|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$42,510.00
|
|
|
Service Code
|
MSDRG 251
|
| Min. Negotiated Rate |
$15,291.26 |
| Max. Negotiated Rate |
$42,510.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,291.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,358.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,568.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,292.02
|
| Rate for Payer: Anthem Medicare Advantage |
$15,291.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,291.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,291.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,291.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,966.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,291.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,944.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,291.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,291.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,291.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,291.26
|
| Rate for Payer: NAPHCARE Commercial |
$22,936.89
|
| Rate for Payer: Quartz Medicare Advantage |
$15,291.26
|
| Rate for Payer: The Alliance Commercial |
$42,510.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,291.26
|
| Rate for Payer: United Healthcare PPO |
$24,090.73
|
| Rate for Payer: Wellcare Medicare |
$15,291.26
|
|
|
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$4,957.00
|
|
| Hospital Charge Code |
2960562
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,387.96 |
| Max. Negotiated Rate |
$19,828.00 |
| Rate for Payer: Aetna Commercial |
$4,461.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,263.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,387.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,222.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,478.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,379.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,627.21
|
| Rate for Payer: Cash Price |
$1,487.10
|
| Rate for Payer: Cigna Commercial |
$4,560.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,773.94
|
| Rate for Payer: Health EOS Commercial |
$4,411.73
|
| Rate for Payer: HFN Commercial |
$4,560.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,717.75
|
| Rate for Payer: Multiplan Commercial |
$3,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,974.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,560.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.93
|
| Rate for Payer: Quartz Commercial |
$3,222.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,974.20
|
| Rate for Payer: The Alliance Commercial |
$19,828.00
|
| Rate for Payer: WEA Trust Commercial |
$2,726.35
|
| Rate for Payer: WPS Commercial |
$3,671.65
|
|
|
PERCUTANEOUS ENDOSCOPIC GASTROSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$4,957.00
|
|
| Hospital Charge Code |
2960562
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,428.93 |
| Max. Negotiated Rate |
$4,560.44 |
| Rate for Payer: Aetna Commercial |
$4,461.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,263.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,627.21
|
| Rate for Payer: Cash Price |
$1,487.10
|
| Rate for Payer: Cigna Commercial |
$4,560.44
|
| Rate for Payer: Health EOS Commercial |
$4,411.73
|
| Rate for Payer: HFN Commercial |
$4,560.44
|
| Rate for Payer: Multiplan Commercial |
$3,965.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,974.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,560.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,428.93
|
| Rate for Payer: Quartz Commercial |
$2,974.20
|
| Rate for Payer: WEA Trust Commercial |
$2,726.35
|
| Rate for Payer: WPS Commercial |
$3,671.65
|
|
|
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL
|
Facility
|
OP
|
$27,039.44
|
|
|
Service Code
|
CPT 63650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,757.59 |
| Max. Negotiated Rate |
$27,039.44 |
| Rate for Payer: Wellcare Medicare |
$6,759.86
|
| Rate for Payer: Aetna Managed Medicare |
$6,759.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,759.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,759.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,759.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,759.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,759.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,146.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,759.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,759.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,759.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,759.86
|
| Rate for Payer: NAPHCARE Commercial |
$10,139.79
|
| Rate for Payer: Quartz Medicare Advantage |
$6,759.86
|
| Rate for Payer: The Alliance Commercial |
$27,039.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,759.86
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
|
|
PERCUTANEOUS INSERTION KIT 2.4MM PUSHLOCK AR-2922PK
|
Facility
