|
PRAFO - PT Equipment Issued Rehab
|
Facility
|
OP
|
$988.00
|
|
|
Service Code
|
HCPCS L1930
|
| Hospital Charge Code |
2989873
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$169.57 |
| Max. Negotiated Rate |
$3,952.00 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Aetna Managed Medicare |
$276.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$552.88
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.00
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$642.20
|
| Rate for Payer: Quartz Medicare Advantage |
$592.80
|
| Rate for Payer: The Alliance Commercial |
$3,952.00
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
|
Prealbumin
|
Facility
|
IP
|
$413.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
978043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.37 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$247.80
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$247.80
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
Prealbumin
|
Facility
|
OP
|
$413.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
978043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.85 |
| Max. Negotiated Rate |
$379.96 |
| Rate for Payer: Aetna Commercial |
$371.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Aetna Managed Medicare |
$14.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.22
|
| Rate for Payer: Anthem Medicaid |
$7.85
|
| Rate for Payer: Anthem Medicare Advantage |
$14.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.59
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$379.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.11
|
| Rate for Payer: Dean Health Medicaid |
$7.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.59
|
| Rate for Payer: Health EOS Commercial |
$367.57
|
| Rate for Payer: HFN Commercial |
$379.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.59
|
| Rate for Payer: Managed Health Services Medicaid |
$8.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.59
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: NAPHCARE Commercial |
$21.88
|
| Rate for Payer: Preferred Network Access Commercial |
$379.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.37
|
| Rate for Payer: Quartz Commercial |
$268.45
|
| Rate for Payer: Quartz Medicare Advantage |
$14.59
|
| Rate for Payer: The Alliance Commercial |
$58.36
|
| Rate for Payer: United Healthcare Medicaid |
$7.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.59
|
| Rate for Payer: United Healthcare PPO |
$309.75
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: Wellcare Medicare |
$14.59
|
| Rate for Payer: WMAP Medicaid |
$7.85
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
Prealbumin
|
Professional
|
Both
|
$413.00
|
|
|
Service Code
|
CPT 84134
|
| Hospital Charge Code |
978043
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.50 |
| Max. Negotiated Rate |
$392.35 |
| Rate for Payer: Aetna Commercial |
$392.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.18
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cash Price |
$123.90
|
| Rate for Payer: Cigna Commercial |
$392.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.80
|
| Rate for Payer: Health EOS Commercial |
$375.83
|
| Rate for Payer: HFN Commercial |
$392.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.50
|
| Rate for Payer: Multiplan Commercial |
$330.40
|
| Rate for Payer: Preferred Network Access Commercial |
$392.35
|
| Rate for Payer: Quartz Beloit One Network |
$181.72
|
| Rate for Payer: Quartz Commercial |
$235.41
|
| Rate for Payer: The Alliance Commercial |
$206.50
|
| Rate for Payer: WEA Trust Commercial |
$227.15
|
| Rate for Payer: WPS Commercial |
$305.91
|
|
|
Pre and Post - Pulmonary Function Test Charge
|
Facility
|
IP
|
$537.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
3006993
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$263.13 |
| Max. Negotiated Rate |
$494.04 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$322.20
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$322.20
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
Pre and Post - Pulmonary Function Test Charge
|
Facility
|
OP
|
$537.00
|
|
|
Service Code
|
CPT 94060
|
| Hospital Charge Code |
3006993
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$257.76 |
| Max. Negotiated Rate |
$1,240.96 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$257.76
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$349.05
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$402.75
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
PRECISION PIN GAMMA4 3.2/3.9 X 450MM TAPERED 1420-0065S
|
Facility
|
IP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6181748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,266.25 |
| Max. Negotiated Rate |
$4,255.00 |
| Rate for Payer: Aetna Commercial |
$4,162.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,977.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,451.25
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,255.00
|
| Rate for Payer: Health EOS Commercial |
$4,116.25
|
| Rate for Payer: HFN Commercial |
$4,255.00
|
| Rate for Payer: Multiplan Commercial |
$3,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,775.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,255.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,266.25
|
| Rate for Payer: Quartz Commercial |
$2,775.00
|
| Rate for Payer: WEA Trust Commercial |
$2,543.75
|
| Rate for Payer: WPS Commercial |
$3,425.74
|
|
|
PRECISION PIN GAMMA4 3.2/3.9 X 450MM TAPERED 1420-0065S
|
Facility
|
OP
|
