|
XR Urography Retro Lt
|
Professional
|
Both
|
$1,252.00
|
|
|
Service Code
|
CPT 74420 TC
|
| Hospital Charge Code |
4596968
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.55 |
| Max. Negotiated Rate |
$1,189.40 |
| Rate for Payer: Aetna Commercial |
$1,189.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,076.72
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$1,189.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$626.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.20
|
| Rate for Payer: Health EOS Commercial |
$1,139.32
|
| Rate for Payer: HFN Commercial |
$1,189.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$175.55
|
| Rate for Payer: Multiplan Commercial |
$1,001.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.40
|
| Rate for Payer: Quartz Beloit One Network |
$550.88
|
| Rate for Payer: Quartz Commercial |
$713.64
|
| Rate for Payer: The Alliance Commercial |
$626.00
|
| Rate for Payer: WEA Trust Commercial |
$688.60
|
| Rate for Payer: WPS Commercial |
$927.36
|
|
|
XR Urography Retro Lt
|
Facility
|
OP
|
$1,252.00
|
|
|
Service Code
|
CPT 74420 TC
|
| Hospital Charge Code |
4596968
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,520.48 |
| Rate for Payer: Aetna Commercial |
$1,126.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,076.72
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,425.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.34
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$663.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$1,151.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$700.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$1,114.28
|
| Rate for Payer: HFN Commercial |
$1,151.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$1,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,151.84
|
| Rate for Payer: Quartz Beloit One Network |
$613.48
|
| Rate for Payer: Quartz Commercial |
$813.80
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$688.60
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$927.36
|
|
|
XR Urography Retro Lt
|
Facility
|
IP
|
$1,252.00
|
|
|
Service Code
|
CPT 74420 TC
|
| Hospital Charge Code |
4596968
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$613.48 |
| Max. Negotiated Rate |
$1,151.84 |
| Rate for Payer: Aetna Commercial |
$1,126.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,076.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$663.56
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$1,151.84
|
| Rate for Payer: Health EOS Commercial |
$1,114.28
|
| Rate for Payer: HFN Commercial |
$1,151.84
|
| Rate for Payer: Multiplan Commercial |
$1,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$751.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,151.84
|
| Rate for Payer: Quartz Beloit One Network |
$613.48
|
| Rate for Payer: Quartz Commercial |
$751.20
|
| Rate for Payer: WEA Trust Commercial |
$688.60
|
| Rate for Payer: WPS Commercial |
$927.36
|
|
|
XR Urography Retro Rt
|
Facility
|
OP
|
$1,252.00
|
|
|
Service Code
|
CPT 74420 TC
|
| Hospital Charge Code |
4596965
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,520.48 |
| Rate for Payer: Aetna Commercial |
$1,126.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,076.72
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,425.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.34
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$663.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$1,151.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$700.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$1,114.28
|
| Rate for Payer: HFN Commercial |
$1,151.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$1,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,151.84
|
| Rate for Payer: Quartz Beloit One Network |
$613.48
|
| Rate for Payer: Quartz Commercial |
$813.80
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$688.60
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$927.36
|
|
|
XR Urography Retro Rt
|
Professional
|
Both
|
$1,252.00
|
|
|
Service Code
|
CPT 74420 TC
|
| Hospital Charge Code |
4596965
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$175.55 |
| Max. Negotiated Rate |
$1,189.40 |
| Rate for Payer: Aetna Commercial |
$1,189.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,076.72
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$1,189.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$626.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.20
|
| Rate for Payer: Health EOS Commercial |
$1,139.32
|
| Rate for Payer: HFN Commercial |
$1,189.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$175.55
|
| Rate for Payer: Multiplan Commercial |
$1,001.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.40
|
| Rate for Payer: Quartz Beloit One Network |
$550.88
|
| Rate for Payer: Quartz Commercial |
$713.64
|
| Rate for Payer: The Alliance Commercial |
$626.00
|
| Rate for Payer: WEA Trust Commercial |
$688.60
|
| Rate for Payer: WPS Commercial |
$927.36
|
|
|
XR Urography Retro Rt
|
Facility
|
IP
|
$1,252.00
|
|
|
Service Code
|
CPT 74420 TC
|
| Hospital Charge Code |
4596965
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$613.48 |
| Max. Negotiated Rate |
$1,151.84 |
| Rate for Payer: Aetna Commercial |
$1,126.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,076.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$663.56
|
| Rate for Payer: Cash Price |
$375.60
|
| Rate for Payer: Cigna Commercial |
$1,151.84
