|
XR Clavicle Left
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536952
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$553.28 |
| Rate for Payer: Aetna Commercial |
$553.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$553.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.44
|
| Rate for Payer: Health EOS Commercial |
$529.98
|
| Rate for Payer: HFN Commercial |
$553.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Preferred Network Access Commercial |
$553.28
|
| Rate for Payer: Quartz Beloit One Network |
$256.26
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: The Alliance Commercial |
$291.20
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Left
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629752
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$371.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$274.56
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$371.80
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$423.67
|
|
|
XR Clavicle Left
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629752
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$33.06
|
| Rate for Payer: Anthem Medicare Advantage |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.06
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.06
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.06
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.59
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: Quartz Medicare Advantage |
$33.06
|
| Rate for Payer: The Alliance Commercial |
$125.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.06
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$165.31
|
|
|
XR Clavicle Left
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 73000 LT,TC
|
| Hospital Charge Code |
1536952
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$163.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.92
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.80
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$349.44
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$378.56
|
| Rate for Payer: Quartz Medicare Advantage |
$349.44
|
| Rate for Payer: The Alliance Commercial |
$291.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Left
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629752
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.67
|
|
|
XR Clavicle Right
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 73000 RT,TC
|
| Hospital Charge Code |
1536954
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$163.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.92
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.80
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$349.44
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$378.56
|
| Rate for Payer: Quartz Medicare Advantage |
$349.44
|
| Rate for Payer: The Alliance Commercial |
$291.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Right
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 73000 TC,RT
|
| Hospital Charge Code |
2979991
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$553.28 |
| Rate for Payer: Aetna Commercial |
$553.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$553.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.44
|
| Rate for Payer: Health EOS Commercial |
$529.98
|
| Rate for Payer: HFN Commercial |
$553.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Preferred Network Access Commercial |
$553.28
|
| Rate for Payer: Quartz Beloit One Network |
$256.26
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: The Alliance Commercial |
$291.20
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Right
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 73000 RT,TC
|
| Hospital Charge Code |
1536954
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.96 |
| Max. Negotiated Rate |
$553.28 |
| Rate for Payer: Aetna Commercial |
$553.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$553.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.44
|
| Rate for Payer: Health EOS Commercial |
$529.98
|
| Rate for Payer: HFN Commercial |
$553.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Preferred Network Access Commercial |
$553.28
|
| Rate for Payer: Quartz Beloit One Network |
$256.26
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: The Alliance Commercial |
$291.20
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Right
|
Facility
|
IP
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629754
|
| Min. Negotiated Rate |
$280.28 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$423.67
|
|
|
XR Clavicle Right
|
Facility
|
OP
|
$560.00
|
|
|
Service Code
|
CPT 73000 TC,RT
|
| Hospital Charge Code |
2979991
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$163.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.92
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.80
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$349.44
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$378.56
|
| Rate for Payer: Quartz Medicare Advantage |
$349.44
|
| Rate for Payer: The Alliance Commercial |
$291.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Right
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 73000 RT,TC
|
| Hospital Charge Code |
1536954
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.38 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$349.44
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Clavicle Right
|
Facility
|
OP
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629754
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$526.24 |
| Rate for Payer: Aetna Commercial |
$514.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$371.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$274.56
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$526.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$509.08
|
| Rate for Payer: HFN Commercial |
$526.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$526.24
|
| Rate for Payer: Quartz Beloit One Network |
$280.28
|
| Rate for Payer: Quartz Commercial |
$371.80
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$423.67
|
|
|
XR Clavicle Right
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
CPT 73000
|
| Hospital Charge Code |
629754
|
| Min. Negotiated Rate |
$33.06 |
| Max. Negotiated Rate |
$543.40 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$33.06
|
| Rate for Payer: Anthem Medicare Advantage |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.06
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.06
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$112.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.06
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.59
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: Quartz Medicare Advantage |
$33.06
|
| Rate for Payer: The Alliance Commercial |
$125.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.06
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$165.31
|
|
|
XR Clavicle Right
|
Facility
|
IP
|
$560.00
|
|
|
Service Code
|
CPT 73000 TC,RT
|
| Hospital Charge Code |
2979991
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$285.38 |
| Max. Negotiated Rate |
$535.81 |
| Rate for Payer: Aetna Commercial |
$524.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.67
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$535.81
|
| Rate for Payer: Health EOS Commercial |
$518.34
|
| Rate for Payer: HFN Commercial |
$535.81
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: Preferred Network Access Commercial |
$535.81
|
| Rate for Payer: Quartz Beloit One Network |
$285.38
|
| Rate for Payer: Quartz Commercial |
$349.44
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$431.37
|
|
|
XR Coccyx
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 72220 TC
|
| Hospital Charge Code |
1536956
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$319.01 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$390.62
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
XR Coccyx
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
629756
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$573.04 |
| Rate for Payer: Aetna Commercial |
$573.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Medicare Advantage |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.74
