|
US Thoracentesis
|
Professional
|
$2,270.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
661686
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$2,156.50 |
| Rate for Payer: Aetna Commercial |
$2,156.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,952.20
|
| Rate for Payer: Aetna Managed Medicare |
$102.87
|
| Rate for Payer: Anthem Medicare Advantage |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.87
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cash Price |
$681.00
|
| Rate for Payer: Cigna Commercial |
$2,156.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,135.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.87
|
| Rate for Payer: Health EOS Commercial |
$2,065.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$373.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.87
|
| Rate for Payer: Multiplan Commercial |
$1,816.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,156.50
|
| Rate for Payer: Quartz Beloit One Network |
$998.80
|
| Rate for Payer: Quartz Commercial |
$1,293.90
|
| Rate for Payer: Quartz Medicare Advantage |
$102.87
|
| Rate for Payer: The Alliance Commercial |
$437.20
|
| Rate for Payer: United Healthcare Medicaid |
$90.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.87
|
| Rate for Payer: WEA Trust Commercial |
$1,248.50
|
| Rate for Payer: WPS Commercial |
$462.92
|
|
|
US Thoracentesis
|
Facility
OP
|
$2,950.00
|
|
|
Service Code
|
CPT 32555
|
| Hospital Charge Code |
2544979
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.00 |
| Max. Negotiated Rate |
$50,159.28 |
| Rate for Payer: Aetna Commercial |
$2,655.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,537.00
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,563.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cash Price |
$885.00
|
| Rate for Payer: Cigna Commercial |
$2,714.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Health EOS Commercial |
$2,625.50
|
| Rate for Payer: HFN Commercial |
$2,714.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: Multiplan Commercial |
$2,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,714.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,445.50
|
| Rate for Payer: Quartz Commercial |
$1,917.50
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$50,159.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,622.50
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$2,185.06
|
|
|
US Thyroid
|
Professional
|
$1,691.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$81.55 |
| Max. Negotiated Rate |
$1,606.45 |
| Rate for Payer: Aetna Commercial |
$1,606.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,454.26
|
| Rate for Payer: Aetna Managed Medicare |
$81.55
|
| Rate for Payer: Anthem Medicare Advantage |
$81.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.55
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,606.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$845.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.55
|
| Rate for Payer: Health EOS Commercial |
$1,538.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$302.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.55
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,606.45
|
| Rate for Payer: Quartz Beloit One Network |
$744.04
|
| Rate for Payer: Quartz Commercial |
$963.87
|
| Rate for Payer: Quartz Medicare Advantage |
$81.55
|
| Rate for Payer: The Alliance Commercial |
$309.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.55
|
| Rate for Payer: WEA Trust Commercial |
$930.05
|
| Rate for Payer: WPS Commercial |
$407.75
|
|
|
US Thyroid
|
Facility
IP
|
$1,374.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
661688
|
| Min. Negotiated Rate |
$673.26 |
| Max. Negotiated Rate |
$1,264.08 |
| Rate for Payer: Aetna Commercial |
$1,236.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.22
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,264.08
|
| Rate for Payer: Health EOS Commercial |
$1,222.86
|
| Rate for Payer: HFN Commercial |
$1,264.08
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: NAPHCARE Commercial |
$824.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.08
|
| Rate for Payer: Quartz Beloit One Network |
$673.26
|
| Rate for Payer: Quartz Commercial |
$824.40
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: WPS Commercial |
$1,017.72
|
|
|
US Thyroid
|
Professional
|
$1,374.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
661688
|
| Min. Negotiated Rate |
$107.72 |
| Max. Negotiated Rate |
$1,305.30 |
| Rate for Payer: Aetna Commercial |
$1,305.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.64
|
| Rate for Payer: Aetna Managed Medicare |
$107.72
|
| Rate for Payer: Anthem Medicare Advantage |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.72
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,305.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$687.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.72
|
| Rate for Payer: Health EOS Commercial |
$1,250.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.72
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,305.30
|
| Rate for Payer: Quartz Beloit One Network |
$604.56
|
| Rate for Payer: Quartz Commercial |
$783.18
|