|
| Rate for Payer: Health EOS Commercial |
$1,114.28
|
| Rate for Payer: HFN Commercial |
$1,151.84
|
| Rate for Payer: Multiplan Commercial |
$1,001.60
|
| Rate for Payer: NAPHCARE Commercial |
$751.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,151.84
|
| Rate for Payer: Quartz Beloit One Network |
$613.48
|
| Rate for Payer: Quartz Commercial |
$751.20
|
| Rate for Payer: WEA Trust Commercial |
$688.60
|
| Rate for Payer: WPS Commercial |
$927.36
|
|
|
XR US Guidance
|
Facility
|
IP
|
$454.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
3242195
|
| Min. Negotiated Rate |
$222.46 |
| Max. Negotiated Rate |
$417.68 |
| Rate for Payer: Aetna Commercial |
$408.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.62
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$417.68
|
| Rate for Payer: Health EOS Commercial |
$404.06
|
| Rate for Payer: HFN Commercial |
$417.68
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$417.68
|
| Rate for Payer: Quartz Beloit One Network |
$222.46
|
| Rate for Payer: Quartz Commercial |
$272.40
|
| Rate for Payer: WEA Trust Commercial |
$249.70
|
| Rate for Payer: WPS Commercial |
$336.28
|
|
|
XR US Guidance
|
Facility
|
OP
|
$454.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
3242195
|
| Min. Negotiated Rate |
$127.12 |
| Max. Negotiated Rate |
$1,816.00 |
| Rate for Payer: Aetna Commercial |
$408.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.44
|
| Rate for Payer: Aetna Managed Medicare |
$127.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$227.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.62
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$417.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.06
|
| Rate for Payer: Health EOS Commercial |
$404.06
|
| Rate for Payer: HFN Commercial |
$417.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.50
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$417.68
|
| Rate for Payer: Quartz Beloit One Network |
$222.46
|
| Rate for Payer: Quartz Commercial |
$295.10
|
| Rate for Payer: Quartz Medicare Advantage |
$272.40
|
| Rate for Payer: The Alliance Commercial |
$1,816.00
|
| Rate for Payer: WEA Trust Commercial |
$249.70
|
| Rate for Payer: WPS Commercial |
$336.28
|
|
|
XR US Guidance
|
Professional
|
Both
|
$454.00
|
|
|
Service Code
|
CPT 76937
|
| Hospital Charge Code |
3242195
|
| Min. Negotiated Rate |
$130.50 |
| Max. Negotiated Rate |
$431.30 |
| Rate for Payer: Aetna Commercial |
$431.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.44
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cash Price |
$136.20
|
| Rate for Payer: Cigna Commercial |
$431.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.40
|
| Rate for Payer: Health EOS Commercial |
$413.14
|
| Rate for Payer: HFN Commercial |
$431.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.50
|
| Rate for Payer: Multiplan Commercial |
$363.20
|
| Rate for Payer: Preferred Network Access Commercial |
$431.30
|
| Rate for Payer: Quartz Beloit One Network |
$199.76
|
| Rate for Payer: Quartz Commercial |
$258.78
|
| Rate for Payer: The Alliance Commercial |
$227.00
|
| Rate for Payer: WEA Trust Commercial |
$249.70
|
| Rate for Payer: WPS Commercial |
$336.28
|
|
|
XR US Guided Midline
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
5552128
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$124.60 |
| Max. Negotiated Rate |
$1,780.00 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Aetna Managed Medicare |
$124.60
|
| 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 |
$235.85
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249.02
|
| Rate for Payer: Health EOS Commercial |
$396.05
|
| Rate for Payer: HFN Commercial |
$409.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.75
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: NAPHCARE Commercial |
$267.00
|
| Rate for Payer: Preferred Network Access Commercial |
$409.40
|
| Rate for Payer: Quartz Beloit One Network |
$218.05
|
| Rate for Payer: Quartz Commercial |
$289.25
|
| Rate for Payer: Quartz Medicare Advantage |
$267.00
|
| Rate for Payer: The Alliance Commercial |
$1,780.00
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
XR US Guided Midline
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
5552128
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$83.56 |
| Max. Negotiated Rate |
$422.75 |
| Rate for Payer: Aetna Commercial |
$422.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$422.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.00
|
| Rate for Payer: Health EOS Commercial |
$404.95
|
| Rate for Payer: HFN Commercial |
$422.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.56
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$422.75
|
| Rate for Payer: Quartz Beloit One Network |
$195.80
|
| Rate for Payer: Quartz Commercial |
$253.65
|
| Rate for Payer: The Alliance Commercial |
$222.50
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
XR US Guided Midline
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 76937 TC
|
| Hospital Charge Code |
5552128
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$218.05 |
| Max. Negotiated Rate |
$409.40 |
| Rate for Payer: Aetna Commercial |
$400.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.85
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$409.40
|
| Rate for Payer: Health EOS Commercial |
$396.05
|
| Rate for Payer: HFN Commercial |
$409.40
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: NAPHCARE Commercial |
