|
Gabapentin Level
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
977954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: The Alliance Commercial |
$163.00
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: WPS Commercial |
$241.47
|
| Rate for Payer: Aetna Commercial |
$309.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$309.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.60
|
| Rate for Payer: Health EOS Commercial |
$296.66
|
| Rate for Payer: HFN Commercial |
$309.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$309.70
|
| Rate for Payer: Quartz Beloit One Network |
$143.44
|
| Rate for Payer: Quartz Commercial |
$185.82
|
|
|
GADS INTRODUCTORY KIT
|
Facility
|
IP
|
$1,876.00
|
|
| Hospital Charge Code |
2972752
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$919.24 |
| Max. Negotiated Rate |
$1,725.92 |
| Rate for Payer: Aetna Commercial |
$1,688.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,613.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.28
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cigna Commercial |
$1,725.92
|
| Rate for Payer: Health EOS Commercial |
$1,669.64
|
| Rate for Payer: HFN Commercial |
$1,725.92
|
| Rate for Payer: Multiplan Commercial |
$1,500.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.92
|
| Rate for Payer: Quartz Beloit One Network |
$919.24
|
| Rate for Payer: Quartz Commercial |
$1,125.60
|
| Rate for Payer: WEA Trust Commercial |
$1,031.80
|
| Rate for Payer: WPS Commercial |
$1,389.55
|
|
|
GADS INTRODUCTORY KIT
|
Facility
|
OP
|
$1,876.00
|
|
| Hospital Charge Code |
2972752
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$525.28 |
| Max. Negotiated Rate |
$7,504.00 |
| Rate for Payer: Aetna Commercial |
$1,688.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,613.36
|
| Rate for Payer: Aetna Managed Medicare |
$525.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,219.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$900.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.28
|
| Rate for Payer: Cash Price |
$562.80
|
| Rate for Payer: Cigna Commercial |
$1,725.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,049.81
|
| Rate for Payer: Health EOS Commercial |
$1,669.64
|
| Rate for Payer: HFN Commercial |
$1,725.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.00
|
| Rate for Payer: Multiplan Commercial |
$1,500.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,125.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,725.92
|
| Rate for Payer: Quartz Beloit One Network |
$919.24
|
| Rate for Payer: Quartz Commercial |
$1,219.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,125.60
|
| Rate for Payer: The Alliance Commercial |
$7,504.00
|
| Rate for Payer: WEA Trust Commercial |
$1,031.80
|
| Rate for Payer: WPS Commercial |
$1,389.55
|
|
|
Gait Training Charges
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
752350
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$130.80
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Gait Training Charges
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
5247107
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$130.80
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Gait Training Charges
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
752350
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$872.00 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Aetna Managed Medicare |
$61.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.99
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$141.70
|
| Rate for Payer: Quartz Medicare Advantage |
$130.80
|
| Rate for Payer: The Alliance Commercial |
$872.00
|
| Rate for Payer: United Healthcare PPO |
$163.50
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Gait Training Charges
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 97116
|
| Hospital Charge Code |
5247107
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$872.00 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Aetna Managed Medicare |
$61.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.99
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$141.70
|
| Rate for Payer: Quartz Medicare Advantage |
$130.80
|
| Rate for Payer: The Alliance Commercial |
$872.00
|
| Rate for Payer: United Healthcare PPO |
$163.50
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Gait Training Charges
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 97116 GP
|
| Hospital Charge Code |
752350
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$95.92 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna Commercial |
$207.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$207.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.80
|
| Rate for Payer: Health EOS Commercial |
$198.38
|
| Rate for Payer: HFN Commercial |
$207.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.58
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Preferred Network Access Commercial |
$207.10
|
| Rate for Payer: Quartz Beloit One Network |
$95.92
|
| Rate for Payer: Quartz Commercial |
$124.26
|
| Rate for Payer: The Alliance Commercial |
$109.00
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Galactose Alpha 1, 3Galactose IgE
|
Professional
|
Both
|
$228.00
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
4532678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna Commercial |
$216.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$216.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.80
|
| Rate for Payer: Health EOS Commercial |
$207.48
|
| Rate for Payer: HFN Commercial |
$216.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$216.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.32
|
| Rate for Payer: Quartz Commercial |
$129.96
|
| Rate for Payer: The Alliance Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
Galactose Alpha 1, 3Galactose IgE
|
Facility
|
IP
|
$228.00
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
4532678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.84
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
Galactose Alpha 1, 3Galactose IgE
|
Facility
|
OP
|
$228.00
|
|
|
Service Code
|
CPT 86008
|
| Hospital Charge Code |
4532678
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$17.71
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.59
|
| Rate for Payer: Dean Health Medicaid |
$17.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$18.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.71
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$17.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$17.71
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
Gallium-67(per mCi)
|
Facility
|
OP
|
$177.00
|
|
| Hospital Charge Code |
1486822
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$49.56 |
| Max. Negotiated Rate |
$708.00 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Aetna Managed Medicare |
$49.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.05
