|
XR Knee 4 Views w/ Tunnel + Sunrise Right
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711791
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| 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 |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| 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 |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee 4 Views w/ Tunnel + Sunrise Right
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711791
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee 4 Views w/ Tunnel + Sunrise Right
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
711791
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Aetna Commercial |
$722.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$722.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.00
|
| Rate for Payer: Health EOS Commercial |
$691.60
|
| Rate for Payer: HFN Commercial |
$722.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.00
|
| Rate for Payer: Quartz Beloit One Network |
$334.40
|
| Rate for Payer: Quartz Commercial |
$433.20
|
| Rate for Payer: The Alliance Commercial |
$380.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee Complete Bilateral
|
Facility
|
OP
|
$1,520.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630391
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Aetna Commercial |
$1,368.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.20
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$988.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$760.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$729.60
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.60
|
| 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 |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,398.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$850.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,352.80
|
| Rate for Payer: HFN Commercial |
$1,398.40
|
| 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 |
$1,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.80
|
| Rate for Payer: Quartz Commercial |
$988.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$836.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,125.86
|
|
|
XR Knee Complete Bilateral
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| 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 |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| 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 |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$533.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Bilateral
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.29 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$492.60
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Bilateral
|
Professional
|
Both
|
$1,520.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630391
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$1,444.00 |
| Rate for Payer: Aetna Commercial |
$1,444.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.20
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,444.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$760.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.00
|
| Rate for Payer: Health EOS Commercial |
$1,383.20
|
| Rate for Payer: HFN Commercial |
$1,444.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Multiplan Commercial |
$1,216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,444.00
|
| Rate for Payer: Quartz Beloit One Network |
$668.80
|
| Rate for Payer: Quartz Commercial |
$866.40
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: WEA Trust Commercial |
$836.00
|
| Rate for Payer: WPS Commercial |
$1,125.86
|
|
|
XR Knee Complete Bilateral
|
Facility
|
IP
|
$1,520.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630391
|
| Min. Negotiated Rate |
$744.80 |
| Max. Negotiated Rate |
$1,398.40 |
| Rate for Payer: Aetna Commercial |
$1,368.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.60
|
| Rate for Payer: Cash Price |
$456.00
|
| Rate for Payer: Cigna Commercial |
$1,398.40
|
| Rate for Payer: Health EOS Commercial |
$1,352.80
|
| Rate for Payer: HFN Commercial |
$1,398.40
|
| Rate for Payer: Multiplan Commercial |
$1,216.00
|
| Rate for Payer: NAPHCARE Commercial |
$912.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.40
|
| Rate for Payer: Quartz Beloit One Network |
$744.80
|
| Rate for Payer: Quartz Commercial |
$912.00
|
| Rate for Payer: WEA Trust Commercial |
$836.00
|
| Rate for Payer: WPS Commercial |
$1,125.86
|
|
|
XR Knee Complete Bilateral
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537162
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Aetna Commercial |
$779.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$779.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.60
|
| Rate for Payer: Health EOS Commercial |
$747.11
|
| Rate for Payer: HFN Commercial |
$779.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$779.95
|
| Rate for Payer: Quartz Beloit One Network |
$361.24
|
| Rate for Payer: Quartz Commercial |
$467.97
|
| Rate for Payer: The Alliance Commercial |
$410.50
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Left
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.29 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$492.60
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Left
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| 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 |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| 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 |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$533.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Left
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630373
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Aetna Commercial |
$722.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$722.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.00
|
| Rate for Payer: Health EOS Commercial |
$691.60
|
| Rate for Payer: HFN Commercial |
$722.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.00
|
| Rate for Payer: Quartz Beloit One Network |
$334.40
|
| Rate for Payer: Quartz Commercial |
$433.20
|
| Rate for Payer: The Alliance Commercial |
$380.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee Complete Left
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630373
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee Complete Left
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
CPT 73564 LT,TC
|
| Hospital Charge Code |
1537164
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Aetna Commercial |
$779.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$779.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.60
|