| Rate for Payer: Quartz Medicare Advantage |
$107.72
|
| Rate for Payer: The Alliance Commercial |
$409.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.72
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: WPS Commercial |
$538.60
|
|
|
US Thyroid
|
Facility
OP
|
$1,374.00
|
|
|
Service Code
|
CPT 76536
|
| Hospital Charge Code |
661688
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$1,264.08 |
| Rate for Payer: Aetna Commercial |
$1,236.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,181.64
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$893.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$687.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$659.52
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$728.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,264.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,222.86
|
| Rate for Payer: HFN Commercial |
$1,264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,099.20
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,264.08
|
| Rate for Payer: Quartz Beloit One Network |
$673.26
|
| Rate for Payer: Quartz Commercial |
$893.10
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$35.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$755.70
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,017.72
|
|
|
US Thyroid
|
Facility
OP
|
$1,691.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$473.48 |
| Max. Negotiated Rate |
$6,764.00 |
| Rate for Payer: Aetna Commercial |
$1,521.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,454.26
|
| Rate for Payer: Aetna Managed Medicare |
$473.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.23
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,555.72
|
| Rate for Payer: Health EOS Commercial |
$1,504.99
|
| Rate for Payer: HFN Commercial |
$1,555.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,268.25
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,014.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,555.72
|
| Rate for Payer: Quartz Beloit One Network |
$828.59
|
| Rate for Payer: Quartz Commercial |
$1,099.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,014.60
|
| Rate for Payer: The Alliance Commercial |
$6,764.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$930.05
|
| Rate for Payer: WPS Commercial |
$1,252.52
|
|
|
US Thyroid
|
Facility
IP
|
$1,691.00
|
|
|
Service Code
|
CPT 76536 TC
|
| Hospital Charge Code |
2544981
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$828.59 |
| Max. Negotiated Rate |
$1,555.72 |
| Rate for Payer: Aetna Commercial |
$1,521.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.23
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,555.72
|
| Rate for Payer: Health EOS Commercial |
$1,504.99
|
| Rate for Payer: HFN Commercial |
$1,555.72
|
| Rate for Payer: Multiplan Commercial |
$1,352.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,014.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,555.72
|
| Rate for Payer: Quartz Beloit One Network |
$828.59
|
| Rate for Payer: Quartz Commercial |
$1,014.60
|
| Rate for Payer: WEA Trust Commercial |
$930.05
|
| Rate for Payer: WPS Commercial |
$1,252.52
|
|
|
US, Transrectal 7687226
|
Professional
|
$220.00
|
|
|
Service Code
|
CPT 76872 26
|
| Hospital Charge Code |
3165709
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Aetna Managed Medicare |
$31.32
|
| Rate for Payer: Anthem Medicare Advantage |
$31.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.32
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.32
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.32
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: Quartz Medicare Advantage |
$31.32
|
| Rate for Payer: The Alliance Commercial |
$119.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.32
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$156.60
|
|
|
US, Transrectal 7687226PP
|
Professional
|
$220.00
|
|
|
Service Code
|
CPT 76872 26
|
| Hospital Charge Code |
3303484
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$31.32 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Aetna Managed Medicare |
$31.32
|
| Rate for Payer: Anthem Medicare Advantage |
$31.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.32
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.32
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.32
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: Quartz Medicare Advantage |
$31.32
|
| Rate for Payer: The Alliance Commercial |
$119.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.32
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$156.60
|
|
|
US Transvaginal Non-Ob
|
Facility
OP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
3072676
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Aetna Managed Medicare |
$297.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.86
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$977.04
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.50
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$690.30
|
| Rate for Payer: Quartz Medicare Advantage |
$637.20
|
| Rate for Payer: The Alliance Commercial |
$4,248.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
US Transvaginal Non-Ob
|
Professional