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$573.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.74
|
| Rate for Payer: Health EOS Commercial |
$548.91
|
| Rate for Payer: HFN Commercial |
$573.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.74
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$47.61
|
| Rate for Payer: Preferred Network Access Commercial |
$573.04
|
| Rate for Payer: Quartz Beloit One Network |
$265.41
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: Quartz Medicare Advantage |
$31.74
|
| Rate for Payer: The Alliance Commercial |
$120.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.74
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$158.70
|
|
|
XR Coccyx
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 72220 TC
|
| Hospital Charge Code |
1536956
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$618.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$23.40
|
| Rate for Payer: Anthem Medicare Advantage |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.40
|
| 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 |
$618.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.40
|
| Rate for Payer: Health EOS Commercial |
$592.45
|
| Rate for Payer: HFN Commercial |
$618.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$35.10
|
| Rate for Payer: Preferred Network Access Commercial |
$618.49
|
| Rate for Payer: Quartz Beloit One Network |
$286.46
|
| Rate for Payer: Quartz Commercial |
$371.09
|
| Rate for Payer: Quartz Medicare Advantage |
$23.40
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.40
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$117.00
|
|
|
XR Coccyx
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 72220 TC
|
| Hospital Charge Code |
1536956
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.60 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| 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 |
$598.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.33
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.28
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$390.62
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$423.18
|
| Rate for Payer: Quartz Medicare Advantage |
$390.62
|
| Rate for Payer: The Alliance Commercial |
$93.60
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
XR Coccyx
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
629756
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
XR Coccyx
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 72220
|
| Hospital Charge Code |
629756
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$392.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$289.54
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
XR Cystography
|
Facility
|
IP
|
$977.00
|
|
|
Service Code
|
CPT 74430 TC
|
| Hospital Charge Code |
3072713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$497.88 |
| Max. Negotiated Rate |
$934.79 |
| Rate for Payer: Aetna Commercial |
$914.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.52
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$934.79
|
| Rate for Payer: Health EOS Commercial |
$904.31
|
| Rate for Payer: HFN Commercial |
$934.79
|
| Rate for Payer: Multiplan Commercial |
$812.86
|
| Rate for Payer: Preferred Network Access Commercial |
$934.79
|
| Rate for Payer: Quartz Beloit One Network |
$497.88
|
| Rate for Payer: Quartz Commercial |
$609.65
|
| Rate for Payer: WEA Trust Commercial |
$558.84
|
| Rate for Payer: WPS Commercial |
$752.58
|
|
|
XR Cystography
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
CPT 74430 TC
|
| Hospital Charge Code |
3072713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$105.58 |
| Max. Negotiated Rate |
$1,482.47 |
| Rate for Payer: Aetna Commercial |
$914.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.83
|
| Rate for Payer: Aetna Managed Medicare |
$284.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.52
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$934.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.61
|
| Rate for Payer: Health EOS Commercial |
$904.31
|
| Rate for Payer: HFN Commercial |
$934.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.06
|
| Rate for Payer: Multiplan Commercial |
$812.86
|
| Rate for Payer: NAPHCARE Commercial |
$609.65
|
| Rate for Payer: Preferred Network Access Commercial |
$934.79
|
| Rate for Payer: Quartz Beloit One Network |
$497.88
|
| Rate for Payer: Quartz Commercial |
$660.45
|
| Rate for Payer: Quartz Medicare Advantage |
$609.65
|
| Rate for Payer: The Alliance Commercial |
$105.58
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$558.84
|
| Rate for Payer: WPS Commercial |
$752.58
|
|
|
XR Cystography
|
Professional
|
Both
|
$977.00
|
|
|
Service Code
|
CPT 74430 TC
|
| Hospital Charge Code |
3072713
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$965.28 |
| Rate for Payer: Aetna Commercial |
$965.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.83
|
| Rate for Payer: Aetna Managed Medicare |
$26.40
|
| Rate for Payer: Anthem Medicare Advantage |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.40
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$965.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$508.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.40
|
| Rate for Payer: Health EOS Commercial |
$924.63
|
| Rate for Payer: HFN Commercial |
$965.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.40
|
| Rate for Payer: Multiplan Commercial |
$812.86
|
| Rate for Payer: NAPHCARE Commercial |
$39.59
|
| Rate for Payer: Preferred Network Access Commercial |
$965.28
|
| Rate for Payer: Quartz Beloit One Network |
$447.08
|
| Rate for Payer: Quartz Commercial |
$579.17
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$100.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$558.84
|
| Rate for Payer: WPS Commercial |
$131.98
|
|
|
XR Drainage Abscess or Cyst
|
Professional
|
Both
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536970
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$111.81 |
| Max. Negotiated Rate |
$2,275.36 |
| Rate for Payer: Aetna Commercial |
$2,275.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$111.81
|
| Rate for Payer: Anthem Medicare Advantage |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$111.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$111.81
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,275.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,197.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.81
|
| Rate for Payer: Health EOS Commercial |
$2,179.56
|
| Rate for Payer: HFN Commercial |
$2,275.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$111.81
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$167.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,275.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,053.85
|
| Rate for Payer: Quartz Commercial |
$1,365.22
|
| Rate for Payer: Quartz Medicare Advantage |
$111.81
|
| Rate for Payer: The Alliance Commercial |
$424.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$111.81
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$559.05
|
|
|
XR Drainage Abscess or Cyst
|
Facility
|
OP
|
$2,303.00
|
|
|
Service Code
|
CPT 75989
|
| Hospital Charge Code |
1536970
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$2,203.51 |
| Rate for Payer: Aetna Commercial |
$2,155.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,059.80
|
| Rate for Payer: Aetna Managed Medicare |
$670.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.41
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cash Price |
$690.90
|
| Rate for Payer: Cigna Commercial |
$2,203.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.35
|
| Rate for Payer: Health EOS Commercial |
$2,131.66
|
| Rate for Payer: HFN Commercial |
$2,203.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,796.34
|
| Rate for Payer: Multiplan Commercial |
$1,916.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,203.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.61
|
| Rate for Payer: Quartz Commercial |
$1,556.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.07
|
| Rate for Payer: The Alliance Commercial |
$447.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,317.32
|
| Rate for Payer: WPS Commercial |
$1,774.00
|
|