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.75
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| Rate for Payer: Quartz Medicare Advantage |
$106.20
|
| Rate for Payer: The Alliance Commercial |
$708.00
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Gallium-67(per mCi)
|
Professional
|
Both
|
$177.00
|
|
| Hospital Charge Code |
1486822
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: HFN Commercial |
$168.15
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Gallium-67(per mCi)
|
Facility
|
IP
|
$177.00
|
|
| Hospital Charge Code |
1486822
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
Gamma Glutamyl Transferase
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
633733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.42 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna Commercial |
$110.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.60
|
| Rate for Payer: Health EOS Commercial |
$105.56
|
| Rate for Payer: HFN Commercial |
$110.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.42
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Preferred Network Access Commercial |
$110.20
|
| Rate for Payer: Quartz Beloit One Network |
$51.04
|
| Rate for Payer: Quartz Commercial |
$66.12
|
| Rate for Payer: The Alliance Commercial |
$58.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
Gamma Glutamyl Transferase
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
633733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.84 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$69.60
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
Gamma Glutamyl Transferase
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
633733
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.20 |
| Max. Negotiated Rate |
$106.72 |
| Rate for Payer: Aetna Commercial |
$104.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$7.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.95
|
| Rate for Payer: Anthem Medicaid |
$7.44
|
| Rate for Payer: Anthem Medicare Advantage |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.20
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$106.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.91
|
| Rate for Payer: Dean Health Medicaid |
$7.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.20
|
| Rate for Payer: Health EOS Commercial |
$103.24
|
| Rate for Payer: HFN Commercial |
$106.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.20
|
| Rate for Payer: Managed Health Services Medicaid |
$7.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.20
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$106.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.44
|
| Rate for Payer: Quartz Beloit One Network |
$56.84
|
| Rate for Payer: Quartz Commercial |
$75.40
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$28.80
|
| Rate for Payer: United Healthcare Medicaid |
$7.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.20
|
| Rate for Payer: United Healthcare PPO |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: Wellcare Medicare |
$7.20
|
| Rate for Payer: WMAP Medicaid |
$7.44
|
| Rate for Payer: WPS Commercial |
$85.92
|
|
|
Gamma-Hydroxybutyric Acid Screen, Urine
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5569257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.80 |
| Max. Negotiated Rate |
$219.35 |
| Rate for Payer: Aetna Commercial |
$161.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$161.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.00
|
| Rate for Payer: Health EOS Commercial |
$154.70
|
| Rate for Payer: HFN Commercial |
$161.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.35
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.50
|
| Rate for Payer: Quartz Beloit One Network |
$74.80
|
| Rate for Payer: Quartz Commercial |
$96.90
|
| Rate for Payer: The Alliance Commercial |
$85.00
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Gamma-Hydroxybutyric Acid Screen, Urine
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5569257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.30 |
| Max. Negotiated Rate |
$156.40 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.10
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$102.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Gamma-Hydroxybutyric Acid Screen, Urine
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 80307
|
| Hospital Charge Code |
5569257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$248.56 |
| Rate for Payer: Aetna Commercial |
$153.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$146.20
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$233.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.15
|
| Rate for Payer: Anthem Medicaid |
$63.40
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$156.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.13
|
| Rate for Payer: Dean Health Medicaid |
$63.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$151.30
|
| Rate for Payer: HFN Commercial |
$156.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Managed Health Services Medicaid |
$65.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$136.00
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$156.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.40
|
| Rate for Payer: Quartz Beloit One Network |
$83.30
|
| Rate for Payer: Quartz Commercial |
$110.50
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$248.56
|
| Rate for Payer: United Healthcare Medicaid |
$63.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: United Healthcare PPO |
$127.50
|
| Rate for Payer: WEA Trust Commercial |
$93.50
|
| Rate for Payer: Wellcare Medicare |
$62.14
|
| Rate for Payer: WMAP Medicaid |
$63.40
|
| Rate for Payer: WPS Commercial |
$125.92
|
|
|
Ganglioside GD1b Antibody IgG
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5582229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$144.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.20
|
| Rate for Payer: Health EOS Commercial |
$138.32
|
| Rate for Payer: HFN Commercial |
$144.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Preferred Network Access Commercial |
$144.40
|
| Rate for Payer: Quartz Beloit One Network |
$66.88
|
| Rate for Payer: Quartz Commercial |
$86.64
|
| Rate for Payer: The Alliance Commercial |
$76.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Ganglioside GD1b Antibody IgG
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5582229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Ganglioside GD1b Antibody IgG
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5582229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Ganglioside GM-1 Antibody IgG & IgM
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
1039122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Ganglioside GM-1 Antibody IgG & IgM
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
1039122
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