$4,625.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6181748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,295.00 |
| Max. Negotiated Rate |
$18,500.00 |
| Rate for Payer: Aetna Commercial |
$4,162.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,977.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,295.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,006.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,312.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,220.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,451.25
|
| Rate for Payer: Cash Price |
$1,387.50
|
| Rate for Payer: Cigna Commercial |
$4,255.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,588.15
|
| Rate for Payer: Health EOS Commercial |
$4,116.25
|
| Rate for Payer: HFN Commercial |
$4,255.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,468.75
|
| Rate for Payer: Multiplan Commercial |
$3,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,775.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,255.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,266.25
|
| Rate for Payer: Quartz Commercial |
$3,006.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,775.00
|
| Rate for Payer: The Alliance Commercial |
$18,500.00
|
| Rate for Payer: WEA Trust Commercial |
$2,543.75
|
| Rate for Payer: WPS Commercial |
$3,425.74
|
|
|
PRE CUT POLYFORM MED.
|
Facility
|
OP
|
$229.00
|
|
| Hospital Charge Code |
2971397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$916.00 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Aetna Managed Medicare |
$64.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.15
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.75
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$148.85
|
| Rate for Payer: Quartz Medicare Advantage |
$137.40
|
| Rate for Payer: The Alliance Commercial |
$916.00
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
PRE CUT POLYFORM MED.
|
Facility
|
IP
|
$229.00
|
|
| Hospital Charge Code |
2971397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.21 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$137.40
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
Prednisolone 1% Ophth Suspension 5ml [Med]
|
Facility
|
IP
|
$171.00
|
|
| Hospital Charge Code |
2974973
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$102.60
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
Prednisolone 1% Ophth Suspension 5ml [Med]
|
Facility
|
OP
|
$171.00
|
|
| Hospital Charge Code |
2974973
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.88 |
| Max. Negotiated Rate |
$684.00 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Aetna Managed Medicare |
$47.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$85.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.69
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.25
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$111.15
|
| Rate for Payer: Quartz Medicare Advantage |
$102.60
|
| Rate for Payer: The Alliance Commercial |
$684.00
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
Prednisone oral 1 mg J7512
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
5492829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.01
|
| Rate for Payer: Health EOS Commercial |
$5.46
|
| Rate for Payer: HFN Commercial |
$5.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.01
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5.70
|
| Rate for Payer: Quartz Beloit One Network |
$2.64
|
| Rate for Payer: Quartz Commercial |
$3.42
|
| Rate for Payer: The Alliance Commercial |
$3.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.01
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$0.02
|
|
|
Prednisone oral 1 mg J7512
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
5492829
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
Prednisone oral 1 mg J7512
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J7512
|
| Hospital Charge Code |
5492829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.01 |
| 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: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.01
|
| 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 |
$0.02
|
|
|
Pregabalin Level
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5812131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna Commercial |
$399.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$399.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.00
|
| Rate for Payer: Health EOS Commercial |
$382.20
|
| Rate for Payer: HFN Commercial |
$399.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$399.00
|
| Rate for Payer: Quartz Beloit One Network |
$184.80
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: The Alliance Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Pregabalin Level
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5812131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$378.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.03
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$373.80
|
| Rate for Payer: HFN Commercial |
$386.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$386.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$205.80
|
| Rate for Payer: Quartz Commercial |
$273.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$315.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Pregabalin Level
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5812131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$378.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Health EOS Commercial |
$373.80
|
| Rate for Payer: HFN Commercial |
$386.40
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: NAPHCARE Commercial |
