|
Reclast 5 mg Charge
|
Facility
|
IP
|
$5,966.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2958941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,923.34 |
| Max. Negotiated Rate |
$5,488.72 |
| Rate for Payer: Aetna Commercial |
$5,369.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,130.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.98
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cigna Commercial |
$5,488.72
|
| Rate for Payer: Health EOS Commercial |
$5,309.74
|
| Rate for Payer: HFN Commercial |
$5,488.72
|
| Rate for Payer: Multiplan Commercial |
$4,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,488.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.34
|
| Rate for Payer: Quartz Commercial |
$3,579.60
|
| Rate for Payer: WEA Trust Commercial |
$3,281.30
|
| Rate for Payer: WPS Commercial |
$4,419.02
|
|
|
Reclast 5 mg Charge
|
Facility
|
OP
|
$5,966.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
2958941
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$23,864.00 |
| Rate for Payer: Aetna Commercial |
$5,369.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,130.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,670.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,877.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,983.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,863.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,161.98
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cash Price |
$1,789.80
|
| Rate for Payer: Cigna Commercial |
$5,488.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.18
|
| Rate for Payer: Health EOS Commercial |
$5,309.74
|
| Rate for Payer: HFN Commercial |
$5,488.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,474.50
|
| Rate for Payer: Multiplan Commercial |
$4,772.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,579.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,488.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,923.34
|
| Rate for Payer: Quartz Commercial |
$3,877.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,579.60
|
| Rate for Payer: The Alliance Commercial |
$23,864.00
|
| Rate for Payer: WEA Trust Commercial |
$3,281.30
|
| Rate for Payer: WPS Commercial |
$17.34
|
|
|
Reclast 5mg charge J3489
|
Facility
|
OP
|
$6,083.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4410630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.18 |
| Max. Negotiated Rate |
$24,332.00 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,703.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,953.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,041.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,919.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.18
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,562.25
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,953.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,649.80
|
| Rate for Payer: The Alliance Commercial |
$24,332.00
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$17.34
|
|
|
Reclast 5mg charge J3489
|
Facility
|
IP
|
$6,083.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4410630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,980.67 |
| Max. Negotiated Rate |
$5,596.36 |
| Rate for Payer: Aetna Commercial |
$5,474.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,223.99
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,596.36
|
| Rate for Payer: Health EOS Commercial |
$5,413.87
|
| Rate for Payer: HFN Commercial |
$5,596.36
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,649.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,596.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,980.67
|
| Rate for Payer: Quartz Commercial |
$3,649.80
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$4,505.68
|
|
|
Reclast 5mg charge J3489
|
Professional
|
Both
|
$6,083.00
|
|
|
Service Code
|
HCPCS J3489
|
| Hospital Charge Code |
4410630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.94 |
| Max. Negotiated Rate |
$5,778.85 |
| Rate for Payer: Aetna Commercial |
$5,778.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,231.38
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cash Price |
$1,824.90
|
| Rate for Payer: Cigna Commercial |
$5,778.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.94
|
| Rate for Payer: Health EOS Commercial |
$5,535.53
|
| Rate for Payer: HFN Commercial |
$5,778.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.97
|
| Rate for Payer: Multiplan Commercial |
$4,866.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,778.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,676.52
|
| Rate for Payer: Quartz Commercial |
$3,467.31
|
| Rate for Payer: The Alliance Commercial |
$3,041.50
|
| Rate for Payer: United Healthcare Medicaid |
$6.94
|
| Rate for Payer: WEA Trust Commercial |
$3,345.65
|
| Rate for Payer: WPS Commercial |
$17.34
|
|
|
RECON SCREW 6.5MM/100MM X L40MM FOR IM NAIL 04.046.700S
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.80 |
| Max. Negotiated Rate |
$2,134.40 |
| Rate for Payer: Aetna Commercial |
$2,088.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,995.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,229.60
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,134.40
|
| Rate for Payer: Health EOS Commercial |
$2,064.80
|
| Rate for Payer: HFN Commercial |
$2,134.40
|
| Rate for Payer: Multiplan Commercial |
$1,856.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,134.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,136.80
|
| Rate for Payer: Quartz Commercial |
$1,392.00
|
| Rate for Payer: WEA Trust Commercial |
$1,276.00
|
| Rate for Payer: WPS Commercial |
$1,718.42
|
|
|
