|
XR Upper Extremity Infant Bilateral
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$298.90
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Upper Extremity Infant Bilateral
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$473.25 |
| Rate for Payer: Aetna Commercial |
$473.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$473.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.90
|
| Rate for Payer: Health EOS Commercial |
$453.33
|
| Rate for Payer: HFN Commercial |
$473.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$473.25
|
| Rate for Payer: Quartz Beloit One Network |
$219.19
|
| Rate for Payer: Quartz Commercial |
$283.95
|
| Rate for Payer: The Alliance Commercial |
$249.08
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Upper Extremity Infant Bilateral
|
Facility
|
OP
|
$922.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613588
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$882.17 |
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.64
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.26
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$882.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$853.40
|
| Rate for Payer: HFN Commercial |
$882.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$767.10
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$882.17
|
| Rate for Payer: Quartz Beloit One Network |
$469.85
|
| Rate for Payer: Quartz Commercial |
$623.27
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$527.38
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$710.22
|
|
|
XR Upper Extremity Infant Bilateral
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537433
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.48 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.78
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.62
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$298.90
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$323.80
|
| Rate for Payer: Quartz Medicare Advantage |
$298.90
|
| Rate for Payer: The Alliance Commercial |
$249.08
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Upper Extremity Infant Left
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537435
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$473.25 |
| Rate for Payer: Aetna Commercial |
$473.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$473.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.90
|
| Rate for Payer: Health EOS Commercial |
$453.33
|
| Rate for Payer: HFN Commercial |
$473.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$473.25
|
| Rate for Payer: Quartz Beloit One Network |
$219.19
|
| Rate for Payer: Quartz Commercial |
$283.95
|
| Rate for Payer: The Alliance Commercial |
$249.08
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Upper Extremity Infant Left
|
Facility
|
IP
|
$461.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613590
|
| Min. Negotiated Rate |
$234.93 |
| Max. Negotiated Rate |
$441.08 |
| Rate for Payer: Aetna Commercial |
$431.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.10
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$441.08
|
| Rate for Payer: Health EOS Commercial |
$426.70
|
| Rate for Payer: HFN Commercial |
$441.08
|
| Rate for Payer: Multiplan Commercial |
$383.55
|
| Rate for Payer: Preferred Network Access Commercial |
$441.08
|
| Rate for Payer: Quartz Beloit One Network |
$234.93
|
| Rate for Payer: Quartz Commercial |
$287.66
|
| Rate for Payer: WEA Trust Commercial |
$263.69
|
| Rate for Payer: WPS Commercial |
$355.11
|
|
|
XR Upper Extremity Infant Left
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537435
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$298.90
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Upper Extremity Infant Left
|
Facility
|
OP
|
$461.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613590
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$441.08 |
| Rate for Payer: Aetna Commercial |
$431.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.32
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$311.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$230.13
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$441.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$426.70
|
| Rate for Payer: HFN Commercial |
$441.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$383.55
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$441.08
|
| Rate for Payer: Quartz Beloit One Network |
$234.93
|
| Rate for Payer: Quartz Commercial |
$311.64
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$263.69
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$355.11
|
|
|
XR Upper Extremity Infant Left
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 73092 LT,TC
|
| Hospital Charge Code |
1537435
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.48 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.78
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.62
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$298.90
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$323.80
|
| Rate for Payer: Quartz Medicare Advantage |
$298.90
|
| Rate for Payer: The Alliance Commercial |
$249.08
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Upper Extremity Infant Left
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613590
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$455.47 |
| Rate for Payer: Aetna Commercial |
$455.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.32
|
| Rate for Payer: Aetna Managed Medicare |
$30.40
|
| Rate for Payer: Anthem Medicare Advantage |
$30.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.40
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$455.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.40
|
| Rate for Payer: Health EOS Commercial |
$436.29
|
| Rate for Payer: HFN Commercial |
$455.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$383.55
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$455.47
|
| Rate for Payer: Quartz Beloit One Network |
$210.95
|
| Rate for Payer: Quartz Commercial |
$273.28
|
| Rate for Payer: Quartz Medicare Advantage |
$30.40
|
| Rate for Payer: The Alliance Commercial |
$115.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.40
|
| Rate for Payer: WEA Trust Commercial |
$263.69
|
| Rate for Payer: WPS Commercial |
$152.00
|
|
|
XR Upper Extremity Infant Right
|
Professional
|
Both
|
$508.00
|
|
|
Service Code
|
CPT 73092 RT,TC
|
| Hospital Charge Code |
1537437
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$501.90 |
| Rate for Payer: Aetna Commercial |
