|
MRI Knee w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$12,160.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
631079
|
| Min. Negotiated Rate |
$379.71 |
| Max. Negotiated Rate |
$12,014.08 |
| Rate for Payer: Aetna Commercial |
$12,014.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.90
|
| Rate for Payer: Aetna Managed Medicare |
$379.71
|
| Rate for Payer: Anthem Medicare Advantage |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$379.71
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$12,014.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,323.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.71
|
| Rate for Payer: Health EOS Commercial |
$11,508.22
|
| Rate for Payer: HFN Commercial |
$12,014.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$379.71
|
| Rate for Payer: Multiplan Commercial |
$10,117.12
|
| Rate for Payer: NAPHCARE Commercial |
$569.57
|
| Rate for Payer: Preferred Network Access Commercial |
$12,014.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,564.42
|
| Rate for Payer: Quartz Commercial |
$7,208.45
|
| Rate for Payer: Quartz Medicare Advantage |
$379.71
|
| Rate for Payer: The Alliance Commercial |
$1,442.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.71
|
| Rate for Payer: WEA Trust Commercial |
$6,955.52
|
| Rate for Payer: WPS Commercial |
$1,898.57
|
|
|
MRI Knee w/ + w/o Contrast Bilateral
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611171
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,562.68 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| 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 |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.16
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Knee w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$12,160.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
631079
|
| Min. Negotiated Rate |
$6,196.74 |
| Max. Negotiated Rate |
$11,634.69 |
| Rate for Payer: Aetna Commercial |
$11,381.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,875.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,702.59
|
| Rate for Payer: Cash Price |
$3,648.00
|
| Rate for Payer: Cigna Commercial |
$11,634.69
|
| Rate for Payer: Health EOS Commercial |
$11,255.30
|
| Rate for Payer: HFN Commercial |
$11,634.69
|
| Rate for Payer: Multiplan Commercial |
$10,117.12
|
| Rate for Payer: Preferred Network Access Commercial |
$11,634.69
|
| Rate for Payer: Quartz Beloit One Network |
$6,196.74
|
| Rate for Payer: Quartz Commercial |
$7,587.84
|
| Rate for Payer: WEA Trust Commercial |
$6,955.52
|
| Rate for Payer: WPS Commercial |
$9,366.85
|
|
|
MRI Knee w/ + w/o Contrast Bilateral
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611171
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| 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 |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Knee w/ + w/o Contrast Bilateral
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611171
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Knee w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611173
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,207.93 |
| Max. Negotiated Rate |
$6,023.06 |
| Rate for Payer: Aetna Commercial |
$5,892.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,469.80
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,023.06
|
| Rate for Payer: Health EOS Commercial |
$5,826.65
|
| Rate for Payer: HFN Commercial |
$6,023.06
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,023.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.93
|
| Rate for Payer: Quartz Commercial |
$3,928.08
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Knee w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
631083
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,161.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.14
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$4,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Knee w/ + w/o Contrast Left
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
631083
|
| Min. Negotiated Rate |
$3,098.37 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$3,793.92
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Knee w/ + w/o Contrast Left
|
Facility
|
OP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611173
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,833.10 |
| Max. Negotiated Rate |
$6,023.06 |
| Rate for Payer: Aetna Commercial |
$5,892.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.10
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,469.80
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,023.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,663.69
|
| Rate for Payer: Health EOS Commercial |
$5,826.65
|
| Rate for Payer: HFN Commercial |
$6,023.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,910.10
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: NAPHCARE Commercial |
$3,928.08
|
| Rate for Payer: Preferred Network Access Commercial |
$6,023.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.93
|
| Rate for Payer: Quartz Commercial |
$4,255.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,928.08