$267.00
|
| Rate for Payer: Preferred Network Access Commercial |
$409.40
|
| Rate for Payer: Quartz Beloit One Network |
$218.05
|
| Rate for Payer: Quartz Commercial |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
XR Venogram Lower Extremity Bilateral
|
Professional
|
Both
|
$1,723.00
|
|
|
Service Code
|
CPT 75822 TC
|
| Hospital Charge Code |
3072721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.70 |
| Max. Negotiated Rate |
$1,636.85 |
| Rate for Payer: Aetna Commercial |
$1,636.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,636.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$861.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.80
|
| Rate for Payer: Health EOS Commercial |
$1,567.93
|
| Rate for Payer: HFN Commercial |
$1,636.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.70
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,636.85
|
| Rate for Payer: Quartz Beloit One Network |
$758.12
|
| Rate for Payer: Quartz Commercial |
$982.11
|
| Rate for Payer: The Alliance Commercial |
$861.50
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
XR Venogram Lower Extremity Bilateral
|
Facility
|
IP
|
$1,723.00
|
|
|
Service Code
|
CPT 75822 TC
|
| Hospital Charge Code |
3072721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$844.27 |
| Max. Negotiated Rate |
$1,585.16 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,033.80
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
XR Venogram Lower Extremity Bilateral
|
Facility
|
OP
|
$1,723.00
|
|
|
Service Code
|
CPT 75822 TC
|
| Hospital Charge Code |
3072721
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$827.04 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,119.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$861.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$827.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$964.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,119.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
XR Venogram Lower Extremity Left
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072728
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$615.44 |
| Max. Negotiated Rate |
$1,155.52 |
| Rate for Payer: Aetna Commercial |
$1,130.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.68
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,155.52
|
| Rate for Payer: Health EOS Commercial |
$1,117.84
|
| Rate for Payer: HFN Commercial |
$1,155.52
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$753.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.52
|
| Rate for Payer: Quartz Beloit One Network |
$615.44
|
| Rate for Payer: Quartz Commercial |
$753.60
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
XR Venogram Lower Extremity Left
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072728
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$399.84 |
| Max. Negotiated Rate |
$1,193.20 |
| Rate for Payer: Aetna Commercial |
$1,193.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,193.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$628.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.60
|
| Rate for Payer: Health EOS Commercial |
$1,142.96
|
| Rate for Payer: HFN Commercial |
$1,193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.84
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,193.20
|
| Rate for Payer: Quartz Beloit One Network |
$552.64
|
| Rate for Payer: Quartz Commercial |
$715.92
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
XR Venogram Lower Extremity Left
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072728
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$1,130.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,936.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,748.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,511.46
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,155.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$1,117.84
|
| Rate for Payer: HFN Commercial |
$1,155.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.52
|
| Rate for Payer: Quartz Beloit One Network |
$615.44
|
| Rate for Payer: Quartz Commercial |
$816.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
XR Venogram Lower Extremity Right
|
Facility
|
IP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,RT
|
| Hospital Charge Code |
3072729
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$615.44 |
| Max. Negotiated Rate |
$1,155.52 |
| Rate for Payer: Aetna Commercial |
$1,130.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.68
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,155.52
|
| Rate for Payer: Health EOS Commercial |
$1,117.84
|
| Rate for Payer: HFN Commercial |
$1,155.52
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$753.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.52
|
| Rate for Payer: Quartz Beloit One Network |
$615.44
|
| Rate for Payer: Quartz Commercial |
$753.60
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
XR Venogram Lower Extremity Right
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,RT
|
| Hospital Charge Code |
3072729
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$399.84 |
| Max. Negotiated Rate |
$1,193.20 |
| Rate for Payer: Aetna Commercial |
$1,193.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,193.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$628.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.60
|
| Rate for Payer: Health EOS Commercial |
$1,142.96
|
| Rate for Payer: HFN Commercial |
