|
SWABS SUCTION SYSTEM 6552
|
Facility
|
OP
|
$276.00
|
|
| Hospital Charge Code |
2963001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.37 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$80.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$186.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.63
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$172.22
|
| Rate for Payer: The Alliance Commercial |
$143.52
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
SWABS SUCTION SYSTEM 6552
|
Facility
|
IP
|
$276.00
|
|
| Hospital Charge Code |
2963001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
SWABS SUCTION SYSTEM W/ CHG 6914
|
Facility
|
IP
|
$485.00
|
|
| Hospital Charge Code |
2962919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.16 |
| Max. Negotiated Rate |
$464.05 |
| Rate for Payer: Aetna Commercial |
$453.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$433.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.33
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$464.05
|
| Rate for Payer: Health EOS Commercial |
$448.92
|
| Rate for Payer: HFN Commercial |
$464.05
|
| Rate for Payer: Multiplan Commercial |
$403.52
|
| Rate for Payer: Preferred Network Access Commercial |
$464.05
|
| Rate for Payer: Quartz Beloit One Network |
$247.16
|
| Rate for Payer: Quartz Commercial |
$302.64
|
| Rate for Payer: WEA Trust Commercial |
$277.42
|
| Rate for Payer: WPS Commercial |
$373.60
|
|
|
SWABS SUCTION SYSTEM W/ CHG 6914
|
Facility
|
OP
|
$485.00
|
|
| Hospital Charge Code |
2962919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.23 |
| Max. Negotiated Rate |
$464.05 |
| Rate for Payer: Aetna Commercial |
$453.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$433.78
|
| Rate for Payer: Aetna Managed Medicare |
$141.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$327.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$252.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$242.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.33
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$464.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.27
|
| Rate for Payer: Health EOS Commercial |
$448.92
|
| Rate for Payer: HFN Commercial |
$464.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$378.30
|
| Rate for Payer: Multiplan Commercial |
$403.52
|
| Rate for Payer: NAPHCARE Commercial |
$302.64
|
| Rate for Payer: Preferred Network Access Commercial |
$464.05
|
| Rate for Payer: Quartz Beloit One Network |
$247.16
|
| Rate for Payer: Quartz Commercial |
$327.86
|
| Rate for Payer: Quartz Medicare Advantage |
$302.64
|
| Rate for Payer: The Alliance Commercial |
$252.20
|
| Rate for Payer: WEA Trust Commercial |
$277.42
|
| Rate for Payer: WPS Commercial |
$373.60
|
|
|
Swallow Therapy Treatment
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5184733
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$589.39 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Aetna Managed Medicare |
$179.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.51
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: NAPHCARE Commercial |
$384.38
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$416.42
|
| Rate for Payer: Quartz Medicare Advantage |
$384.38
|
| Rate for Payer: The Alliance Commercial |
$320.32
|
| Rate for Payer: United Healthcare PPO |
$480.48
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
Swallow Therapy Treatment
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5184733
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$313.91 |
| Max. Negotiated Rate |
$589.39 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$384.38
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
SWEA 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutan
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
3147641
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.07
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
SWEA 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutan
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
3147641
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$276.71 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$338.83
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
SWEA 10061 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3147642
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$452.02 |
| Max. Negotiated Rate |
$848.68 |
| Rate for Payer: Aetna Commercial |
$830.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.91
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$848.68
|
| Rate for Payer: Health EOS Commercial |
$821.01
|
| Rate for Payer: HFN Commercial |
$848.68
|
| Rate for Payer: Multiplan Commercial |
$737.98
|
| Rate for Payer: Preferred Network Access Commercial |
$848.68
|
| Rate for Payer: Quartz Beloit One Network |
$452.02
|
| Rate for Payer: Quartz Commercial |
$553.49
|
| Rate for Payer: WEA Trust Commercial |
$507.36
|
| Rate for Payer: WPS Commercial |
$683.26
|
|
|
SWEA 10061 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3147642
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$427.81 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$830.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.33
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$599.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$442.79
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$488.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$848.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$821.01