|
| Rate for Payer: The Alliance Commercial |
$3,273.40
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Knee w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,LT
|
| Hospital Charge Code |
1611173
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,562.68 |
| Max. Negotiated Rate |
$6,219.46 |
| Rate for Payer: Aetna Commercial |
$6,219.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,219.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,273.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,928.08
|
| Rate for Payer: Health EOS Commercial |
$5,957.59
|
| Rate for Payer: HFN Commercial |
$6,219.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,219.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,880.59
|
| Rate for Payer: Quartz Commercial |
$3,731.68
|
| Rate for Payer: The Alliance Commercial |
$3,273.40
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Knee w/ + w/o Contrast Left
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
631083
|
| Min. Negotiated Rate |
$379.71 |
| Max. Negotiated Rate |
$6,007.04 |
| Rate for Payer: Aetna Commercial |
$6,007.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$379.71
|
| Rate for Payer: Anthem Medicare Advantage |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$379.71
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$6,007.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,161.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.71
|
| Rate for Payer: Health EOS Commercial |
$5,754.11
|
| Rate for Payer: HFN Commercial |
$6,007.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$379.71
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$569.57
|
| Rate for Payer: Preferred Network Access Commercial |
$6,007.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,782.21
|
| Rate for Payer: Quartz Commercial |
$3,604.22
|
| Rate for Payer: Quartz Medicare Advantage |
$379.71
|
| Rate for Payer: The Alliance Commercial |
$1,442.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.71
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,898.57
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Professional
|
Both
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
2980112
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,562.68 |
| Max. Negotiated Rate |
$5,893.42 |
| Rate for Payer: Aetna Commercial |
$5,893.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| 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 |
$5,893.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,101.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,722.16
|
| Rate for Payer: Health EOS Commercial |
$5,645.28
|
| Rate for Payer: HFN Commercial |
$5,893.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,893.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,729.58
|
| Rate for Payer: Quartz Commercial |
$3,536.05
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
631088
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,110.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,161.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,035.14
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,538.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$4,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
1611175
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,207.93 |
| Max. Negotiated Rate |
$6,023.06 |
| Rate for Payer: Aetna Commercial |
$5,892.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,469.80
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,023.06
|
| Rate for Payer: Health EOS Commercial |
$5,826.65
|
| Rate for Payer: HFN Commercial |
$6,023.06
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,023.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.93
|
| Rate for Payer: Quartz Commercial |
$3,928.08
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Facility
|
IP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
2980112
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$3,039.76 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| Rate for Payer: Cash Price |
$1,789.50
|
| Rate for Payer: Cigna Commercial |
$5,707.31
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$3,722.16
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Facility
|
OP
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
1611175
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,833.10 |
| Max. Negotiated Rate |
$6,023.06 |
| Rate for Payer: Aetna Commercial |
$5,892.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.10
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,469.80
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,023.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,663.69
|
| Rate for Payer: Health EOS Commercial |
$5,826.65
|
| Rate for Payer: HFN Commercial |
$6,023.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,910.10
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: NAPHCARE Commercial |
$3,928.08
|
| Rate for Payer: Preferred Network Access Commercial |
$6,023.06
|
| Rate for Payer: Quartz Beloit One Network |
$3,207.93
|
| Rate for Payer: Quartz Commercial |
