|
Poliovirus Type 3
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
2942974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$401.13 |
| Rate for Payer: Aetna Commercial |
$401.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Aetna Managed Medicare |
$17.59
|
| Rate for Payer: Anthem Medicare Advantage |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.59
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$401.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.59
|
| Rate for Payer: Health EOS Commercial |
$384.24
|
| Rate for Payer: HFN Commercial |
$401.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.59
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: NAPHCARE Commercial |
$26.38
|
| Rate for Payer: Preferred Network Access Commercial |
$401.13
|
| Rate for Payer: Quartz Beloit One Network |
$185.79
|
| Rate for Payer: Quartz Commercial |
$240.68
|
| Rate for Payer: Quartz Medicare Advantage |
$17.59
|
| Rate for Payer: The Alliance Commercial |
$69.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.59
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$77.38
|
|
|
Poliovirus Type 3
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
2942974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.90 |
| Max. Negotiated Rate |
$388.46 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$253.34
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Poliovirus Type 3
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 86382
|
| Hospital Charge Code |
2942974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.59 |
| Max. Negotiated Rate |
$388.46 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Aetna Managed Medicare |
$17.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.19
|
| Rate for Payer: Anthem Medicare Advantage |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.59
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.59
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.59
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: NAPHCARE Commercial |
$26.38
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$274.46
|
| Rate for Payer: Quartz Medicare Advantage |
$17.59
|
| Rate for Payer: The Alliance Commercial |
$70.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.59
|
| Rate for Payer: United Healthcare PPO |
$316.68
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: Wellcare Medicare |
$17.59
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
POLYFORM SOLID 1/16 X 12 X 18 #A29213
|
Facility
|
IP
|
$1,248.00
|
|
| Hospital Charge Code |
2972143
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$635.98 |
| Max. Negotiated Rate |
$1,194.09 |
| Rate for Payer: Aetna Commercial |
$1,168.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,116.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$687.90
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cigna Commercial |
$1,194.09
|
| Rate for Payer: Health EOS Commercial |
$1,155.15
|
| Rate for Payer: HFN Commercial |
$1,194.09
|
| Rate for Payer: Multiplan Commercial |
$1,038.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,194.09
|
| Rate for Payer: Quartz Beloit One Network |
$635.98
|
| Rate for Payer: Quartz Commercial |
$778.75
|
| Rate for Payer: WEA Trust Commercial |
$713.86
|
| Rate for Payer: WPS Commercial |
$961.33
|
|
|
POLYFORM SOLID 1/16 X 12 X 18 #A29213
|
Facility
|
OP
|
$1,248.00
|
|
| Hospital Charge Code |
2972143
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$363.42 |
| Max. Negotiated Rate |
$1,194.09 |
| Rate for Payer: Aetna Commercial |
$1,168.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,116.21
|
| Rate for Payer: Aetna Managed Medicare |
$363.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$843.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$648.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$623.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$687.90
|
| Rate for Payer: Cash Price |
$374.40
|
| Rate for Payer: Cigna Commercial |
$1,194.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$726.34
|
| Rate for Payer: Health EOS Commercial |
$1,155.15
|
| Rate for Payer: HFN Commercial |
$1,194.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$973.44
|
| Rate for Payer: Multiplan Commercial |
$1,038.34
|
| Rate for Payer: NAPHCARE Commercial |
$778.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,194.09
|
| Rate for Payer: Quartz Beloit One Network |
$635.98
|
| Rate for Payer: Quartz Commercial |
$843.65
|
| Rate for Payer: Quartz Medicare Advantage |
$778.75
|
| Rate for Payer: The Alliance Commercial |
$648.96
|
| Rate for Payer: WEA Trust Commercial |
$713.86
|
| Rate for Payer: WPS Commercial |
$961.33
|
|
|
POLYFORM SPLINTINE 1/8 x 18" x 24" BEIGE #A292-02-4C4"
|
Facility
|
IP
|
$854.00
|
|
| Hospital Charge Code |
2970231
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$435.20 |
| Max. Negotiated Rate |
$817.11 |
| Rate for Payer: Aetna Commercial |
$799.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.72
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$817.11
|
| Rate for Payer: Health EOS Commercial |
$790.46
|
| Rate for Payer: HFN Commercial |
$817.11
