|
REPAIR OF FOOT TENDON 28200
|
Professional
|
Both
|
$2,210.00
|
|
|
Service Code
|
CPT 28200
|
| Hospital Charge Code |
3014216
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$2,099.50 |
| Rate for Payer: Aetna Commercial |
$2,099.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,900.60
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$2,099.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,326.00
|
| Rate for Payer: Health EOS Commercial |
$2,011.10
|
| Rate for Payer: HFN Commercial |
$2,099.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,093.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,093.59
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,099.50
|
| Rate for Payer: Quartz Beloit One Network |
$972.40
|
| Rate for Payer: Quartz Commercial |
$1,259.70
|
| Rate for Payer: The Alliance Commercial |
$1,105.00
|
| Rate for Payer: United Healthcare Medicaid |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$1,215.50
|
| Rate for Payer: WPS Commercial |
$1,636.95
|
|
|
REPAIR OF FOOT TENDON 28208
|
Professional
|
Both
|
$1,070.00
|
|
|
Service Code
|
CPT 28208
|
| Hospital Charge Code |
3014217
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$1,069.91 |
| Rate for Payer: Aetna Commercial |
$1,016.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$920.20
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cash Price |
$321.00
|
| Rate for Payer: Cigna Commercial |
$1,016.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.00
|
| Rate for Payer: Health EOS Commercial |
$973.70
|
| Rate for Payer: HFN Commercial |
$1,016.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,069.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,069.91
|
| Rate for Payer: Multiplan Commercial |
$856.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.50
|
| Rate for Payer: Quartz Beloit One Network |
$470.80
|
| Rate for Payer: Quartz Commercial |
$609.90
|
| Rate for Payer: The Alliance Commercial |
$535.00
|
| Rate for Payer: United Healthcare Medicaid |
$180.80
|
| Rate for Payer: WEA Trust Commercial |
$588.50
|
| Rate for Payer: WPS Commercial |
$792.55
|
|
|
REPAIR OF HAMMERTOE 28285
|
Professional
|
Both
|
$2,286.00
|
|
|
Service Code
|
CPT 28285
|
| Hospital Charge Code |
3014229
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$274.92 |
| Max. Negotiated Rate |
$2,171.70 |
| Rate for Payer: Aetna Commercial |
$2,171.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,965.96
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cash Price |
$685.80
|
| Rate for Payer: Cigna Commercial |
$2,171.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$274.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,371.60
|
| Rate for Payer: Health EOS Commercial |
$2,080.26
|
| Rate for Payer: HFN Commercial |
$2,171.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,287.00
|
| Rate for Payer: Multiplan Commercial |
$1,828.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,171.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,005.84
|
| Rate for Payer: Quartz Commercial |
$1,303.02
|
| Rate for Payer: The Alliance Commercial |
$1,143.00
|
| Rate for Payer: United Healthcare Medicaid |
$274.92
|
| Rate for Payer: WEA Trust Commercial |
$1,257.30
|
| Rate for Payer: WPS Commercial |
$1,693.24
|
|
|
REPAIR OF HAMMERTOE 28286
|
Professional
|
Both
|
$1,884.00
|
|
|
Service Code
|
CPT 28286
|
| Hospital Charge Code |
3014230
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,789.80 |
| Rate for Payer: Aetna Commercial |
$1,789.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.24
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cash Price |
$565.20
|
| Rate for Payer: Cigna Commercial |
$1,789.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,130.40
|
| Rate for Payer: Health EOS Commercial |
$1,714.44
|
| Rate for Payer: HFN Commercial |
$1,789.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,003.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,003.51
|
| Rate for Payer: Multiplan Commercial |
$1,507.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,789.80
|
| Rate for Payer: Quartz Beloit One Network |
$828.96
|
| Rate for Payer: Quartz Commercial |
$1,073.88
|
| Rate for Payer: The Alliance Commercial |
$942.00
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$1,036.20
|
| Rate for Payer: WPS Commercial |
$1,395.48
|
|
|
REPAIR OF METATARSALS 28322
|
Professional
|
Both
|
$1,638.00
|
|
|
Service Code
|
CPT 28322
|
| Hospital Charge Code |
3014244
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$1,925.83 |
| Rate for Payer: Aetna Commercial |
$1,556.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cash Price |
$491.40
|
| Rate for Payer: Cigna Commercial |
$1,556.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$982.80
|
| Rate for Payer: Health EOS Commercial |
$1,490.58
|
| Rate for Payer: HFN Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,925.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,925.83
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.10
|
| Rate for Payer: Quartz Beloit One Network |
$720.72
|
| Rate for Payer: Quartz Commercial |
$933.66
|
| Rate for Payer: The Alliance Commercial |
$819.00
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.27
|
|
|
REPAIR OF NAIL BED 11760