$4,255.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3,928.08
|
| Rate for Payer: The Alliance Commercial |
$3,273.40
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Facility
|
IP
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
631088
|
| Min. Negotiated Rate |
$3,098.37 |
| Max. Negotiated Rate |
$5,817.34 |
| Rate for Payer: Aetna Commercial |
$5,690.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,351.30
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$5,817.34
|
| Rate for Payer: Health EOS Commercial |
$5,627.65
|
| Rate for Payer: HFN Commercial |
$5,817.34
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: Preferred Network Access Commercial |
$5,817.34
|
| Rate for Payer: Quartz Beloit One Network |
$3,098.37
|
| Rate for Payer: Quartz Commercial |
$3,793.92
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$4,683.42
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Facility
|
OP
|
$5,965.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
2980112
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,737.01 |
| Max. Negotiated Rate |
$5,707.31 |
| Rate for Payer: Aetna Commercial |
$5,583.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,335.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,737.01
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,287.91
|
| 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 |
$5,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,471.63
|
| Rate for Payer: Health EOS Commercial |
$5,521.20
|
| Rate for Payer: HFN Commercial |
$5,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,652.70
|
| Rate for Payer: Multiplan Commercial |
$4,962.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,722.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,707.31
|
| Rate for Payer: Quartz Beloit One Network |
$3,039.76
|
| Rate for Payer: Quartz Commercial |
$4,032.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,722.16
|
| Rate for Payer: The Alliance Commercial |
$3,101.80
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$3,411.98
|
| Rate for Payer: WPS Commercial |
$4,594.84
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,080.00
|
|
|
Service Code
|
CPT 73723
|
| Hospital Charge Code |
631088
|
| Min. Negotiated Rate |
$379.71 |
| Max. Negotiated Rate |
$6,007.04 |
| Rate for Payer: Aetna Commercial |
$6,007.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,437.95
|
| Rate for Payer: Aetna Managed Medicare |
$379.71
|
| Rate for Payer: Anthem Medicare Advantage |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$379.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$379.71
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cash Price |
$1,824.00
|
| Rate for Payer: Cigna Commercial |
$6,007.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,161.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$379.71
|
| Rate for Payer: Health EOS Commercial |
$5,754.11
|
| Rate for Payer: HFN Commercial |
$6,007.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$379.71
|
| Rate for Payer: Multiplan Commercial |
$5,058.56
|
| Rate for Payer: NAPHCARE Commercial |
$569.57
|
| Rate for Payer: Preferred Network Access Commercial |
$6,007.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,782.21
|
| Rate for Payer: Quartz Commercial |
$3,604.22
|
| Rate for Payer: Quartz Medicare Advantage |
$379.71
|
| Rate for Payer: The Alliance Commercial |
$1,442.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$379.71
|
| Rate for Payer: WEA Trust Commercial |
$3,477.76
|
| Rate for Payer: WPS Commercial |
$1,898.57
|
|
|
MRI Knee w/ + w/o Contrast Right
|
Professional
|
Both
|
$6,295.00
|
|
|
Service Code
|
CPT 73723 TC,RT
|
| Hospital Charge Code |
1611175
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,562.68 |
| Max. Negotiated Rate |
$6,219.46 |
| Rate for Payer: Aetna Commercial |
$6,219.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,630.25
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cash Price |
$1,888.50
|
| Rate for Payer: Cigna Commercial |
$6,219.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,273.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,928.08
|
| Rate for Payer: Health EOS Commercial |
$5,957.59
|
| Rate for Payer: HFN Commercial |
$6,219.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,562.68
|
| Rate for Payer: Multiplan Commercial |
$5,237.44
|
| Rate for Payer: Preferred Network Access Commercial |
$6,219.46
|
| Rate for Payer: Quartz Beloit One Network |
$2,880.59
|
| Rate for Payer: Quartz Commercial |
$3,731.68
|
| Rate for Payer: The Alliance Commercial |
$3,273.40
|
| Rate for Payer: WEA Trust Commercial |
$3,600.74
|
| Rate for Payer: WPS Commercial |
$4,849.04
|
|
|
MRI LE Joint w/ Contrast Bilateral
|
Facility
|
OP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631137
|
| Min. Negotiated Rate |
$824.99 |
| Max. Negotiated Rate |
$9,729.70 |
| Rate for Payer: Aetna Commercial |
$9,518.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Aetna Managed Medicare |
$824.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,874.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,287.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,076.36