|
| Rate for Payer: Multiplan Commercial |
$710.53
|
| Rate for Payer: Preferred Network Access Commercial |
$817.11
|
| Rate for Payer: Quartz Beloit One Network |
$435.20
|
| Rate for Payer: Quartz Commercial |
$532.90
|
| Rate for Payer: WEA Trust Commercial |
$488.49
|
| Rate for Payer: WPS Commercial |
$657.84
|
|
|
POLYFORM SPLINTINE 1/8 x 18" x 24" BEIGE #A292-02-4C4"
|
Facility
|
OP
|
$854.00
|
|
| Hospital Charge Code |
2970231
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$248.68 |
| Max. Negotiated Rate |
$817.11 |
| Rate for Payer: Aetna Commercial |
$799.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$763.82
|
| Rate for Payer: Aetna Managed Medicare |
$248.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.72
|
| Rate for Payer: Cash Price |
$256.20
|
| Rate for Payer: Cigna Commercial |
$817.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$497.03
|
| Rate for Payer: Health EOS Commercial |
$790.46
|
| Rate for Payer: HFN Commercial |
$817.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.12
|
| Rate for Payer: Multiplan Commercial |
$710.53
|
| Rate for Payer: NAPHCARE Commercial |
$532.90
|
| Rate for Payer: Preferred Network Access Commercial |
$817.11
|
| Rate for Payer: Quartz Beloit One Network |
$435.20
|
| Rate for Payer: Quartz Commercial |
$577.30
|
| Rate for Payer: Quartz Medicare Advantage |
$532.90
|
| Rate for Payer: The Alliance Commercial |
$444.08
|
| Rate for Payer: WEA Trust Commercial |
$488.49
|
| Rate for Payer: WPS Commercial |
$657.84
|
|
|
POLYFORM WRIST THUMB SPICA MED
|
Facility
|
IP
|
$193.00
|
|
| Hospital Charge Code |
2971257
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$120.43
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
POLYFORM WRIST THUMB SPICA MED
|
Facility
|
OP
|
$193.00
|
|
| Hospital Charge Code |
2971257
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.20 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Aetna Managed Medicare |
$56.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.33
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.54
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: NAPHCARE Commercial |
$120.43
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$130.47
|
| Rate for Payer: Quartz Medicare Advantage |
$120.43
|
| Rate for Payer: The Alliance Commercial |
$100.36
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
POLY INSERT INFINITY EVERLAST CROSS-LINK SZ 1/1+ 8MM 33681108
|
Facility
|
IP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6175039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,389.20 |
| Max. Negotiated Rate |
$13,873.60 |
| Rate for Payer: Aetna Commercial |
$13,572.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,968.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,992.40
|
| Rate for Payer: Cash Price |
$4,350.00
|
| Rate for Payer: Cigna Commercial |
$13,873.60
|
| Rate for Payer: Health EOS Commercial |
$13,421.20
|
| Rate for Payer: HFN Commercial |
$13,873.60
|
| Rate for Payer: Multiplan Commercial |
$12,064.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,873.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,389.20
|
| Rate for Payer: Quartz Commercial |
$9,048.00
|
| Rate for Payer: WEA Trust Commercial |
$8,294.00
|
| Rate for Payer: WPS Commercial |
$11,169.35
|
|
|
POLY INSERT INFINITY EVERLAST CROSS-LINK SZ 1/1+ 8MM 33681108
|
Facility
|
OP
|
$14,500.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6175039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,222.40 |
| Max. Negotiated Rate |
$13,873.60 |
| Rate for Payer: Aetna Commercial |
$13,572.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,968.80
|
| Rate for Payer: Aetna Managed Medicare |
$4,222.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,802.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,540.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,238.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,992.40
|
| Rate for Payer: Cash Price |
$4,350.00
|
| Rate for Payer: Cigna Commercial |
$13,873.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,439.00
|
| Rate for Payer: Health EOS Commercial |
$13,421.20
|
| Rate for Payer: HFN Commercial |
$13,873.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,310.00
|
| Rate for Payer: Multiplan Commercial |
$12,064.00
|
| Rate for Payer: NAPHCARE Commercial |
$9,048.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,873.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,389.20
|
| Rate for Payer: Quartz Commercial |
$9,802.00
|
| Rate for Payer: Quartz Medicare Advantage |
$9,048.00
|
| Rate for Payer: The Alliance Commercial |
$7,540.00
|
| Rate for Payer: WEA Trust Commercial |
$8,294.00
|
| Rate for Payer: WPS Commercial |
$11,169.35
|
|
|
POLY INSERT INFINITY EVERLAST CROSS-LINK SZ 2+ H 10MM 33683210
|
Facility
|
IP
|
$18,871.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,616.66 |
| Max. Negotiated Rate |
$18,055.77 |
| Rate for Payer: Aetna Commercial |
$17,663.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,878.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,401.70
|
| Rate for Payer: Cash Price |
$5,661.30
|