|
OP
|
$3,222.00
|
|
| Hospital Charge Code |
5659714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$902.16 |
| Max. Negotiated Rate |
$12,888.00 |
| Rate for Payer: Aetna Commercial |
$2,899.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,770.92
|
| Rate for Payer: Aetna Managed Medicare |
$902.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,094.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,611.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,546.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.66
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$2,964.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,803.03
|
| Rate for Payer: Health EOS Commercial |
$2,867.58
|
| Rate for Payer: HFN Commercial |
$2,964.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,416.50
|
| Rate for Payer: Multiplan Commercial |
$2,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.78
|
| Rate for Payer: Quartz Commercial |
$2,094.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,933.20
|
| Rate for Payer: The Alliance Commercial |
$12,888.00
|
| Rate for Payer: WEA Trust Commercial |
$1,772.10
|
| Rate for Payer: WPS Commercial |
$2,386.54
|
|
|
PERCUTANEOUS INSERTION KIT 2.4MM PUSHLOCK AR-2922PK
|
Facility
|
IP
|
$3,222.00
|
|
| Hospital Charge Code |
5659714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,578.78 |
| Max. Negotiated Rate |
$2,964.24 |
| Rate for Payer: Aetna Commercial |
$2,899.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,770.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,707.66
|
| Rate for Payer: Cash Price |
$966.60
|
| Rate for Payer: Cigna Commercial |
$2,964.24
|
| Rate for Payer: Health EOS Commercial |
$2,867.58
|
| Rate for Payer: HFN Commercial |
$2,964.24
|
| Rate for Payer: Multiplan Commercial |
$2,577.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,964.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,578.78
|
| Rate for Payer: Quartz Commercial |
$1,933.20
|
| Rate for Payer: WEA Trust Commercial |
$1,772.10
|
| Rate for Payer: WPS Commercial |
$2,386.54
|
|
|
PERCUTANEOUS INSERTION KIT 2.9MM PUSHLOCK AR-1923PK
|
Facility
|
OP
|
$2,164.00
|
|
| Hospital Charge Code |
5977660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.92 |
| Max. Negotiated Rate |
$8,656.00 |
| Rate for Payer: Aetna Commercial |
$1,947.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.04
|
| Rate for Payer: Aetna Managed Medicare |
$605.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,406.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,082.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,038.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,146.92
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$1,990.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,210.97
|
| Rate for Payer: Health EOS Commercial |
$1,925.96
|
| Rate for Payer: HFN Commercial |
$1,990.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,623.00
|
| Rate for Payer: Multiplan Commercial |
$1,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,298.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,990.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.36
|
| Rate for Payer: Quartz Commercial |
$1,406.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,298.40
|
| Rate for Payer: The Alliance Commercial |
$8,656.00
|
| Rate for Payer: WEA Trust Commercial |
$1,190.20
|
| Rate for Payer: WPS Commercial |
$1,602.87
|
|
|
PERCUTANEOUS INSERTION KIT 2.9MM PUSHLOCK AR-1923PK
|
Facility
|
IP
|
$2,164.00
|
|
| Hospital Charge Code |
5977660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,060.36 |
| Max. Negotiated Rate |
$1,990.88 |
| Rate for Payer: Aetna Commercial |
$1,947.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,146.92
|
| Rate for Payer: Cash Price |
$649.20
|
| Rate for Payer: Cigna Commercial |
$1,990.88
|
| Rate for Payer: Health EOS Commercial |
$1,925.96
|
| Rate for Payer: HFN Commercial |
$1,990.88
|
| Rate for Payer: Multiplan Commercial |
$1,731.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,298.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,990.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,060.36
|
| Rate for Payer: Quartz Commercial |
$1,298.40
|
| Rate for Payer: WEA Trust Commercial |
$1,190.20
|
| Rate for Payer: WPS Commercial |
$1,602.87
|
|
|
PERCUTANEOUS NEEDLE ACCESS NAVIGUIDE 18GA X 20CM M0067001330
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
5459835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$468.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.75
|
|
|
PERCUTANEOUS NEEDLE ACCESS NAVIGUIDE 18GA X 20CM M0067001330
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
5459835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Aetna Managed Medicare |
$218.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$507.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$390.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$374.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$436.49