|
Professional
|
Both
|
$770.00
|
|
|
Service Code
|
CPT 11760
|
| Hospital Charge Code |
3013573
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$731.50 |
| Rate for Payer: Aetna Commercial |
$731.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$662.20
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cash Price |
$231.00
|
| Rate for Payer: Cigna Commercial |
$731.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$462.00
|
| Rate for Payer: Health EOS Commercial |
$700.70
|
| Rate for Payer: HFN Commercial |
$731.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.15
|
| Rate for Payer: Multiplan Commercial |
$616.00
|
| Rate for Payer: Preferred Network Access Commercial |
$731.50
|
| Rate for Payer: Quartz Beloit One Network |
$338.80
|
| Rate for Payer: Quartz Commercial |
$438.90
|
| Rate for Payer: The Alliance Commercial |
$385.00
|
| Rate for Payer: United Healthcare Medicaid |
$41.87
|
| Rate for Payer: WEA Trust Commercial |
$423.50
|
| Rate for Payer: WPS Commercial |
$570.34
|
|
|
REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL RECONSTRUCTION)
|
Facility
|
OP
|
$23,153.12
|
|
|
Service Code
|
CPT 30465
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$23,153.12 |
| Rate for Payer: Aetna Managed Medicare |
$5,788.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,788.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,788.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,788.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,788.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,532.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,788.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,788.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,788.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,788.28
|
| Rate for Payer: NAPHCARE Commercial |
$8,682.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,788.28
|
| Rate for Payer: The Alliance Commercial |
$23,153.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,788.28
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$5,788.28
|
|
|
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE)
|
Facility
|
OP
|
$52,034.24
|
|
|
Service Code
|
CPT 24430
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,546.14 |
| Max. Negotiated Rate |
$52,034.24 |
| Rate for Payer: Aetna Managed Medicare |
$13,008.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$13,008.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,008.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,008.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,008.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,008.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48,391.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,008.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,008.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,008.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,008.56
|
| Rate for Payer: NAPHCARE Commercial |
$19,512.84
|
| Rate for Payer: Quartz Medicare Advantage |
$13,008.56
|
| Rate for Payer: The Alliance Commercial |
$52,034.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,008.56
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: Wellcare Medicare |
$13,008.56
|
|
|
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF) OPEN; CHRONIC
|
Facility
|
OP
|
$28,284.48
|
|
|
Service Code
|
CPT 23412
|
|
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
|
|
|
Repair of Wound or Lesion 1315150
|
Professional
|
Both
|
$2,126.00
|
|
|
Service Code
|
CPT 13151
|
| Hospital Charge Code |
5382835
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$206.86 |
| Max. Negotiated Rate |
$2,019.70 |
| Rate for Payer: Aetna Commercial |
$2,019.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,828.36
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cash Price |
$637.80
|
| Rate for Payer: Cigna Commercial |
$2,019.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.60
|
| Rate for Payer: Health EOS Commercial |
$1,934.66
|
| Rate for Payer: HFN Commercial |
$2,019.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$931.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$931.43
|
| Rate for Payer: Multiplan Commercial |
$1,700.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.70
|
| Rate for Payer: Quartz Beloit One Network |
$935.44
|
| Rate for Payer: Quartz Commercial |
$1,211.82
|
| Rate for Payer: The Alliance Commercial |
$1,063.00
|
| Rate for Payer: United Healthcare Medicaid |
$206.86
|
| Rate for Payer: WEA Trust Commercial |
$1,169.30
|
| Rate for Payer: WPS Commercial |
$1,574.73
|
|
|
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL
|
Facility
|
OP
|
$28,284.48
|
|
|
Service Code
|
CPT 27695
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,757.59 |
| 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 |
$4,757.59
|
| 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
|
|
|
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLES TENDON;
|
Facility
|
OP
|
$28,284.48
|
|
|
Service Code
|
CPT 27650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,103.00 |
| Max. Negotiated Rate |
$28,284.48 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| 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 |