$252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$386.40
|
| Rate for Payer: Quartz Beloit One Network |
$205.80
|
| Rate for Payer: Quartz Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Pregnancy Test Urine
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
1006872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Pregnancy Test Urine
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
1006872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$8.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.29
|
| Rate for Payer: Anthem Medicaid |
$8.90
|
| Rate for Payer: Anthem Medicare Advantage |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.61
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Dean Health Medicaid |
$8.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.61
|
| Rate for Payer: Managed Health Services Medicaid |
$9.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$12.92
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.90
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$8.61
|
| Rate for Payer: The Alliance Commercial |
$34.44
|
| Rate for Payer: United Healthcare Medicaid |
$8.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Healthcare PPO |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: Wellcare Medicare |
$8.61
|
| Rate for Payer: WMAP Medicaid |
$8.90
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Pregnancy Test Urine
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
1006872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.80
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: HFN Commercial |
$159.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.39
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Pregnenolone, LC/MS/MS
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
983367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$177.38 |
| Max. Negotiated Rate |
$333.04 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.86
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$333.04
|
| Rate for Payer: Health EOS Commercial |
$322.18
|
| Rate for Payer: HFN Commercial |
$333.04
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: NAPHCARE Commercial |
$217.20
|
| Rate for Payer: Preferred Network Access Commercial |
$333.04
|
| Rate for Payer: Quartz Beloit One Network |
$177.38
|
| Rate for Payer: Quartz Commercial |
$217.20
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
Pregnenolone, LC/MS/MS
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
983367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.97 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Aetna Commercial |
$343.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$343.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.20
|
| Rate for Payer: Health EOS Commercial |
$329.42
|
| Rate for Payer: HFN Commercial |
$343.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.97
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: Preferred Network Access Commercial |
$343.90
|
| Rate for Payer: Quartz Beloit One Network |
$159.28
|
| Rate for Payer: Quartz Commercial |
$206.34
|
| Rate for Payer: The Alliance Commercial |
$181.00
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
Pregnenolone, LC/MS/MS
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 84140
|
| Hospital Charge Code |
983367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.67 |
| Max. Negotiated Rate |
$333.04 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.31
|
| Rate for Payer: Anthem Medicaid |
$21.36
|
| Rate for Payer: Anthem Medicare Advantage |
$20.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.67
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$333.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.58
|
| Rate for Payer: Dean Health Medicaid |
$21.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.67
|
| Rate for Payer: Health EOS Commercial |
$322.18
|
| Rate for Payer: HFN Commercial |
$333.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.67
|
| Rate for Payer: Managed Health Services Medicaid |
$22.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.67
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.00
|
| Rate for Payer: Preferred Network Access Commercial |
$333.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.36
|
| Rate for Payer: Quartz Beloit One Network |
$177.38
|
| Rate for Payer: Quartz Commercial |
$235.30
|
| Rate for Payer: Quartz Medicare Advantage |
$20.67
|
| Rate for Payer: The Alliance Commercial |
$82.68
|
| Rate for Payer: United Healthcare Medicaid |
$21.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.67
|
| Rate for Payer: United Healthcare PPO |
$271.50
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: Wellcare Medicare |
$20.67
|
| Rate for Payer: WMAP Medicaid |
$21.36
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
Preg Serum
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 84703
|
| Hospital Charge Code |
993778
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.55 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$132.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.40
|
| Rate for Payer: Health EOS Commercial |
$126.49
|
| Rate for Payer: HFN Commercial |
$132.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.55
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Preferred Network Access Commercial |
$132.05
|
| Rate for Payer: Quartz Beloit One Network |
$61.16
|
| Rate for Payer: Quartz Commercial |
$79.23
|
| Rate for Payer: The Alliance Commercial |
$69.50
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