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$507.00
|
| Rate for Payer: Quartz Medicare Advantage |
$468.00
|
| Rate for Payer: The Alliance Commercial |
$3,120.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.75
|
|
|
PERCUTANEOUS PINNING, HAND/WRIST/FINGER FRACTURE
|
Facility
|
IP
|
$1,757.00
|
|
| Hospital Charge Code |
2950338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
PERCUTANEOUS PINNING, HAND/WRIST/FINGER FRACTURE
|
Facility
|
OP
|
$1,757.00
|
|
| Hospital Charge Code |
2950338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 26608
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 28636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 26727
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,639.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S);
|
Facility
|
OP
|
$22,597.64
|
|
|
Service Code
|
CPT 36904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$22,597.64 |
| Rate for Payer: Aetna Managed Medicare |
$5,649.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,649.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,649.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,649.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,015.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,649.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,649.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,649.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,649.41
|
| Rate for Payer: NAPHCARE Commercial |
$8,474.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5,649.41
|
| Rate for Payer: The Alliance Commercial |
$22,597.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,649.41
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: Wellcare Medicare |
$5,649.41
|
|
|
PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY AND/OR INFUSION FOR THROMBOLYSIS, DIALYSIS CIRCUIT, ANY METHOD, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION, DIAGNOSTIC ANGIOGRAPHY, FLUOROSCOPIC GUIDANCE, CATHETER PLACEMENT(S), AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S); WITH TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL DIALYSIS SEGMENT, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY
|
Facility
|
OP
|
$40,449.87
|
|
|
Service Code
|
CPT 36905
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,596.00 |
| Max. Negotiated Rate |
$40,449.87 |
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$18,485.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
|
|
PERCUTANEOUS ULTRASONIC LITHOTRIPSY WITH LITHOCLAST
|
Facility
|
IP
|
$17,872.00
|
|
|
Service Code
|
CPT 50081
|
| Hospital Charge Code |
5433010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,757.28 |
| Max. Negotiated Rate |
$16,442.24 |
| Rate for Payer: Aetna Commercial |
$16,084.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,369.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,472.16
|
| Rate for Payer: Cash Price |
$5,361.60
|
| Rate for Payer: Cigna Commercial |
$16,442.24
|
| Rate for Payer: Health EOS Commercial |
$15,906.08
|
| Rate for Payer: HFN Commercial |
$16,442.24
|
| Rate for Payer: Multiplan Commercial |
$14,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,723.20
|
| Rate for Payer: Preferred Network Access Commercial |
$16,442.24
|
| Rate for Payer: Quartz Beloit One Network |
$8,757.28
|
| Rate for Payer: Quartz Commercial |
$10,723.20
|
| Rate for Payer: WEA Trust Commercial |
$9,829.60
|
| Rate for Payer: WPS Commercial |
$13,237.79
|
|
|
PERCUTANEOUS ULTRASONIC LITHOTRIPSY WITH LITHOCLAST
|
Facility
|
OP
|
$17,872.00
|
|
|
Service Code
|
CPT 50081
|
| Hospital Charge Code |
5433010
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,757.28 |
| Max. Negotiated Rate |
$33,872.50 |
| Rate for Payer: Aetna Commercial |
$16,084.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,369.92
|
| Rate for Payer: Aetna Managed Medicare |
$9,105.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9,105.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,472.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,105.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,105.51
|
| Rate for Payer: Cash Price |
$5,361.60
|
| Rate for Payer: Cash Price |
$5,361.60
|
| Rate for Payer: Cash Price |
$5,361.60
|
| Rate for Payer: Cigna Commercial |
$16,442.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,105.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,105.51
|
| Rate for Payer: Health EOS Commercial |
$15,906.08
|
| Rate for Payer: HFN Commercial |
$16,442.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,872.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,105.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,105.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,105.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,105.51
|
| Rate for Payer: Multiplan Commercial |
$14,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$13,658.26
|