$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 |
$6,546.14
|
| 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 |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE; CRUCIATE
|
Facility
|
OP
|
$28,284.48
|
|
|
Service Code
|
CPT 27407
|
|
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 |
$7,795.33
|
| 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
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED OR STRANGULATED
|
Facility
|
OP
|
$29,911.44
|
|
|
Service Code
|
CPT 49521
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,103.00 |
| Max. Negotiated Rate |
$29,911.44 |
| Rate for Payer: Aetna Managed Medicare |
$7,477.86
|
| 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 |
$7,477.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,477.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,477.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,477.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,639.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,477.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,817.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,477.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,477.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,477.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,477.86
|
| Rate for Payer: NAPHCARE Commercial |
$11,216.79
|
| Rate for Payer: Quartz Medicare Advantage |
$7,477.86
|
| Rate for Payer: The Alliance Commercial |
$29,911.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,477.86
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$7,477.86
|
|
|
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
|
Facility
|
OP
|
$13,678.24
|
|
|
Service Code
|
CPT 49520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,419.56 |
| Max. Negotiated Rate |
$13,678.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,419.56
|
| 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 |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,419.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,419.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,419.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,639.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,419.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,720.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,419.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,419.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,419.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,419.56
|
| Rate for Payer: NAPHCARE Commercial |
$5,129.34
|
| Rate for Payer: Quartz Medicare Advantage |
$3,419.56
|
| Rate for Payer: The Alliance Commercial |
$13,678.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,419.56
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,419.56
|
|
|
REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT
|
Facility
|
OP
|
$28,284.48
|
|
|
Service Code
|
CPT 27654
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,546.14 |
| 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 |
$6,546.14
|
| 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
|
|
|
Repair Superficial Wounds (S) 12001
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3713510
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$465.50 |
| 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 |
$51.36
|
| 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 |
$144.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$144.91
|
| 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 |
$51.36
|
| Rate for Payer: WEA Trust Commercial |
$269.50
|
| Rate for Payer: WPS Commercial |
$362.94
|
|
|
Repair Superficial Wounds (S) 3779912001
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
5453139
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.28 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Aetna Commercial |
$438.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.32
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$438.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$231.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.20
|
| Rate for Payer: Health EOS Commercial |
$420.42
|
| Rate for Payer: HFN Commercial |
$438.90
|
| Rate for Payer: Multiplan Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$438.90
|
| Rate for Payer: Quartz Beloit One Network |
$203.28
|
| Rate for Payer: Quartz Commercial |
$263.34
|
| Rate for Payer: The Alliance Commercial |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$254.10
|
| Rate for Payer: WPS Commercial |
$342.20
|
|
|
REPAIR SYSTEM AC KNOTLESS AR-2371
|
Facility
|
OP
|
$13,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5307086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,641.12 |
| Max. Negotiated Rate |
$52,016.00 |
| Rate for Payer: Aetna Commercial |
$11,703.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,183.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,641.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,452.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,502.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,241.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,892.12
|
| Rate for Payer: Cash Price |
$3,901.20
|
| Rate for Payer: Cigna Commercial |
