|
OXYMASK ADULT OM-1125-8
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2972417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
OXYMASK ADULT OM-1125-8
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2972417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
OXYMASK ETCO2 ADULT OM-2125-8SLM
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
5520692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
OXYMASK ETCO2 ADULT OM-2125-8SLM
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
5520692
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$88.20
|
| Rate for Payer: The Alliance Commercial |
$588.00
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
OXYMASK ETCO2 KID OK-2125-8SLM
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
5520691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
OXYMASK ETCO2 KID OK-2125-8SLM
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
5520691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Oxymetazoline Nasal Spray 15ml [Med]
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
2974905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.60
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
Oxymetazoline Nasal Spray 15ml [Med]
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
2974905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Aetna Managed Medicare |
$1.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.36
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3.60
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
Oxytocin 20units/1ml vial [Med]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2974967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$2.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.04
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.40
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
Oxytocin 20units/1ml vial [Med]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2974967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.40
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
Oxytocin (Pitocin) 10units/ml [MED]
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
3260805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.62
|
| Rate for Payer: Aetna Managed Medicare |
$4.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.01
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$15.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.51
|
| Rate for Payer: Health EOS Commercial |
$15.13
|
| Rate for Payer: HFN Commercial |
$15.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15.64
|
| Rate for Payer: Quartz Beloit One Network |
$8.33
|
| Rate for Payer: Quartz Commercial |
$11.05
|
| Rate for Payer: Quartz Medicare Advantage |
$10.20
|
| Rate for Payer: The Alliance Commercial |
$68.00
|
| Rate for Payer: WEA Trust Commercial |
$9.35
|
| Rate for Payer: WPS Commercial |
$12.59
|
|
|
Oxytocin (Pitocin) 10units/ml [MED]
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
3260805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$15.64 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.01
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$15.64
|
| Rate for Payer: Health EOS Commercial |
$15.13
|
| Rate for Payer: HFN Commercial |
$15.64
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15.64
|
| Rate for Payer: Quartz Beloit One Network |
$8.33
|
| Rate for Payer: Quartz Commercial |
$10.20
|
| Rate for Payer: WEA Trust Commercial |
$9.35
|
| Rate for Payer: WPS Commercial |
$12.59
|
|
|
Pace Gen Change Dual Lead
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
3052390
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,416.59 |
| Max. Negotiated Rate |
$42,217.88 |
| Rate for Payer: Aetna Commercial |
$2,601.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.26
|
| Rate for Payer: Aetna Managed Medicare |
$10,554.47
|
| 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 |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,554.47
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,659.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,554.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,554.47
|
| Rate for Payer: Health EOS Commercial |
$2,572.99
|
| Rate for Payer: HFN Commercial |
$2,659.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,262.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,554.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,554.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,554.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,554.47
|
| Rate for Payer: Multiplan Commercial |
$2,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$15,831.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.59
|
| Rate for Payer: Quartz Commercial |
$1,879.15
|
| Rate for Payer: Quartz Medicare Advantage |
$10,554.47
|
| Rate for Payer: The Alliance Commercial |
$42,217.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,554.47
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,590.05
|
| Rate for Payer: Wellcare Medicare |
$10,554.47
|
| Rate for Payer: WPS Commercial |
$2,141.36
|
|
|
Pace Gen Change Dual Lead
|
Facility
|
IP
|
$2,891.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
3052390
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,416.59 |
| Max. Negotiated Rate |
$2,659.72 |
| Rate for Payer: Aetna Commercial |
$2,601.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,486.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,532.23
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,659.72
|
| Rate for Payer: Health EOS Commercial |
$2,572.99
|
| Rate for Payer: HFN Commercial |
$2,659.72
|
| Rate for Payer: Multiplan Commercial |
$2,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,734.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,659.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.59
|
| Rate for Payer: Quartz Commercial |
$1,734.60
|
| Rate for Payer: WEA Trust Commercial |
$1,590.05
|
| Rate for Payer: WPS Commercial |
$2,141.36
|
|
|
Pace Gen Change Multi Lead System
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
4125705
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,212.75 |
| Max. Negotiated Rate |
$77,037.28 |
| Rate for Payer: Aetna Commercial |
$2,227.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,128.50
|
| Rate for Payer: Aetna Managed Medicare |
$19,259.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$19,259.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,311.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,259.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,259.32
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$2,277.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,259.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,259.32