| Rate for Payer: Preferred Network Access Commercial |
$16,442.24
|
| Rate for Payer: Quartz Beloit One Network |
$8,757.28
|
| Rate for Payer: Quartz Commercial |
$11,616.80
|
| Rate for Payer: Quartz Medicare Advantage |
$9,105.51
|
| Rate for Payer: The Alliance Commercial |
$15,479.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,105.51
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$9,829.60
|
| Rate for Payer: Wellcare Medicare |
$9,105.51
|
| Rate for Payer: WPS Commercial |
$13,237.79
|
|
|
Percutaneous Vertebroplsty Lumbosacral w/guidance 22511
|
Professional
|
Both
|
$3,961.00
|
|
|
Service Code
|
CPT 22511
|
| Hospital Charge Code |
5232607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,330.00 |
| Max. Negotiated Rate |
$3,762.95 |
| Rate for Payer: Aetna Commercial |
$3,762.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,406.46
|
| Rate for Payer: Cash Price |
$1,188.30
|
| Rate for Payer: Cash Price |
$1,188.30
|
| Rate for Payer: Cash Price |
$1,188.30
|
| Rate for Payer: Cigna Commercial |
$3,762.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,330.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,376.60
|
| Rate for Payer: Health EOS Commercial |
$3,604.51
|
| Rate for Payer: HFN Commercial |
$3,762.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,351.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,351.78
|
| Rate for Payer: Multiplan Commercial |
$3,168.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,762.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,742.84
|
| Rate for Payer: Quartz Commercial |
$2,257.77
|
| Rate for Payer: The Alliance Commercial |
$1,980.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,330.00
|
| Rate for Payer: WEA Trust Commercial |
$2,178.55
|
| Rate for Payer: WPS Commercial |
$2,933.91
|
|
|
Percutans Test Sequtl/Incremtl,W/Drgs,Bio Or Venms,Immed React
|
Professional
|
Both
|
$23.00
|
|
| Hospital Charge Code |
1188808
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$21.85 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.80
|
| Rate for Payer: Health EOS Commercial |
$20.93
|
| Rate for Payer: HFN Commercial |
$21.85
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21.85
|
| Rate for Payer: Quartz Beloit One Network |
$10.12
|
| Rate for Payer: Quartz Commercial |
$13.11
|
| Rate for Payer: The Alliance Commercial |
$11.50
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Pericardial DRG 6YR+ W/O CGen Car Anomaly
|
Facility
|
IP
|
$3,065.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
6172827
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,501.85 |
| Max. Negotiated Rate |
$2,819.80 |
| Rate for Payer: Aetna Commercial |
$2,758.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,635.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,624.45
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,819.80
|
| Rate for Payer: Health EOS Commercial |
$2,727.85
|
| Rate for Payer: HFN Commercial |
$2,819.80
|
| Rate for Payer: Multiplan Commercial |
$2,452.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,839.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,819.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,501.85
|
| Rate for Payer: Quartz Commercial |
$1,839.00
|
| Rate for Payer: WEA Trust Commercial |
$1,685.75
|
| Rate for Payer: WPS Commercial |
$2,270.25
|
|
|
Pericardial DRG 6YR+ W/O CGen Car Anomaly
|
Facility
|
OP
|
$3,065.00
|
|
|
Service Code
|
CPT 33017
|
| Hospital Charge Code |
6172827
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$858.20 |
| Max. Negotiated Rate |
$12,260.00 |
| Rate for Payer: Aetna Commercial |
$2,758.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,635.90
|
| Rate for Payer: Aetna Managed Medicare |
$858.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,992.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,532.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,471.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,624.45
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,819.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Health EOS Commercial |
$2,727.85
|
| Rate for Payer: HFN Commercial |
$2,819.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,298.75
|
| Rate for Payer: Multiplan Commercial |
$2,452.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,839.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,819.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,501.85
|
| Rate for Payer: Quartz Commercial |
$1,992.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,839.00
|
| Rate for Payer: The Alliance Commercial |
$12,260.00
|
| Rate for Payer: WEA Trust Commercial |
$1,685.75
|
| Rate for Payer: WPS Commercial |
$2,270.25
|
|
|
PERICARDIAL WINDOW
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
4494602
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
PERICARDIAL WINDOW
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
4494602
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