| Rate for Payer: Health EOS Commercial |
$747.11
|
| Rate for Payer: HFN Commercial |
$779.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$779.95
|
| Rate for Payer: Quartz Beloit One Network |
$361.24
|
| Rate for Payer: Quartz Commercial |
$467.97
|
| Rate for Payer: The Alliance Commercial |
$410.50
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Left
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630373
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| 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 |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| 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 |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee Complete Right
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 73564 RT,TC
|
| Hospital Charge Code |
1537166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| 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 |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| 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 |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$533.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Right
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
CPT 73564 RT,TC
|
| Hospital Charge Code |
1537166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Aetna Commercial |
$779.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$779.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.60
|
| Rate for Payer: Health EOS Commercial |
$747.11
|
| Rate for Payer: HFN Commercial |
$779.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$779.95
|
| Rate for Payer: Quartz Beloit One Network |
$361.24
|
| Rate for Payer: Quartz Commercial |
$467.97
|
| Rate for Payer: The Alliance Commercial |
$410.50
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Right
|
Facility
|
OP
|
$821.00
|
|
|
Service Code
|
CPT 73564 TC,RT
|
| Hospital Charge Code |
2980058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$407.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$326.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.71
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| 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 |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| 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 |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$533.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Right
|
Facility
|
IP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630369
|
| Min. Negotiated Rate |
$372.40 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$456.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$456.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee Complete Right
|
Facility
|
OP
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630369
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$699.20 |
| Rate for Payer: Aetna Commercial |
$684.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$494.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$364.80
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.80
|
| 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 |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$699.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$676.40
|
| Rate for Payer: HFN Commercial |
$699.20
|
| 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 |
$608.00
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$699.20
|
| Rate for Payer: Quartz Beloit One Network |
$372.40
|
| Rate for Payer: Quartz Commercial |
$494.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee Complete Right
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 73564 RT,TC
|
| Hospital Charge Code |
1537166
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.29 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$492.60
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Right
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
CPT 73564
|
| Hospital Charge Code |
630369
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$722.00 |
| Rate for Payer: Aetna Commercial |
$722.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.60
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$722.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.00
|
| Rate for Payer: Health EOS Commercial |
$691.60
|
| Rate for Payer: HFN Commercial |
$722.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Multiplan Commercial |
$608.00
|
| Rate for Payer: Preferred Network Access Commercial |
$722.00
|
| Rate for Payer: Quartz Beloit One Network |
$334.40
|
| Rate for Payer: Quartz Commercial |
$433.20
|
| Rate for Payer: The Alliance Commercial |
$380.00
|
| Rate for Payer: WEA Trust Commercial |
$418.00
|
| Rate for Payer: WPS Commercial |
$562.93
|
|
|
XR Knee Complete Right
|
Facility
|
IP
|
$821.00
|
|
|
Service Code
|
CPT 73564 TC,RT
|
| Hospital Charge Code |
2980058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$402.29 |
| Max. Negotiated Rate |
$755.32 |
| Rate for Payer: Aetna Commercial |
$738.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.13
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$755.32
|
| Rate for Payer: Health EOS Commercial |
$730.69
|
| Rate for Payer: HFN Commercial |
$755.32
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: NAPHCARE Commercial |
$492.60
|
| Rate for Payer: Preferred Network Access Commercial |
$755.32
|
| Rate for Payer: Quartz Beloit One Network |
$402.29
|
| Rate for Payer: Quartz Commercial |
$492.60
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Complete Right
|
Professional
|
Both
|
$821.00
|
|
|
Service Code
|
CPT 73564 TC,RT
|
| Hospital Charge Code |
2980058
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$155.46 |
| Max. Negotiated Rate |
$779.95 |
| Rate for Payer: Aetna Commercial |
$779.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.06
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cash Price |
$246.30
|
| Rate for Payer: Cigna Commercial |
$779.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$492.60
|
| Rate for Payer: Health EOS Commercial |
$747.11
|
| Rate for Payer: HFN Commercial |
$779.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.46
|
| Rate for Payer: Multiplan Commercial |
$656.80
|
| Rate for Payer: Preferred Network Access Commercial |
$779.95
|
| Rate for Payer: Quartz Beloit One Network |
$361.24
|
| Rate for Payer: Quartz Commercial |
$467.97
|
| Rate for Payer: The Alliance Commercial |
$410.50
|
| Rate for Payer: WEA Trust Commercial |
$451.55
|
| Rate for Payer: WPS Commercial |
$608.11
|
|
|
XR Knee Standing AP Bilateral
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 73565
|
| Hospital Charge Code |
630351
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