$1,193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.84
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,193.20
|
| Rate for Payer: Quartz Beloit One Network |
$552.64
|
| Rate for Payer: Quartz Commercial |
$715.92
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
XR Venogram Lower Extremity Right
|
Facility
|
OP
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,RT
|
| Hospital Charge Code |
3072729
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$1,130.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,936.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,748.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,511.46
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,155.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$702.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$1,117.84
|
| Rate for Payer: HFN Commercial |
$1,155.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.52
|
| Rate for Payer: Quartz Beloit One Network |
$615.44
|
| Rate for Payer: Quartz Commercial |
$816.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
|
XR Venogram Upper Extremity Bilateral
|
Facility
|
IP
|
$1,723.00
|
|
|
Service Code
|
CPT 75822 TC
|
| Hospital Charge Code |
3072722
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$844.27 |
| Max. Negotiated Rate |
$1,585.16 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,033.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,033.80
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
XR Venogram Upper Extremity Bilateral
|
Facility
|
OP
|
$1,723.00
|
|
|
Service Code
|
CPT 75822 TC
|
| Hospital Charge Code |
3072722
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$827.04 |
| Max. Negotiated Rate |
$6,331.88 |
| Rate for Payer: Aetna Commercial |
$1,550.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,582.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,119.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$861.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$827.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$913.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,582.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,582.97
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,585.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,582.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$964.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,582.97
|
| Rate for Payer: Health EOS Commercial |
$1,533.47
|
| Rate for Payer: HFN Commercial |
$1,585.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,888.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,582.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,582.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,582.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,582.97
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,374.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,585.16
|
| Rate for Payer: Quartz Beloit One Network |
$844.27
|
| Rate for Payer: Quartz Commercial |
$1,119.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,582.97
|
| Rate for Payer: The Alliance Commercial |
$6,331.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,582.97
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: Wellcare Medicare |
$1,582.97
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
XR Venogram Upper Extremity Bilateral
|
Professional
|
Both
|
$1,723.00
|
|
|
Service Code
|
CPT 75822 TC
|
| Hospital Charge Code |
3072722
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$241.70 |
| Max. Negotiated Rate |
$1,636.85 |
| Rate for Payer: Aetna Commercial |
$1,636.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,481.78
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cash Price |
$516.90
|
| Rate for Payer: Cigna Commercial |
$1,636.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$861.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.80
|
| Rate for Payer: Health EOS Commercial |
$1,567.93
|
| Rate for Payer: HFN Commercial |
$1,636.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.70
|
| Rate for Payer: Multiplan Commercial |
$1,378.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,636.85
|
| Rate for Payer: Quartz Beloit One Network |
$758.12
|
| Rate for Payer: Quartz Commercial |
$982.11
|
| Rate for Payer: The Alliance Commercial |
$861.50
|
| Rate for Payer: WEA Trust Commercial |
$947.65
|
| Rate for Payer: WPS Commercial |
$1,276.23
|
|
|
XR Venogram Upper Extremity Left
|
Professional
|
Both
|
$1,256.00
|
|
|
Service Code
|
CPT 75820 TC,LT
|
| Hospital Charge Code |
3072730
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$399.84 |
| Max. Negotiated Rate |
$1,193.20 |
| Rate for Payer: Aetna Commercial |
$1,193.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.16
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cash Price |
$376.80
|
| Rate for Payer: Cigna Commercial |
$1,193.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$628.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.60
|
| Rate for Payer: Health EOS Commercial |
$1,142.96
|
| Rate for Payer: HFN Commercial |
$1,193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.84
|
| Rate for Payer: Multiplan Commercial |
$1,004.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,193.20
|
| Rate for Payer: Quartz Beloit One Network |
$552.64
|
| Rate for Payer: Quartz Commercial |
$715.92
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$690.80
|
| Rate for Payer: WPS Commercial |
$930.32
|
|