| Rate for Payer: Cigna Commercial |
$18,055.77
|
| Rate for Payer: Health EOS Commercial |
$17,467.00
|
| Rate for Payer: HFN Commercial |
$18,055.77
|
| Rate for Payer: Multiplan Commercial |
$15,700.67
|
| Rate for Payer: Preferred Network Access Commercial |
$18,055.77
|
| Rate for Payer: Quartz Beloit One Network |
$9,616.66
|
| Rate for Payer: Quartz Commercial |
$11,775.50
|
| Rate for Payer: WEA Trust Commercial |
$10,794.21
|
| Rate for Payer: WPS Commercial |
$14,536.33
|
|
|
POLY INSERT INFINITY EVERLAST CROSS-LINK SZ 2+ H 10MM 33683210
|
Facility
|
OP
|
$18,871.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,495.24 |
| Max. Negotiated Rate |
$18,055.77 |
| Rate for Payer: Aetna Commercial |
$17,663.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,878.22
|
| Rate for Payer: Aetna Managed Medicare |
$5,495.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,756.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,812.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,420.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,401.70
|
| Rate for Payer: Cash Price |
$5,661.30
|
| Rate for Payer: Cigna Commercial |
$18,055.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,982.92
|
| Rate for Payer: Health EOS Commercial |
$17,467.00
|
| Rate for Payer: HFN Commercial |
$18,055.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,719.38
|
| Rate for Payer: Multiplan Commercial |
$15,700.67
|
| Rate for Payer: NAPHCARE Commercial |
$11,775.50
|
| Rate for Payer: Preferred Network Access Commercial |
$18,055.77
|
| Rate for Payer: Quartz Beloit One Network |
$9,616.66
|
| Rate for Payer: Quartz Commercial |
$12,756.80
|
| Rate for Payer: Quartz Medicare Advantage |
$11,775.50
|
| Rate for Payer: The Alliance Commercial |
$9,812.92
|
| Rate for Payer: WEA Trust Commercial |
$10,794.21
|
| Rate for Payer: WPS Commercial |
$14,536.33
|
|
|
POLYPECTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
POLYPECTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960317
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Polysomnogram
|
Facility
|
IP
|
$7,000.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
3103324
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,567.20 |
| Max. Negotiated Rate |
$6,697.60 |
| Rate for Payer: Aetna Commercial |
$6,552.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,260.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,858.40
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$6,697.60
|
| Rate for Payer: Health EOS Commercial |
$6,479.20
|
| Rate for Payer: HFN Commercial |
$6,697.60
|
| Rate for Payer: Multiplan Commercial |
$5,824.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,697.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,567.20
|
| Rate for Payer: Quartz Commercial |
$4,368.00
|
| Rate for Payer: WEA Trust Commercial |
$4,004.00
|
| Rate for Payer: WPS Commercial |
$5,392.10
|
|
|
Polysomnogram
|
Facility
|
OP
|
$7,000.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
3103324
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$6,697.60 |
| Rate for Payer: Aetna Commercial |
$6,552.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,260.80
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,858.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cash Price |
$2,100.00
|
| Rate for Payer: Cigna Commercial |
$6,697.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,074.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$6,479.20
|
| Rate for Payer: HFN Commercial |
$6,697.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$5,824.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,697.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,567.20
|
| Rate for Payer: Quartz Commercial |
$4,732.00
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$5,460.00
|
| Rate for Payer: WEA Trust Commercial |
$4,004.00
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$5,392.10
|
|
|
Polysomnogram CPAP - Sleep Test
|
Facility
|
OP
|
$8,380.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
1526804
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$8,017.98 |
| Rate for Payer: Aetna Commercial |
$7,843.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,495.07
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,619.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cigna Commercial |
$8,017.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,877.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$7,756.53
|
| Rate for Payer: HFN Commercial |
$8,017.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$6,972.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$8,017.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,270.45
|
| Rate for Payer: Quartz Commercial |
$5,664.88
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$6,536.40
|
| Rate for Payer: WEA Trust Commercial |
$4,793.36
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$6,455.11
|
|
|
Polysomnogram CPAP - Sleep Test
|
Facility
|
IP
|
$8,380.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
1526804
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,270.45 |
| Max. Negotiated Rate |
$8,017.98 |