|
| Rate for Payer: Health EOS Commercial |
$2,202.75
|
| Rate for Payer: HFN Commercial |
$2,277.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71,644.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,259.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,259.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,259.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,259.32
|
| Rate for Payer: Multiplan Commercial |
$1,980.00
|
| Rate for Payer: NAPHCARE Commercial |
$28,888.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,212.75
|
| Rate for Payer: Quartz Commercial |
$1,608.75
|
| Rate for Payer: Quartz Medicare Advantage |
$19,259.32
|
| Rate for Payer: The Alliance Commercial |
$77,037.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,259.32
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$1,361.25
|
| Rate for Payer: Wellcare Medicare |
$19,259.32
|
| Rate for Payer: WPS Commercial |
$1,833.23
|
|
|
Pace Gen Change Multi Lead System
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
4125705
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,212.75 |
| Max. Negotiated Rate |
$2,277.00 |
| Rate for Payer: Aetna Commercial |
$2,227.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,128.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,311.75
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$2,277.00
|
| Rate for Payer: Health EOS Commercial |
$2,202.75
|
| Rate for Payer: HFN Commercial |
$2,277.00
|
| Rate for Payer: Multiplan Commercial |
$1,980.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,485.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,212.75
|
| Rate for Payer: Quartz Commercial |
$1,485.00
|
| Rate for Payer: WEA Trust Commercial |
$1,361.25
|
| Rate for Payer: WPS Commercial |
$1,833.23
|
|
|
Pace Gen Change Single Lead System
|
Facility
|
OP
|
$2,796.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
4294731
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,370.04 |
| Max. Negotiated Rate |
$33,588.76 |
| Rate for Payer: Aetna Commercial |
$2,516.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,404.56
|
| Rate for Payer: Aetna Managed Medicare |
$8,397.19
|
| 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 |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,481.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,397.19
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cigna Commercial |
$2,572.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,397.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,397.19
|
| Rate for Payer: Health EOS Commercial |
$2,488.44
|
| Rate for Payer: HFN Commercial |
$2,572.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,237.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,397.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,397.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,397.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,397.19
|
| Rate for Payer: Multiplan Commercial |
$2,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,572.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,370.04
|
| Rate for Payer: Quartz Commercial |
$1,817.40
|
| Rate for Payer: Quartz Medicare Advantage |
$8,397.19
|
| Rate for Payer: The Alliance Commercial |
$33,588.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,397.19
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,537.80
|
| Rate for Payer: Wellcare Medicare |
$8,397.19
|
| Rate for Payer: WPS Commercial |
$2,071.00
|
|
|
Pace Gen Change Single Lead System
|
Facility
|
IP
|
$2,796.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
4294731
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,370.04 |
| Max. Negotiated Rate |
$2,572.32 |
| Rate for Payer: Aetna Commercial |
$2,516.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,404.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,481.88
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cigna Commercial |
$2,572.32
|
| Rate for Payer: Health EOS Commercial |
$2,488.44
|
| Rate for Payer: HFN Commercial |
$2,572.32
|
| Rate for Payer: Multiplan Commercial |
$2,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,677.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,572.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,370.04
|
| Rate for Payer: Quartz Commercial |
$1,677.60
|
| Rate for Payer: WEA Trust Commercial |
$1,537.80
|
| Rate for Payer: WPS Commercial |
$2,071.00
|
|
|
Pace Gen INS/Rep Plus Atrial Lead
|
Facility
|
OP
|
$6,812.00
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
3052372
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,337.88 |
| Max. Negotiated Rate |
$42,217.88 |
| Rate for Payer: Aetna Commercial |
$6,130.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,858.32
|
| Rate for Payer: Aetna Managed Medicare |
$10,554.47
|
| 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 |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,610.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,554.47
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cigna Commercial |
$6,267.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,554.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,554.47
|
| Rate for Payer: Health EOS Commercial |
$6,062.68
|
| Rate for Payer: HFN Commercial |
$6,267.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,262.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,554.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,554.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,554.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,554.47
|
| Rate for Payer: Multiplan Commercial |
$5,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$15,831.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,267.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.88
|
| Rate for Payer: Quartz Commercial |
$4,427.80
|
| Rate for Payer: Quartz Medicare Advantage |
$10,554.47
|
| Rate for Payer: The Alliance Commercial |
$42,217.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,554.47
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$3,746.60
|
| Rate for Payer: Wellcare Medicare |
$10,554.47
|
| Rate for Payer: WPS Commercial |
$5,045.65
|
|
|
Pace Gen INS/Rep Plus Atrial Lead
|
Facility
|
IP
|
$6,812.00
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
3052372
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,337.88 |
| Max. Negotiated Rate |
$6,267.04 |
| Rate for Payer: Aetna Commercial |
$6,130.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,858.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,610.36
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cigna Commercial |
$6,267.04