RECON SCREW 6.5MM/100MM X L40MM FOR IM NAIL 04.046.700S
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.60 |
| Max. Negotiated Rate |
$9,280.00 |
| Rate for Payer: Aetna Commercial |
$2,088.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,995.20
|
| Rate for Payer: Aetna Managed Medicare |
$649.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,508.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,160.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,113.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,229.60
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,134.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,298.27
|
| Rate for Payer: Health EOS Commercial |
$2,064.80
|
| Rate for Payer: HFN Commercial |
$2,134.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,740.00
|
| Rate for Payer: Multiplan Commercial |
$1,856.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,134.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,136.80
|
| Rate for Payer: Quartz Commercial |
$1,508.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,392.00
|
| Rate for Payer: The Alliance Commercial |
$9,280.00
|
| Rate for Payer: WEA Trust Commercial |
$1,276.00
|
| Rate for Payer: WPS Commercial |
$1,718.42
|
|
|
RECON SCREW 6.5MM/105MM X L40MM FOR IM NAIL 04.046.705S
|
Facility
|
OP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$649.60 |
| Max. Negotiated Rate |
$9,280.00 |
| Rate for Payer: Aetna Commercial |
$2,088.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,995.20
|
| Rate for Payer: Aetna Managed Medicare |
$649.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,508.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,160.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,113.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,229.60
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,134.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,298.27
|
| Rate for Payer: Health EOS Commercial |
$2,064.80
|
| Rate for Payer: HFN Commercial |
$2,134.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,740.00
|
| Rate for Payer: Multiplan Commercial |
$1,856.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,134.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,136.80
|
| Rate for Payer: Quartz Commercial |
$1,508.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,392.00
|
| Rate for Payer: The Alliance Commercial |
$9,280.00
|
| Rate for Payer: WEA Trust Commercial |
$1,276.00
|
| Rate for Payer: WPS Commercial |
$1,718.42
|
|
|
RECON SCREW 6.5MM/105MM X L40MM FOR IM NAIL 04.046.705S
|
Facility
|
IP
|
$2,320.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6182644
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,136.80 |
| Max. Negotiated Rate |
$2,134.40 |
| Rate for Payer: Aetna Commercial |
$2,088.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,995.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,229.60
|
| Rate for Payer: Cash Price |
$696.00
|
| Rate for Payer: Cigna Commercial |
$2,134.40
|
| Rate for Payer: Health EOS Commercial |
$2,064.80
|
| Rate for Payer: HFN Commercial |
$2,134.40
|
| Rate for Payer: Multiplan Commercial |
$1,856.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,392.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,134.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,136.80
|
| Rate for Payer: Quartz Commercial |
$1,392.00
|
| Rate for Payer: WEA Trust Commercial |
$1,276.00
|
| Rate for Payer: WPS Commercial |
$1,718.42
|
|
|
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUE PROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES)
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 28313
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION, CHRONIC (INCLUDES ACROMIOPLASTY)
|
Facility
|
OP
|
$28,284.48
|
|
|
Service Code
|
CPT 23420
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,071.12 |
| Max. Negotiated Rate |
$28,284.48 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,639.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$28,284.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
RECTAL EXAM/PROLAPSE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
RECTAL EXAM/PROLAPSE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960339
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
RECTAL RESECTION WITH CC
|
Facility
|
IP
|
$55,606.00
|
|
|
Service Code
|
MSDRG 333
|
| Min. Negotiated Rate |
$20,002.14 |
| Max. Negotiated Rate |
$55,606.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,002.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43,638.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,448.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,778.24
|
| Rate for Payer: Anthem Medicare Advantage |
$20,002.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,002.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,002.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,002.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,276.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,002.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,550.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,002.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,002.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,002.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,002.14
|
| Rate for Payer: NAPHCARE Commercial |
$30,003.21
|
| Rate for Payer: Quartz Medicare Advantage |
$20,002.14
|
| Rate for Payer: The Alliance Commercial |
$55,606.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,002.14
|
| Rate for Payer: United Healthcare PPO |
$31,568.89
|
| Rate for Payer: Wellcare Medicare |
$20,002.14
|
|
|
RECTAL RESECTION WITH MCC
|
Facility
|
IP
|
$97,473.00
|
|
|