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
3072676
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.13 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Aetna Managed Medicare |
$84.13
|
| Rate for Payer: Anthem Medicare Advantage |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.13
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,008.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.13
|
| Rate for Payer: Health EOS Commercial |
$966.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.13
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,008.90
|
| Rate for Payer: Quartz Beloit One Network |
$467.28
|
| Rate for Payer: Quartz Commercial |
$605.34
|
| Rate for Payer: Quartz Medicare Advantage |
$84.13
|
| Rate for Payer: The Alliance Commercial |
$319.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.13
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$420.65
|
|
|
US Transvaginal Non-Ob
|
Facility
IP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
3072676
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$520.38 |
| Max. Negotiated Rate |
$977.04 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.86
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$977.04
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$637.20
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
US Transvaginal Non-OB
|
Professional
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2544983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$84.13 |
| Max. Negotiated Rate |
$1,008.90 |
| Rate for Payer: Aetna Commercial |
$1,008.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Aetna Managed Medicare |
$84.13
|
| Rate for Payer: Anthem Medicare Advantage |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.13
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,008.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$531.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.13
|
| Rate for Payer: Health EOS Commercial |
$966.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.13
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,008.90
|
| Rate for Payer: Quartz Beloit One Network |
$467.28
|
| Rate for Payer: Quartz Commercial |
$605.34
|
| Rate for Payer: Quartz Medicare Advantage |
$84.13
|
| Rate for Payer: The Alliance Commercial |
$319.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.13
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$420.65
|
|
|
US Transvaginal Non-OB
|
Facility
IP
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$504.70 |
| Max. Negotiated Rate |
$947.60 |
| Rate for Payer: Aetna Commercial |
$927.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.90
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$947.60
|
| Rate for Payer: Health EOS Commercial |
$916.70
|
| Rate for Payer: HFN Commercial |
$947.60
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: NAPHCARE Commercial |
$618.00
|
| Rate for Payer: Preferred Network Access Commercial |
$947.60
|
| Rate for Payer: Quartz Beloit One Network |
$504.70
|
| Rate for Payer: Quartz Commercial |
$618.00
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
|
US Transvaginal Non-OB
|
Facility
OP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2544983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Aetna Managed Medicare |
$297.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.86
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$977.04
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.50
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$690.30
|
| Rate for Payer: Quartz Medicare Advantage |
$637.20
|
| Rate for Payer: The Alliance Commercial |
$4,248.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
US Transvaginal Non-OB
|
Facility
OP
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$35.52 |
| Max. Negotiated Rate |
$947.60 |
| Rate for Payer: Aetna Commercial |
$927.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.40
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$545.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$947.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$916.70
|
| Rate for Payer: HFN Commercial |
$947.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$947.60
|
| Rate for Payer: Quartz Beloit One Network |
$504.70
|
| Rate for Payer: Quartz Commercial |
$669.50
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$35.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
|
US Transvaginal Non-OB
|
Professional
|
$1,030.00
|
|
|
Service Code
|
CPT 76830
|
| Hospital Charge Code |
630827
|
| Min. Negotiated Rate |
$116.31 |
| Max. Negotiated Rate |
$978.50 |
| Rate for Payer: Aetna Commercial |
$978.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Aetna Managed Medicare |
$116.31
|
| Rate for Payer: Anthem Medicare Advantage |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.31
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$978.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$515.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.31
|
| Rate for Payer: Health EOS Commercial |
$937.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.31
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: Preferred Network Access Commercial |
$978.50
|