| Rate for Payer: Aetna Commercial |
$7,843.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,495.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,619.06
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cigna Commercial |
$8,017.98
|
| Rate for Payer: Health EOS Commercial |
$7,756.53
|
| Rate for Payer: HFN Commercial |
$8,017.98
|
| Rate for Payer: Multiplan Commercial |
$6,972.16
|
| Rate for Payer: Preferred Network Access Commercial |
$8,017.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,270.45
|
| Rate for Payer: Quartz Commercial |
$5,229.12
|
| Rate for Payer: WEA Trust Commercial |
$4,793.36
|
| Rate for Payer: WPS Commercial |
$6,455.11
|
|
|
Polysomnogram CPAP With Titration - Sleep Test
|
Facility
|
IP
|
$8,380.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
1526805
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$4,270.45 |
| Max. Negotiated Rate |
$8,017.98 |
| Rate for Payer: Aetna Commercial |
$7,843.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,495.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,619.06
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cigna Commercial |
$8,017.98
|
| Rate for Payer: Health EOS Commercial |
$7,756.53
|
| Rate for Payer: HFN Commercial |
$8,017.98
|
| Rate for Payer: Multiplan Commercial |
$6,972.16
|
| Rate for Payer: Preferred Network Access Commercial |
$8,017.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,270.45
|
| Rate for Payer: Quartz Commercial |
$5,229.12
|
| Rate for Payer: WEA Trust Commercial |
$4,793.36
|
| Rate for Payer: WPS Commercial |
$6,455.11
|
|
|
Polysomnogram CPAP With Titration - Sleep Test
|
Facility
|
OP
|
$8,380.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
1526805
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$8,017.98 |
| Rate for Payer: Aetna Commercial |
$7,843.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,495.07
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,619.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cash Price |
$2,514.00
|
| Rate for Payer: Cigna Commercial |
$8,017.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,877.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$7,756.53
|
| Rate for Payer: HFN Commercial |
$8,017.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$6,972.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$8,017.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,270.45
|
| Rate for Payer: Quartz Commercial |
$5,664.88
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$6,536.40
|
| Rate for Payer: WEA Trust Commercial |
$4,793.36
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$6,455.11
|
|
|
Polysomnogram - Sleep Test
|
Facility
|
OP
|
$7,737.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
1526803
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$7,402.76 |
| Rate for Payer: Aetna Commercial |
$7,241.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,919.97
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,264.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cigna Commercial |
$7,402.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,502.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$7,161.37
|
| Rate for Payer: HFN Commercial |
$7,402.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$6,437.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$7,402.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,942.78
|
| Rate for Payer: Quartz Commercial |
$5,230.21
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$6,034.86
|
| Rate for Payer: WEA Trust Commercial |
$4,425.56
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$5,959.81
|
|
|
Polysomnogram - Sleep Test
|
Facility
|
IP
|
$7,737.00
|
|
|
Service Code
|
CPT 95810
|
| Hospital Charge Code |
1526803
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,942.78 |
| Max. Negotiated Rate |
$7,402.76 |
| Rate for Payer: Aetna Commercial |
$7,241.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,919.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,264.63
|
| Rate for Payer: Cash Price |
$2,321.10
|
| Rate for Payer: Cigna Commercial |
$7,402.76
|
| Rate for Payer: Health EOS Commercial |
$7,161.37
|
| Rate for Payer: HFN Commercial |
$7,402.76
|
| Rate for Payer: Multiplan Commercial |
$6,437.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,402.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,942.78
|
| Rate for Payer: Quartz Commercial |
$4,827.89
|
| Rate for Payer: WEA Trust Commercial |
$4,425.56
|
| Rate for Payer: WPS Commercial |
$5,959.81
|
|
|
Polysomnogram With CPAP
|
Facility
|
OP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3103326
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,462.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$5,183.57
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$5,981.04
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
|
Polysomnogram With CPAP
|
Facility
|
IP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3103326
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,907.61 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$4,784.83
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