Service Code
|
MSDRG 332
|
| Min. Negotiated Rate |
$35,062.41 |
| Max. Negotiated Rate |
$97,473.00 |
| Rate for Payer: Aetna Managed Medicare |
$35,062.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,157.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,374.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,459.14
|
| Rate for Payer: Anthem Medicare Advantage |
$35,062.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35,062.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35,062.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35,062.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61,564.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35,062.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70,738.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35,062.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35,062.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35,062.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35,062.41
|
| Rate for Payer: NAPHCARE Commercial |
$52,593.62
|
| Rate for Payer: Quartz Medicare Advantage |
$35,062.41
|
| Rate for Payer: The Alliance Commercial |
$97,473.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,062.41
|
| Rate for Payer: United Healthcare PPO |
$55,070.60
|
| Rate for Payer: Wellcare Medicare |
$35,062.41
|
|
|
RECTAL RESECTION WITHOUT CC/MCC
|
Facility
|
IP
|
$42,994.00
|
|
|
Service Code
|
MSDRG 334
|
| Min. Negotiated Rate |
$15,465.31 |
| Max. Negotiated Rate |
$42,994.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,465.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,777.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,890.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,597.58
|
| Rate for Payer: Anthem Medicare Advantage |
$15,465.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,465.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,465.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,465.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,305.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,465.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,299.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,465.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,465.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,465.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,465.31
|
| Rate for Payer: NAPHCARE Commercial |
$23,197.96
|
| Rate for Payer: Quartz Medicare Advantage |
$15,465.31
|
| Rate for Payer: The Alliance Commercial |
$42,994.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,465.31
|
| Rate for Payer: United Healthcare PPO |
$24,367.02
|
| Rate for Payer: Wellcare Medicare |
$15,465.31
|
|
|
Rectal Sensation, Tone And Compliance Test
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
CPT 91120
|
| Hospital Charge Code |
1190817
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$1,824.97 |
| Rate for Payer: Aetna Commercial |
$465.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$421.40
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$465.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$385.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.00
|
| Rate for Payer: Health EOS Commercial |
$445.90
|
| Rate for Payer: HFN Commercial |
$465.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,824.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,824.97
|
| Rate for Payer: Multiplan Commercial |
$392.00
|
| Rate for Payer: Preferred Network Access Commercial |
$465.50
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$279.30
|
| Rate for Payer: The Alliance Commercial |
$245.00
|
| Rate for Payer: United Healthcare Medicaid |
$385.90
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$37,637.00
|
|
|
Service Code
|
MSDRG 811
|
| Min. Negotiated Rate |
$13,538.31 |
| Max. Negotiated Rate |
$37,637.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,538.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,372.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,513.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,389.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13,538.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,538.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,538.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,538.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,743.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,538.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,370.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,538.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,538.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,538.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,538.31
|
| Rate for Payer: NAPHCARE Commercial |
$20,307.46
|
| Rate for Payer: Quartz Medicare Advantage |
$13,538.31
|
| Rate for Payer: The Alliance Commercial |
$37,637.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,538.31
|
| Rate for Payer: United Healthcare PPO |
$21,308.05
|
| Rate for Payer: Wellcare Medicare |
$13,538.31
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$24,266.00
|
|
|
Service Code
|
MSDRG 812
|
| Min. Negotiated Rate |
$8,728.93 |
| Max. Negotiated Rate |
$24,266.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,728.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,882.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,472.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,750.20
|
| Rate for Payer: Anthem Medicare Advantage |