|
| Rate for Payer: Health EOS Commercial |
$6,062.68
|
| Rate for Payer: HFN Commercial |
$6,267.04
|
| Rate for Payer: Multiplan Commercial |
$5,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,267.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.88
|
| Rate for Payer: Quartz Commercial |
$4,087.20
|
| Rate for Payer: WEA Trust Commercial |
$3,746.60
|
| Rate for Payer: WPS Commercial |
$5,045.65
|
|
|
Pace Gen Ins/Rep Plus AV + CS Leads
|
Facility
|
OP
|
$3,854.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4308712
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,888.46 |
| Max. Negotiated Rate |
$42,217.88 |
| Rate for Payer: Aetna Commercial |
$3,468.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,314.44
|
| Rate for Payer: Aetna Managed Medicare |
$10,554.47
|
| 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 |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,042.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,554.47
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$3,545.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,554.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,554.47
|
| Rate for Payer: Health EOS Commercial |
$3,430.06
|
| Rate for Payer: HFN Commercial |
$3,545.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,262.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,554.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,554.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,554.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,554.47
|
| Rate for Payer: Multiplan Commercial |
$3,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,831.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,545.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,888.46
|
| Rate for Payer: Quartz Commercial |
$2,505.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,554.47
|
| Rate for Payer: The Alliance Commercial |
$42,217.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,554.47
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,119.70
|
| Rate for Payer: Wellcare Medicare |
$10,554.47
|
| Rate for Payer: WPS Commercial |
$2,854.66
|
|
|
Pace Gen Ins/Rep Plus AV + CS Leads
|
Facility
|
IP
|
$3,854.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4308712
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,888.46 |
| Max. Negotiated Rate |
$3,545.68 |
| Rate for Payer: Aetna Commercial |
$3,468.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,314.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,042.62
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$3,545.68
|
| Rate for Payer: Health EOS Commercial |
$3,430.06
|
| Rate for Payer: HFN Commercial |
$3,545.68
|
| Rate for Payer: Multiplan Commercial |
$3,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,312.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,545.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,888.46
|
| Rate for Payer: Quartz Commercial |
$2,312.40
|
| Rate for Payer: WEA Trust Commercial |
$2,119.70
|
| Rate for Payer: WPS Commercial |
$2,854.66
|
|
|
Pace Gen Ins/Rep Plus AV Leads
|
Facility
|
OP
|
$3,854.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4308833
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,888.46 |
| Max. Negotiated Rate |
$42,217.88 |
| Rate for Payer: Aetna Commercial |
$3,468.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,314.44
|
| Rate for Payer: Aetna Managed Medicare |
$10,554.47
|
| 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 |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,042.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,554.47
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$3,545.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,554.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,554.47
|
| Rate for Payer: Health EOS Commercial |
$3,430.06
|
| Rate for Payer: HFN Commercial |
$3,545.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,262.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,554.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,554.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,554.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,554.47
|
| Rate for Payer: Multiplan Commercial |
$3,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$15,831.70
|
| Rate for Payer: Preferred Network Access Commercial |
$3,545.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,888.46
|
| Rate for Payer: Quartz Commercial |
$2,505.10
|
| Rate for Payer: Quartz Medicare Advantage |
$10,554.47
|
| Rate for Payer: The Alliance Commercial |
$42,217.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,554.47
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,119.70
|
| Rate for Payer: Wellcare Medicare |
$10,554.47
|
| Rate for Payer: WPS Commercial |
$2,854.66
|
|
|
Pace Gen Ins/Rep Plus AV Leads
|
Facility
|
IP
|
$3,854.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4308833
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,888.46 |
| Max. Negotiated Rate |
$3,545.68 |
| Rate for Payer: Aetna Commercial |
$3,468.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,314.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,042.62
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$3,545.68
|
| Rate for Payer: Health EOS Commercial |
$3,430.06
|
| Rate for Payer: HFN Commercial |
$3,545.68
|
| Rate for Payer: Multiplan Commercial |
$3,083.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,312.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,545.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,888.46
|
| Rate for Payer: Quartz Commercial |
$2,312.40
|
| Rate for Payer: WEA Trust Commercial |
$2,119.70
|
| Rate for Payer: WPS Commercial |
$2,854.66
|
|
|
Pace Gen INS/Rep Plus A/V Leads
|
Facility
|
IP
|
$12,394.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
3052374
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,073.06 |
| Max. Negotiated Rate |
$11,402.48 |
| Rate for Payer: Aetna Commercial |
$11,154.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,658.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,568.82
|
| Rate for Payer: Cash Price |
$3,718.20
|
| Rate for Payer: Cigna Commercial |
$11,402.48
|
| Rate for Payer: Health EOS Commercial |
$11,030.66
|
| Rate for Payer: HFN Commercial |
$11,402.48
|
| Rate for Payer: Multiplan Commercial |
$9,915.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,436.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,402.48
|
| Rate for Payer: Quartz Beloit One Network |
$6,073.06
|
| Rate for Payer: Quartz Commercial |
$7,436.40
|
| Rate for Payer: WEA Trust Commercial |
$6,816.70
|
| Rate for Payer: WPS Commercial |
$9,180.24
|
|