$501.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$501.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$264.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.99
|
| Rate for Payer: Health EOS Commercial |
$480.77
|
| Rate for Payer: HFN Commercial |
$501.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: Preferred Network Access Commercial |
$501.90
|
| Rate for Payer: Quartz Beloit One Network |
$232.46
|
| Rate for Payer: Quartz Commercial |
$301.14
|
| Rate for Payer: The Alliance Commercial |
$264.16
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$391.31
|
|
|
XR Upper Extremity Infant Right
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613592
|
| Min. Negotiated Rate |
$30.40 |
| Max. Negotiated Rate |
$464.36 |
| Rate for Payer: Aetna Commercial |
$464.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$30.40
|
| Rate for Payer: Anthem Medicare Advantage |
$30.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.40
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$464.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.40
|
| Rate for Payer: Health EOS Commercial |
$444.81
|
| Rate for Payer: HFN Commercial |
$464.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.40
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$464.36
|
| Rate for Payer: Quartz Beloit One Network |
$215.07
|
| Rate for Payer: Quartz Commercial |
$278.62
|
| Rate for Payer: Quartz Medicare Advantage |
$30.40
|
| Rate for Payer: The Alliance Commercial |
$115.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.40
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$152.00
|
|
|
XR Upper Extremity Infant Right
|
Facility
|
IP
|
$479.00
|
|
|
Service Code
|
CPT 73092 TC,RT
|
| Hospital Charge Code |
2980000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$244.10 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$298.90
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Upper Extremity Infant Right
|
Facility
|
IP
|
$470.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613592
|
| Min. Negotiated Rate |
$239.51 |
| Max. Negotiated Rate |
$449.70 |
| Rate for Payer: Aetna Commercial |
$439.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.06
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$449.70
|
| Rate for Payer: Health EOS Commercial |
$435.03
|
| Rate for Payer: HFN Commercial |
$449.70
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: Preferred Network Access Commercial |
$449.70
|
| Rate for Payer: Quartz Beloit One Network |
$239.51
|
| Rate for Payer: Quartz Commercial |
$293.28
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$362.04
|
|
|
XR Upper Extremity Infant Right
|
Facility
|
OP
|
$479.00
|
|
|
Service Code
|
CPT 73092 TC,RT
|
| Hospital Charge Code |
2980000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$139.48 |
| Max. Negotiated Rate |
$458.31 |
| Rate for Payer: Aetna Commercial |
$448.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Aetna Managed Medicare |
$139.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.02
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$458.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.78
|
| Rate for Payer: Health EOS Commercial |
$443.36
|
| Rate for Payer: HFN Commercial |
$458.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$373.62
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: NAPHCARE Commercial |
$298.90
|
| Rate for Payer: Preferred Network Access Commercial |
$458.31
|
| Rate for Payer: Quartz Beloit One Network |
$244.10
|
| Rate for Payer: Quartz Commercial |
$323.80
|
| Rate for Payer: Quartz Medicare Advantage |
$298.90
|
| Rate for Payer: The Alliance Commercial |
$249.08
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Upper Extremity Infant Right
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 73092 RT,TC
|
| Hospital Charge Code |
1537437
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.93 |
| Max. Negotiated Rate |
$486.05 |
| Rate for Payer: Aetna Commercial |
$475.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Aetna Managed Medicare |
$147.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.01
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$486.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$295.66
|
| Rate for Payer: Health EOS Commercial |
$470.20
|
| Rate for Payer: HFN Commercial |
$486.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.24
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: NAPHCARE Commercial |
$316.99
|
| Rate for Payer: Preferred Network Access Commercial |
$486.05
|
| Rate for Payer: Quartz Beloit One Network |
$258.88
|
| Rate for Payer: Quartz Commercial |
$343.41
|
| Rate for Payer: Quartz Medicare Advantage |
$316.99
|
| Rate for Payer: The Alliance Commercial |
$264.16
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$391.31
|
|
|
XR Upper Extremity Infant Right
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 73092 RT,TC
|
| Hospital Charge Code |
1537437
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$258.88 |
| Max. Negotiated Rate |
$486.05 |
| Rate for Payer: Aetna Commercial |
$475.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.01
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$486.05
|
| Rate for Payer: Health EOS Commercial |
$470.20
|
| Rate for Payer: HFN Commercial |
$486.05
|
| Rate for Payer: Multiplan Commercial |
$422.66
|
| Rate for Payer: Preferred Network Access Commercial |
$486.05
|
| Rate for Payer: Quartz Beloit One Network |
$258.88
|
| Rate for Payer: Quartz Commercial |
$316.99
|
| Rate for Payer: WEA Trust Commercial |
$290.58
|
| Rate for Payer: WPS Commercial |
$391.31
|
|
|
XR Upper Extremity Infant Right
|
Facility
|
OP
|
$470.00
|
|
|
Service Code
|
CPT 73092
|
| Hospital Charge Code |
613592
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$449.70 |
| Rate for Payer: Aetna Commercial |
$439.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.62
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$449.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$435.03
|
| Rate for Payer: HFN Commercial |
$449.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$449.70
|
| Rate for Payer: Quartz Beloit One Network |
$239.51
|
| Rate for Payer: Quartz Commercial |
$317.72
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$362.04
|
|
|
XR Upper Extremity Infant Right
|
Professional
|
Both
|
$479.00
|
|
|
Service Code
|
CPT 73092 TC,RT
|
| Hospital Charge Code |
2980000
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.54 |
| Max. Negotiated Rate |
$473.25 |
| Rate for Payer: Aetna Commercial |