|
| Rate for Payer: Anthem Medicare Advantage |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,605.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$824.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$824.99
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,729.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$824.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,918.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$824.99
|
| Rate for Payer: Health EOS Commercial |
$9,412.43
|
| Rate for Payer: HFN Commercial |
$9,729.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$824.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$824.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$824.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$824.99
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.49
|
| Rate for Payer: Preferred Network Access Commercial |
$9,729.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,182.12
|
| Rate for Payer: Quartz Commercial |
$6,874.24
|
| Rate for Payer: Quartz Medicare Advantage |
$824.99
|
| Rate for Payer: The Alliance Commercial |
$3,299.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$824.99
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: Wellcare Medicare |
$824.99
|
| Rate for Payer: WPS Commercial |
$7,833.18
|
|
|
MRI LE Joint w/ Contrast Bilateral
|
Facility
|
OP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611195
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$1,452.51 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Aetna Managed Medicare |
$1,452.51
|
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,903.02
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,890.64
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,112.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,371.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,112.51
|
| Rate for Payer: The Alliance Commercial |
$2,593.76
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Bilateral
|
Facility
|
IP
|
$4,988.00
|
|
|
Service Code
|
CPT 73722 TC,LT
|
| Hospital Charge Code |
1611195
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,541.88 |
| Max. Negotiated Rate |
$4,772.52 |
| Rate for Payer: Aetna Commercial |
$4,668.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,461.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,749.39
|
| Rate for Payer: Cash Price |
$1,496.40
|
| Rate for Payer: Cigna Commercial |
$4,772.52
|
| Rate for Payer: Health EOS Commercial |
$4,616.89
|
| Rate for Payer: HFN Commercial |
$4,772.52
|
| Rate for Payer: Multiplan Commercial |
$4,150.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,772.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,541.88
|
| Rate for Payer: Quartz Commercial |
$3,112.51
|
| Rate for Payer: WEA Trust Commercial |
$2,853.14
|
| Rate for Payer: WPS Commercial |
$3,842.26
|
|
|
MRI LE Joint w/ Contrast Bilateral
|
Professional
|
Both
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631137
|
| Min. Negotiated Rate |
$313.63 |
| Max. Negotiated Rate |
$10,046.97 |
| Rate for Payer: Aetna Commercial |
$10,046.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Aetna Managed Medicare |
$313.63
|
| Rate for Payer: Anthem Medicare Advantage |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.63
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$10,046.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,287.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.63
|
| Rate for Payer: Health EOS Commercial |
$9,623.94
|
| Rate for Payer: HFN Commercial |
$10,046.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,271.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.63
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: NAPHCARE Commercial |
$470.45
|
| Rate for Payer: Preferred Network Access Commercial |
$10,046.97
|
| Rate for Payer: Quartz Beloit One Network |
$4,653.33
|
| Rate for Payer: Quartz Commercial |
$6,028.18
|
| Rate for Payer: Quartz Medicare Advantage |
$313.63
|
| Rate for Payer: The Alliance Commercial |
$1,191.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.63
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: WPS Commercial |
$1,568.16
|
|
|
MRI LE Joint w/ Contrast Bilateral
|
Facility
|
IP
|
$10,169.00
|
|
|
Service Code
|
CPT 73722
|
| Hospital Charge Code |
631137
|
| Min. Negotiated Rate |
$5,182.12 |
| Max. Negotiated Rate |
$9,729.70 |
| Rate for Payer: Aetna Commercial |
$9,518.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,095.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,605.15
|
| Rate for Payer: Cash Price |
$3,050.70
|
| Rate for Payer: Cigna Commercial |
$9,729.70
|
| Rate for Payer: Health EOS Commercial |
$9,412.43
|
| Rate for Payer: HFN Commercial |
$9,729.70
|
| Rate for Payer: Multiplan Commercial |
$8,460.61
|
| Rate for Payer: Preferred Network Access Commercial |
$9,729.70
|
| Rate for Payer: Quartz Beloit One Network |
$5,182.12
|
| Rate for Payer: Quartz Commercial |
$6,345.46
|
| Rate for Payer: WEA Trust Commercial |
$5,816.67
|
| Rate for Payer: WPS Commercial |
$7,833.18
|
|