$8,728.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,728.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,728.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,728.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,263.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,728.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,563.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,728.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,728.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,728.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,728.93
|
| Rate for Payer: NAPHCARE Commercial |
$13,093.40
|
| Rate for Payer: Quartz Medicare Advantage |
$8,728.93
|
| Rate for Payer: The Alliance Commercial |
$24,266.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,728.93
|
| Rate for Payer: United Healthcare PPO |
$13,673.53
|
| Rate for Payer: Wellcare Medicare |
$8,728.93
|
|
|
Red Blood Cell Membrane Evaluation
|
Facility
|
OP
|
$1,671.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
4606700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$355.28 |
| Max. Negotiated Rate |
$1,537.32 |
| Rate for Payer: Aetna Commercial |
$1,503.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,437.06
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$885.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna Commercial |
$1,537.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$935.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$1,487.19
|
| Rate for Payer: HFN Commercial |
$1,537.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$1,336.80
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,537.32
|
| Rate for Payer: Quartz Beloit One Network |
$818.79
|
| Rate for Payer: Quartz Commercial |
$1,086.15
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$1,253.25
|
| Rate for Payer: WEA Trust Commercial |
$919.05
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$1,237.71
|
|
|
Red Blood Cell Membrane Evaluation
|
Facility
|
IP
|
$1,671.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
4606700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$818.79 |
| Max. Negotiated Rate |
$1,537.32 |
| Rate for Payer: Aetna Commercial |
$1,503.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,437.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$885.63
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna Commercial |
$1,537.32
|
| Rate for Payer: Health EOS Commercial |
$1,487.19
|
| Rate for Payer: HFN Commercial |
$1,537.32
|
| Rate for Payer: Multiplan Commercial |
$1,336.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,002.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,537.32
|
| Rate for Payer: Quartz Beloit One Network |
$818.79
|
| Rate for Payer: Quartz Commercial |
$1,002.60
|
| Rate for Payer: WEA Trust Commercial |
$919.05
|
| Rate for Payer: WPS Commercial |
$1,237.71
|
|
|
Red Blood Cell Membrane Evaluation
|
Professional
|
Both
|
$1,671.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
4606700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.47 |
| Max. Negotiated Rate |
$1,587.45 |
| Rate for Payer: Aetna Commercial |
$1,587.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,437.06
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna Commercial |
$1,587.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$835.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.60
|
| Rate for Payer: Health EOS Commercial |
$1,520.61
|
| Rate for Payer: HFN Commercial |
$1,587.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.47
|
| Rate for Payer: Multiplan Commercial |
$1,336.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.45
|
| Rate for Payer: Quartz Beloit One Network |
$735.24
|
| Rate for Payer: Quartz Commercial |
$952.47
|
| Rate for Payer: The Alliance Commercial |
$835.50
|
| Rate for Payer: WEA Trust Commercial |
$919.05
|
| Rate for Payer: WPS Commercial |
$1,237.71
|
|
|
Red Cell Count, Fluid
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
979868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.72 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$4.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.84
|
| Rate for Payer: Anthem Medicaid |
$4.88
|
| Rate for Payer: Anthem Medicare Advantage |
$4.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.72
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.36
|
| Rate for Payer: Dean Health Medicaid |
$4.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.72
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.72
|
| Rate for Payer: Managed Health Services Medicaid |
$5.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.72
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.08
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.88
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$58.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4.72
|
| Rate for Payer: The Alliance Commercial |
$18.88
|
| Rate for Payer: United Healthcare Medicaid |
$4.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.72
|
| Rate for Payer: United Healthcare PPO |
$67.50
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: Wellcare Medicare |
$4.72
|
| Rate for Payer: WMAP Medicaid |
$4.88
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
Red Cell Count, Fluid
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
979868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.00
|
| Rate for Payer: Health EOS Commercial |
$81.90
|
| Rate for Payer: HFN Commercial |
$85.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.66
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$85.50
|
| Rate for Payer: Quartz Beloit One Network |
$39.60
|
| Rate for Payer: Quartz Commercial |
$51.30
|
| Rate for Payer: The Alliance Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
Red Cell Count, Fluid
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
979868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