$11,963.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,277.04
|
| Rate for Payer: Health EOS Commercial |
$11,573.56
|
| Rate for Payer: HFN Commercial |
$11,963.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,753.00
|
| Rate for Payer: Multiplan Commercial |
$10,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,802.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,963.68
|
| Rate for Payer: Quartz Beloit One Network |
$6,371.96
|
| Rate for Payer: Quartz Commercial |
$8,452.60
|
| Rate for Payer: Quartz Medicare Advantage |
$7,802.40
|
| Rate for Payer: The Alliance Commercial |
$52,016.00
|
| Rate for Payer: WEA Trust Commercial |
$7,152.20
|
| Rate for Payer: WPS Commercial |
$9,632.06
|
|
|
REPAIR SYSTEM AC KNOTLESS AR-2371
|
Facility
|
IP
|
$13,004.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5307086
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,371.96 |
| Max. Negotiated Rate |
$11,963.68 |
| Rate for Payer: Aetna Commercial |
$11,703.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,183.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,892.12
|
| Rate for Payer: Cash Price |
$3,901.20
|
| Rate for Payer: Cigna Commercial |
$11,963.68
|
| Rate for Payer: Health EOS Commercial |
$11,573.56
|
| Rate for Payer: HFN Commercial |
$11,963.68
|
| Rate for Payer: Multiplan Commercial |
$10,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$7,802.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,963.68
|
| Rate for Payer: Quartz Beloit One Network |
$6,371.96
|
| Rate for Payer: Quartz Commercial |
$7,802.40
|
| Rate for Payer: WEA Trust Commercial |
$7,152.20
|
| Rate for Payer: WPS Commercial |
$9,632.06
|
|
|
REPAIR, TENDON, FLEXOR, FOOT; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT, EACH TENDON
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 28200
|
|
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 |
$6,546.14
|
| 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
|
|
|
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST; PRIMARY, SINGLE, EACH TENDON OR MUSCLE
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 25260
|
|
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 |
$7,795.33
|
| 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
|
|
|
REPAIR TOE DISLOCATION 28645
|
Professional
|
Both
|
$2,227.00
|
|
|
Service Code
|
CPT 28645
|
| Hospital Charge Code |
3014272
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$2,115.65 |
| Rate for Payer: Aetna Commercial |
$2,115.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,915.22
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,115.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,336.20
|
| Rate for Payer: Health EOS Commercial |
$2,026.57
|
| Rate for Payer: HFN Commercial |
$2,115.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,635.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,635.10
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,115.65
|
| Rate for Payer: Quartz Beloit One Network |
$979.88
|
| Rate for Payer: Quartz Commercial |
$1,269.39
|
| Rate for Payer: The Alliance Commercial |
$1,113.50
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$1,224.85
|
| Rate for Payer: WPS Commercial |
$1,649.54
|
|
|
REPAIR TOE DISLOCATION 28675
|
Professional
|
Both
|
$1,096.00
|
|
|
Service Code
|
CPT 28675
|
| Hospital Charge Code |
3014275
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,360.53 |
| Rate for Payer: Aetna Commercial |
$1,041.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$942.56
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cash Price |
$328.80
|
| Rate for Payer: Cigna Commercial |
$1,041.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$657.60
|
| Rate for Payer: Health EOS Commercial |
$997.36
|
| Rate for Payer: HFN Commercial |
$1,041.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,360.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,360.53
|
| Rate for Payer: Multiplan Commercial |
$876.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,041.20
|
| Rate for Payer: Quartz Beloit One Network |
$482.24
|
| Rate for Payer: Quartz Commercial |
$624.72
|
| Rate for Payer: The Alliance Commercial |
$548.00
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$602.80
|
| Rate for Payer: WPS Commercial |
$811.81
|
|
|
REPAIR TONGUE LACERATION 41250
|
Professional
|
Both
|
$503.00
|
|
|
Service Code
|
CPT 41250
|
| Hospital Charge Code |
3014617
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$510.97 |
| Rate for Payer: Aetna Commercial |
$477.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$432.58
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$477.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.80
|
| Rate for Payer: Health EOS Commercial |
$457.73
|
| Rate for Payer: HFN Commercial |
$477.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$510.97
|
| Rate for Payer: Multiplan Commercial |
$402.40
|
| Rate for Payer: Preferred Network Access Commercial |
$477.85
|
| Rate for Payer: Quartz Beloit One Network |
$221.32
|
| Rate for Payer: Quartz Commercial |
$286.71
|
| Rate for Payer: The Alliance Commercial |
$251.50
|
| Rate for Payer: United Healthcare Medicaid |
$60.27
|
| Rate for Payer: WEA Trust Commercial |
$276.65
|
| Rate for Payer: WPS Commercial |
$372.57
|
|