| Rate for Payer: Quartz Beloit One Network |
$453.20
|
| Rate for Payer: Quartz Commercial |
$587.10
|
| Rate for Payer: Quartz Medicare Advantage |
$116.31
|
| Rate for Payer: The Alliance Commercial |
$441.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.31
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: WPS Commercial |
$581.55
|
|
|
US Transvaginal Non-OB
|
Facility
IP
|
$1,062.00
|
|
|
Service Code
|
CPT 76830 TC
|
| Hospital Charge Code |
2544983
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$520.38 |
| Max. Negotiated Rate |
$977.04 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.86
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$977.04
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$637.20
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
US Transvaginal OB
|
Professional
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$55.16 |
| Max. Negotiated Rate |
$1,079.20 |
| Rate for Payer: Aetna Commercial |
$1,079.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.96
|
| Rate for Payer: Aetna Managed Medicare |
$55.16
|
| Rate for Payer: Anthem Medicare Advantage |
$55.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$55.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$55.16
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,079.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$568.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.16
|
| Rate for Payer: Health EOS Commercial |
$1,033.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$202.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$55.16
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,079.20
|
| Rate for Payer: Quartz Beloit One Network |
$499.84
|
| Rate for Payer: Quartz Commercial |
$647.52
|
| Rate for Payer: Quartz Medicare Advantage |
$55.16
|
| Rate for Payer: The Alliance Commercial |
$209.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.16
|
| Rate for Payer: WEA Trust Commercial |
$624.80
|
| Rate for Payer: WPS Commercial |
$275.80
|
|
|
US Transvaginal OB
|
Facility
OP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$318.08 |
| Max. Negotiated Rate |
$4,544.00 |
| Rate for Payer: Aetna Commercial |
$1,022.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.96
|
| Rate for Payer: Aetna Managed Medicare |
$318.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.08
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,045.12
|
| Rate for Payer: Health EOS Commercial |
$1,011.04
|
| Rate for Payer: HFN Commercial |
$1,045.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$852.00
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: NAPHCARE Commercial |
$681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.12
|
| Rate for Payer: Quartz Beloit One Network |
$556.64
|
| Rate for Payer: Quartz Commercial |
$738.40
|
| Rate for Payer: Quartz Medicare Advantage |
$681.60
|
| Rate for Payer: The Alliance Commercial |
$4,544.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$624.80
|
| Rate for Payer: WPS Commercial |
$841.44
|
|
|
US Transvaginal OB
|
Facility
IP
|
$1,136.00
|
|
|
Service Code
|
CPT 76817 TC
|
| Hospital Charge Code |
4584697
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$556.64 |
| Max. Negotiated Rate |
$1,045.12 |
| Rate for Payer: Aetna Commercial |
$1,022.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.08
|
| Rate for Payer: Cash Price |
$340.80
|
| Rate for Payer: Cigna Commercial |
$1,045.12
|
| Rate for Payer: Health EOS Commercial |
$1,011.04
|
| Rate for Payer: HFN Commercial |
$1,045.12
|
| Rate for Payer: Multiplan Commercial |
$908.80
|
| Rate for Payer: NAPHCARE Commercial |
$681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.12
|
| Rate for Payer: Quartz Beloit One Network |
$556.64
|
| Rate for Payer: Quartz Commercial |
$681.60
|
| Rate for Payer: WEA Trust Commercial |
$624.80
|
| Rate for Payer: WPS Commercial |
$841.44
|
|
|
US Umbilical Artery Doppler
|
Facility
OP
|
$626.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
6196541
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$175.28 |
| Max. Negotiated Rate |
$2,504.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$175.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.50
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$375.60
|
| Rate for Payer: The Alliance Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
US Umbilical Artery Doppler
|
Professional
|
$626.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
6196541
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$20.39 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$20.39
|
| Rate for Payer: Anthem Medicare Advantage |
$20.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.39
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.39
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.39
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: Quartz Medicare Advantage |
$20.39
|
| Rate for Payer: The Alliance Commercial |
$77.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.39
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$101.95
|
|
|
US Umbilical Artery Doppler
|
Facility
IP
|
$626.00
|
|
|
Service Code
|
CPT 76820 TC
|
| Hospital Charge Code |
6196541
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
