|
ANTIROTATION SCREW FEMORAL NECK 75MM 04.168.475S
|
Facility
|
IP
|
$2,407.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.61 |
| Max. Negotiated Rate |
$2,303.02 |
| Rate for Payer: Aetna Commercial |
$2,252.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,152.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,326.74
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,303.02
|
| Rate for Payer: Health EOS Commercial |
$2,227.92
|
| Rate for Payer: HFN Commercial |
$2,303.02
|
| Rate for Payer: Multiplan Commercial |
$2,002.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,303.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,226.61
|
| Rate for Payer: Quartz Commercial |
$1,501.97
|
| Rate for Payer: WEA Trust Commercial |
$1,376.80
|
| Rate for Payer: WPS Commercial |
$1,854.11
|
|
|
ANTIROTATION SCREW FEMORAL NECK 90MM 04.168.490S
|
Facility
|
OP
|
$2,407.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$700.92 |
| Max. Negotiated Rate |
$2,303.02 |
| Rate for Payer: Aetna Commercial |
$2,252.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,152.82
|
| Rate for Payer: Aetna Managed Medicare |
$700.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,627.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,251.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,201.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,326.74
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,303.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,400.87
|
| Rate for Payer: Health EOS Commercial |
$2,227.92
|
| Rate for Payer: HFN Commercial |
$2,303.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,877.46
|
| Rate for Payer: Multiplan Commercial |
$2,002.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,501.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,303.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,226.61
|
| Rate for Payer: Quartz Commercial |
$1,627.13
|
| Rate for Payer: Quartz Medicare Advantage |
$1,501.97
|
| Rate for Payer: The Alliance Commercial |
$1,251.64
|
| Rate for Payer: WEA Trust Commercial |
$1,376.80
|
| Rate for Payer: WPS Commercial |
$1,854.11
|
|
|
ANTIROTATION SCREW FEMORAL NECK 90MM 04.168.490S
|
Facility
|
IP
|
$2,407.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.61 |
| Max. Negotiated Rate |
$2,303.02 |
| Rate for Payer: Aetna Commercial |
$2,252.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,152.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,326.74
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,303.02
|
| Rate for Payer: Health EOS Commercial |
$2,227.92
|
| Rate for Payer: HFN Commercial |
$2,303.02
|
| Rate for Payer: Multiplan Commercial |
$2,002.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,303.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,226.61
|
| Rate for Payer: Quartz Commercial |
$1,501.97
|
| Rate for Payer: WEA Trust Commercial |
$1,376.80
|
| Rate for Payer: WPS Commercial |
$1,854.11
|
|
|
Antistreptolysin O Screen
|
Professional
|
Both
|
$164.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
633657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$162.03 |
| Rate for Payer: Aetna Commercial |
$162.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Aetna Managed Medicare |
$7.59
|
| Rate for Payer: Anthem Medicare Advantage |
$7.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.59
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$162.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.59
|
| Rate for Payer: Health EOS Commercial |
$155.21
|
| Rate for Payer: HFN Commercial |
$162.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: NAPHCARE Commercial |
$11.39
|
| Rate for Payer: Preferred Network Access Commercial |
$162.03
|
| Rate for Payer: Quartz Beloit One Network |
$75.05
|
| Rate for Payer: Quartz Commercial |
$97.22
|
| Rate for Payer: Quartz Medicare Advantage |
$7.59
|
| Rate for Payer: The Alliance Commercial |
$29.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.59
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: WPS Commercial |
$33.40
|
|
|
Antistreptolysin O Screen
|
Facility
|
OP
|
$164.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
633657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.59 |
| Max. Negotiated Rate |
$156.92 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Aetna Managed Medicare |
$7.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.60
|
| Rate for Payer: Anthem Medicare Advantage |
$7.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.59
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.59
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.59
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: NAPHCARE Commercial |
$11.39
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$110.86
|
| Rate for Payer: Quartz Medicare Advantage |
$7.59
|
| Rate for Payer: The Alliance Commercial |
$30.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.59
|
| Rate for Payer: United Healthcare PPO |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: Wellcare Medicare |
$7.59
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
Antistreptolysin O Screen
|
Facility
|
IP
|
$164.00
|
|
|
Service Code
|
CPT 86060
|
| Hospital Charge Code |
633657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$156.92 |
| Rate for Payer: Aetna Commercial |
$153.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.40
|
| Rate for Payer: Cash Price |
$49.20
|
