Health EOS Commercial |
$5,656.56
|
| Rate for Payer: HFN Commercial |
$5,905.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$671.37
|
| Rate for Payer: Multiplan Commercial |
$4,972.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,905.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,735.04
|
| Rate for Payer: Quartz Commercial |
$3,543.12
|
| Rate for Payer: The Alliance Commercial |
$3,108.00
|
| Rate for Payer: WEA Trust Commercial |
$3,418.80
|
| Rate for Payer: WPS Commercial |
$4,604.19
|
|
|
MRA Neck/Carotids w/o Contrast
|
Professional
|
Both
|
$5,758.00
|
|
|
Service Code
|
CPT 70547 TC
|
| Hospital Charge Code |
1610852
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$615.67 |
| Max. Negotiated Rate |
$5,470.10 |
| Rate for Payer: Aetna Commercial |
$5,470.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,951.88
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$5,470.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,879.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,454.80
|
| Rate for Payer: Health EOS Commercial |
$5,239.78
|
| Rate for Payer: HFN Commercial |
$5,470.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$615.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$615.67
|
| Rate for Payer: Multiplan Commercial |
$4,606.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,470.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,533.52
|
| Rate for Payer: Quartz Commercial |
$3,282.06
|
| Rate for Payer: The Alliance Commercial |
$2,879.00
|
| Rate for Payer: WEA Trust Commercial |
$3,166.90
|
| Rate for Payer: WPS Commercial |
$4,264.95
|
|
|
MRA Neck/Carotids w/o Contrast
|
Facility
|
OP
|
$5,758.00
|
|
|
Service Code
|
CPT 70547 TC
|
| Hospital Charge Code |
1610852
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$5,297.36 |
| Rate for Payer: Aetna Commercial |
$5,182.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,951.88
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,051.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$5,297.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,222.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$5,124.62
|
| Rate for Payer: HFN Commercial |
$5,297.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$4,606.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,297.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,821.42
|
| Rate for Payer: Quartz Commercial |
$3,742.70
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$3,022.00
|
| Rate for Payer: WEA Trust Commercial |
$3,166.90
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$4,264.95
|
|
|
MRA Neck/Carotids w/o Contrast
|
Facility
|
IP
|
$5,758.00
|
|
|
Service Code
|
CPT 70547 TC
|
| Hospital Charge Code |
1610852
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,821.42 |
| Max. Negotiated Rate |
$5,297.36 |
| Rate for Payer: Aetna Commercial |
$5,182.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,951.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,051.74
|
| Rate for Payer: Cash Price |
$1,727.40
|
| Rate for Payer: Cigna Commercial |
$5,297.36
|
| Rate for Payer: Health EOS Commercial |
$5,124.62
|
| Rate for Payer: HFN Commercial |
$5,297.36
|
| Rate for Payer: Multiplan Commercial |
$4,606.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,297.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,821.42
|
| Rate for Payer: Quartz Commercial |
$3,454.80
|
| Rate for Payer: WEA Trust Commercial |
$3,166.90
|
| Rate for Payer: WPS Commercial |
$4,264.95
|
|