$473.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$428.42
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$473.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$249.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.90
|
| Rate for Payer: Health EOS Commercial |
$453.33
|
| Rate for Payer: HFN Commercial |
$473.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.54
|
| Rate for Payer: Multiplan Commercial |
$398.53
|
| Rate for Payer: Preferred Network Access Commercial |
$473.25
|
| Rate for Payer: Quartz Beloit One Network |
$219.19
|
| Rate for Payer: Quartz Commercial |
$283.95
|
| Rate for Payer: The Alliance Commercial |
$249.08
|
| Rate for Payer: WEA Trust Commercial |
$273.99
|
| Rate for Payer: WPS Commercial |
$368.97
|
|
|
XR Upper GI
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1537439
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$589.10 |
| Max. Negotiated Rate |
$1,106.06 |
| Rate for Payer: Aetna Commercial |
$1,082.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$637.19
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$1,106.06
|
| Rate for Payer: Health EOS Commercial |
$1,069.99
|
| Rate for Payer: HFN Commercial |
$1,106.06
|
| Rate for Payer: Multiplan Commercial |
$961.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,106.06
|
| Rate for Payer: Quartz Beloit One Network |
$589.10
|
| Rate for Payer: Quartz Commercial |
$721.34
|
| Rate for Payer: WEA Trust Commercial |
$661.23
|
| Rate for Payer: WPS Commercial |
$890.47
|
|
|
XR Upper GI
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1537439
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,106.06 |
| Rate for Payer: Aetna Commercial |
$1,082.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.93
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$637.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$1,106.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$672.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,069.99
|
| Rate for Payer: HFN Commercial |
$1,106.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$961.79
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,106.06
|
| Rate for Payer: Quartz Beloit One Network |
$589.10
|
| Rate for Payer: Quartz Commercial |
$781.46
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$661.23
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$890.47
|
|
|
XR Upper GI
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
613594
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$1,078.90 |
| Rate for Payer: Aetna Commercial |
$1,078.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.68
|
| Rate for Payer: Aetna Managed Medicare |
$121.47
|
| Rate for Payer: Anthem Medicare Advantage |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.47
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$1,078.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$567.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.47
|
| Rate for Payer: Health EOS Commercial |
$1,033.47
|
| Rate for Payer: HFN Commercial |
$1,078.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$444.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$444.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.47
|
| Rate for Payer: Multiplan Commercial |
$908.54
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.90
|
| Rate for Payer: Quartz Beloit One Network |
$499.70
|
| Rate for Payer: Quartz Commercial |
$647.34
|
| Rate for Payer: Quartz Medicare Advantage |
$121.47
|
| Rate for Payer: The Alliance Commercial |
$461.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.47
|
| Rate for Payer: WEA Trust Commercial |
$624.62
|
| Rate for Payer: WPS Commercial |
$607.36
|
|
|
XR Upper GI
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
613594
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,044.83 |
| Rate for Payer: Aetna Commercial |
$1,022.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.68
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$738.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$545.13
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$1,044.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,010.76
|
| Rate for Payer: HFN Commercial |
$1,044.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$908.54
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.83
|
| Rate for Payer: Quartz Beloit One Network |
$556.48
|
| Rate for Payer: Quartz Commercial |
$738.19
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$624.62
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$841.17
|
|
|
XR Upper GI
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1537439
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$1,142.13 |
| Rate for Payer: Aetna Commercial |
$1,142.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.93
|
| Rate for Payer: Aetna Managed Medicare |
$121.47
|
| Rate for Payer: Anthem Medicare Advantage |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.47
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$1,142.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$601.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.47
|
| Rate for Payer: Health EOS Commercial |
$1,094.04
|
| Rate for Payer: HFN Commercial |
$1,142.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$444.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$444.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.47
|
| Rate for Payer: Multiplan Commercial |
$961.79
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.13
|
| Rate for Payer: Quartz Beloit One Network |
$528.99
|
| Rate for Payer: Quartz Commercial |
$685.28
|
| Rate for Payer: Quartz Medicare Advantage |
$121.47
|
| Rate for Payer: The Alliance Commercial |
$461.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.47
|
| Rate for Payer: WEA Trust Commercial |
$661.23
|
| Rate for Payer: WPS Commercial |
$607.36
|
|
|
XR Upper GI
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
613594
|
| Min. Negotiated Rate |
$556.48 |
| Max. Negotiated Rate |
$1,044.83 |
| Rate for Payer: HFN Commercial |
$1,044.83
|
| Rate for Payer: Aetna Commercial |
$1,022.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.91
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$1,044.83
|
| Rate for Payer: Health EOS Commercial |
$1,010.76
|
| Rate for Payer: Multiplan Commercial |
$908.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.83
|
| Rate for Payer: Quartz Beloit One Network |
$556.48
|
| Rate for Payer: Quartz Commercial |
$681.41
|
| Rate for Payer: WEA Trust Commercial |
$624.62
|
| Rate for Payer: WPS Commercial |
$841.17
|
|