| Rate for Payer: Cigna Commercial |
$156.92
|
| Rate for Payer: Health EOS Commercial |
$151.80
|
| Rate for Payer: HFN Commercial |
$156.92
|
| Rate for Payer: Multiplan Commercial |
$136.45
|
| Rate for Payer: Preferred Network Access Commercial |
$156.92
|
| Rate for Payer: Quartz Beloit One Network |
$83.57
|
| Rate for Payer: Quartz Commercial |
$102.34
|
| Rate for Payer: WEA Trust Commercial |
$93.81
|
| Rate for Payer: WPS Commercial |
$126.33
|
|
|
Antithrombin III, Activity
|
Facility
|
IP
|
$682.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
980026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$347.55 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$425.57
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
Antithrombin III, Activity
|
Facility
|
OP
|
$682.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
980026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.32
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.32
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: NAPHCARE Commercial |
$18.49
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$461.03
|
| Rate for Payer: Quartz Medicare Advantage |
$12.32
|
| Rate for Payer: The Alliance Commercial |
$49.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: United Healthcare PPO |
$531.96
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: Wellcare Medicare |
$12.32
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
Antithrombin III, Activity
|
Professional
|
Both
|
$682.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
980026
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$673.82 |
| Rate for Payer: Aetna Commercial |
$673.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.32
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$673.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$354.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.32
|
| Rate for Payer: Health EOS Commercial |
$645.44
|
| Rate for Payer: HFN Commercial |
$673.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: NAPHCARE Commercial |
$18.49
|
| Rate for Payer: Preferred Network Access Commercial |
$673.82
|
| Rate for Payer: Quartz Beloit One Network |
$312.08
|
| Rate for Payer: Quartz Commercial |
$404.29
|
| Rate for Payer: Quartz Medicare Advantage |
$12.32
|
| Rate for Payer: The Alliance Commercial |
$48.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$54.23
|
|
|
Antithrombin III, Antigen
|
Professional
|
Both
|
$976.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
980027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$964.29 |
| Rate for Payer: Aetna Commercial |
$964.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$872.93
|
| Rate for Payer: Aetna Managed Medicare |
$11.24
|
| Rate for Payer: Anthem Medicare Advantage |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.24
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$964.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$507.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.24
|
| Rate for Payer: Health EOS Commercial |
$923.69
|
| Rate for Payer: HFN Commercial |
$964.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.24
|
| Rate for Payer: Multiplan Commercial |
$812.03
|
| Rate for Payer: NAPHCARE Commercial |
$16.86
|
| Rate for Payer: Preferred Network Access Commercial |
$964.29
|
| Rate for Payer: Quartz Beloit One Network |
$446.62
|
| Rate for Payer: Quartz Commercial |
$578.57
|
| Rate for Payer: Quartz Medicare Advantage |
$11.24
|
| Rate for Payer: The Alliance Commercial |
$44.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.24
|
| Rate for Payer: WEA Trust Commercial |
$558.27
|
| Rate for Payer: WPS Commercial |
$49.47
|
|
|
Antithrombin III, Antigen
|
Facility
|
OP
|
$976.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
980027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$933.84 |
| Rate for Payer: Aetna Commercial |
$913.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$872.93
|
| Rate for Payer: Aetna Managed Medicare |
$11.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.66
|
| Rate for Payer: Anthem Medicare Advantage |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$537.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.24
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$933.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.24
|
| Rate for Payer: Health EOS Commercial |
$903.39
|
| Rate for Payer: HFN Commercial |
$933.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.24
|
| Rate for Payer: Multiplan Commercial |
$812.03
|
| Rate for Payer: NAPHCARE Commercial |
$16.86
|
| Rate for Payer: Preferred Network Access Commercial |
$933.84
|
| Rate for Payer: Quartz Beloit One Network |
$497.37
|
| Rate for Payer: Quartz Commercial |
$659.78
|
| Rate for Payer: Quartz Medicare Advantage |
$11.24
|
| Rate for Payer: The Alliance Commercial |
$44.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.24
|
| Rate for Payer: United Healthcare PPO |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$558.27
|
| Rate for Payer: Wellcare Medicare |
$11.24
|
| Rate for Payer: WPS Commercial |
$751.81
|
|
|
Antithrombin III, Antigen
|
Facility
|
IP
|
$976.00
|
|
|
Service Code
|
CPT 85301
|
| Hospital Charge Code |
980027
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$933.84 |
| Rate for Payer: Aetna Commercial |
$913.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$872.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$537.97
|
| Rate for Payer: Cash Price |
$292.80
|
| Rate for Payer: Cigna Commercial |
$933.84
|
| Rate for Payer: Health EOS Commercial |
$903.39
|
| Rate for Payer: HFN Commercial |
$933.84
|
| Rate for Payer: Multiplan Commercial |
$812.03
|
| Rate for Payer: Preferred Network Access Commercial |
$933.84
|
| Rate for Payer: Quartz Beloit One Network |
$497.37
|
| Rate for Payer: Quartz Commercial |
$609.02
|
| Rate for Payer: WEA Trust Commercial |
$558.27
|
| Rate for Payer: WPS Commercial |
$751.81
|
|
|
Anti-Ustekinumab Ab
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5542921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.42 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.90
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$241.11
|
| Rate for Payer: Health EOS Commercial |
$233.25
|
| Rate for Payer: HFN Commercial |
$241.11
|
| Rate for Payer: Multiplan Commercial |
$209.66
|
| Rate for Payer: Preferred Network Access Commercial |
$241.11
|
| Rate for Payer: Quartz Beloit One Network |
$128.42
|
| Rate for Payer: Quartz Commercial |
$157.25
|
| Rate for Payer: WEA Trust Commercial |
$144.14
|
| Rate for Payer: WPS Commercial |
$194.12
|
|
|
Anti-Ustekinumab Ab
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5542921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$248.98 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.39
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$248.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$238.49
|
| Rate for Payer: HFN Commercial |
$248.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$209.66
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$248.98
|
| Rate for Payer: Quartz Beloit One Network |
$115.32
|
| Rate for Payer: Quartz Commercial |
$149.39
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$144.14
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Anti-Ustekinumab Ab
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5542921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.39
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$241.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$233.25
|
| Rate for Payer: HFN Commercial |
$241.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$209.66
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$241.11
|
| Rate for Payer: Quartz Beloit One Network |
$128.42
|
| Rate for Payer: Quartz Commercial |
$170.35
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$144.14
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$194.12
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
|
IP
|
$189,861.36
|
|
|
Service Code
|
MSDRG 268
|
| Min. Negotiated Rate |
$53,179.09 |
| Max. Negotiated Rate |
$189,861.36 |
| Rate for Payer: Aetna Managed Medicare |
$53,179.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150,070.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115,027.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109,283.78
|
| Rate for Payer: Anthem Medicare Advantage |
$53,179.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53,179.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53,179.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53,179.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121,315.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53,179.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139,013.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53,179.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53,179.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53,179.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53,179.09
|
| Rate for Payer: NAPHCARE Commercial |
$79,768.63
|
| Rate for Payer: Quartz Medicare Advantage |
$53,179.09
|
| Rate for Payer: The Alliance Commercial |
$189,861.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53,179.09
|
| Rate for Payer: United Healthcare PPO |
$108,223.65
|
| Rate for Payer: Wellcare Medicare |
$53,179.09
|
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
|
IP
|
$115,316.24
|
|
|
Service Code
|
MSDRG 269
|
| Min. Negotiated Rate |
$32,848.88 |
| Max. Negotiated Rate |
$115,316.24 |
| Rate for Payer: Aetna Managed Medicare |
$32,848.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92,146.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70,629.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67,102.93
|
| Rate for Payer: Anthem Medicare Advantage |
$32,848.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,848.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,848.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,848.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74,490.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,848.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84,336.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,848.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,848.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,848.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,848.88
|
| Rate for Payer: NAPHCARE Commercial |
$49,273.32
|
| Rate for Payer: Quartz Medicare Advantage |
$32,848.88
|
| Rate for Payer: The Alliance Commercial |
$115,316.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,848.88
|
| Rate for Payer: United Healthcare PPO |
$65,656.98
|
| Rate for Payer: Wellcare Medicare |
$32,848.88
|
|
|
AORTIC VALVE 16MM AP360 #505DA16
|
Facility
|
OP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,127.35 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Aetna Managed Medicare |
$10,127.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,509.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,084.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,361.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,240.80
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,126.84
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: NAPHCARE Commercial |
$21,701.47
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$23,509.93
|
| Rate for Payer: Quartz Medicare Advantage |
$21,701.47
|
| Rate for Payer: The Alliance Commercial |
$18,084.56
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 16MM AP360 #505DA16
|
Facility
|
IP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973948
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,722.87 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$21,701.47
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 18MM AP360 #505DA18
|
Facility
|
IP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,722.87 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$21,701.47
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 18MM AP360 #505DA18
|
Facility
|
OP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973947
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,127.35 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Aetna Managed Medicare |
$10,127.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,509.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,084.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,361.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,240.80
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,126.84
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: NAPHCARE Commercial |
$21,701.47
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$23,509.93
|
| Rate for Payer: Quartz Medicare Advantage |
$21,701.47
|
| Rate for Payer: The Alliance Commercial |
$18,084.56
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 19MM MOSAIC ULTRA 305U219
|
Facility
|
IP
|
$38,439.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19,588.51 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$23,985.94
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
AORTIC VALVE 19MM MOSAIC ULTRA 305U219
|
Facility
|
OP
|
$38,439.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973954
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,193.44 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Aetna Managed Medicare |
$11,193.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,984.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,988.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,188.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,371.50
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,982.42
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: NAPHCARE Commercial |
$23,985.94
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$25,984.76
|
| Rate for Payer: Quartz Medicare Advantage |
$23,985.94
|
| Rate for Payer: The Alliance Commercial |
$19,988.28
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
AORTIC VALVE 19MM TRIFECTA TF-19A
|
Facility
|
OP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,689.27 |
| Max. Negotiated Rate |
$51,550.47 |
| Rate for Payer: Aetna Commercial |
$50,429.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48,188.48
|
| Rate for Payer: Aetna Managed Medicare |
$15,689.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,421.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,016.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,895.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,697.55
|
| Rate for Payer: Cash Price |
$16,163.40
|
| Rate for Payer: Cigna Commercial |
$51,550.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,357.00
|
| Rate for Payer: Health EOS Commercial |
$49,869.48
|
| Rate for Payer: HFN Commercial |
$51,550.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,024.84
|
| Rate for Payer: Multiplan Commercial |
$44,826.50
|
| Rate for Payer: NAPHCARE Commercial |
$33,619.87
|
| Rate for Payer: Preferred Network Access Commercial |
$51,550.47
|
| Rate for Payer: Quartz Beloit One Network |
$27,456.23
|
| Rate for Payer: Quartz Commercial |
$36,421.53
|
| Rate for Payer: Quartz Medicare Advantage |
$33,619.87
|
| Rate for Payer: The Alliance Commercial |
$28,016.56
|
| Rate for Payer: WEA Trust Commercial |
$30,818.22
|
| Rate for Payer: WPS Commercial |
$41,502.22
|
|
|
AORTIC VALVE 19MM TRIFECTA TF-19A
|
Facility
|
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966066
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,456.23 |
| Max. Negotiated Rate |
$51,550.47 |
| Rate for Payer: Aetna Commercial |
$50,429.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48,188.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,697.55
|
| Rate for Payer: Cash Price |
$16,163.40
|
| Rate for Payer: Cigna Commercial |
$51,550.47
|
| Rate for Payer: Health EOS Commercial |
$49,869.48
|
| Rate for Payer: HFN Commercial |
$51,550.47
|
| Rate for Payer: Multiplan Commercial |
$44,826.50
|
| Rate for Payer: Preferred Network Access Commercial |
$51,550.47
|
| Rate for Payer: Quartz Beloit One Network |
$27,456.23
|
| Rate for Payer: Quartz Commercial |
$33,619.87
|
| Rate for Payer: WEA Trust Commercial |
$30,818.22
|
| Rate for Payer: WPS Commercial |
$41,502.22
|
|