|
| Rate for Payer: HFN Commercial |
$848.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: Multiplan Commercial |
$737.98
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$848.68
|
| Rate for Payer: Quartz Beloit One Network |
$452.02
|
| Rate for Payer: Quartz Commercial |
$599.61
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: WEA Trust Commercial |
$507.36
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$683.26
|
|
|
SWEA 10160 Puncture aspiration of abscess, hematoma, bulla, or cyst
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
3147648
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$260.58 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$488.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.88
|
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.58
|
| Rate for Payer: Anthem Medicare Advantage |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$499.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Health EOS Commercial |
$483.16
|
| Rate for Payer: HFN Commercial |
$499.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: Multiplan Commercial |
$434.30
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Preferred Network Access Commercial |
$499.45
|
| Rate for Payer: Quartz Beloit One Network |
$266.01
|
| Rate for Payer: Quartz Commercial |
$352.87
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: WEA Trust Commercial |
$298.58
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
| Rate for Payer: WPS Commercial |
$402.10
|
|
|
SWEA 10160 Puncture aspiration of abscess, hematoma, bulla, or cyst
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
3147648
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$266.01 |
| Max. Negotiated Rate |
$499.45 |
| Rate for Payer: Aetna Commercial |
$488.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.73
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$499.45
|
| Rate for Payer: Health EOS Commercial |
$483.16
|
| Rate for Payer: HFN Commercial |
$499.45
|
| Rate for Payer: Multiplan Commercial |
$434.30
|
| Rate for Payer: Preferred Network Access Commercial |
$499.45
|
| Rate for Payer: Quartz Beloit One Network |
$266.01
|
| Rate for Payer: Quartz Commercial |
$325.73
|
| Rate for Payer: WEA Trust Commercial |
$298.58
|
| Rate for Payer: WPS Commercial |
$402.10
|
|
|
SWEA 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3147668
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$469.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.99
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.60
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$480.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$464.65
|
| Rate for Payer: HFN Commercial |
$480.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: Multiplan Commercial |
$417.66
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$480.31
|
| Rate for Payer: Quartz Beloit One Network |
$255.82
|
| Rate for Payer: Quartz Commercial |
$339.35
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: WEA Trust Commercial |
$287.14
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$386.69
|
|
|
SWEA 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
|
Facility
|
IP
|
$502.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3147668
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$255.82 |
| Max. Negotiated Rate |
$480.31 |
| Rate for Payer: Aetna Commercial |
$469.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.70
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$480.31
|
| Rate for Payer: Health EOS Commercial |
$464.65
|
| Rate for Payer: HFN Commercial |
$480.31
|
| Rate for Payer: Multiplan Commercial |
$417.66
|
| Rate for Payer: Preferred Network Access Commercial |
$480.31
|
| Rate for Payer: Quartz Beloit One Network |
$255.82
|
| Rate for Payer: Quartz Commercial |
$313.25
|
| Rate for Payer: WEA Trust Commercial |
$287.14
|
| Rate for Payer: WPS Commercial |
$386.69
|
|
|
SWEA 12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
|
Facility
|
OP
|
$710.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
3147669
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$664.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.02
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$479.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$369.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.43
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$679.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$657.18
|
| Rate for Payer: HFN Commercial |
$679.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: Multiplan Commercial |
$590.72
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$679.33
|
| Rate for Payer: Quartz Beloit One Network |
$361.82
|
| Rate for Payer: Quartz Commercial |
$479.96
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: WEA Trust Commercial |
$406.12
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$546.91
|
|
|
SWEA 12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
|
Facility
|
IP
|
$710.00
|
|
|
Service Code
|
CPT 12002
|
| Hospital Charge Code |
3147669
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$361.82 |
| Max. Negotiated Rate |
$679.33 |
| Rate for Payer: Aetna Commercial |
$664.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$635.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$391.35
|
| Rate for Payer: Cash Price |
$213.00
|
| Rate for Payer: Cigna Commercial |
$679.33
|
| Rate for Payer: Health EOS Commercial |
$657.18
|
| Rate for Payer: HFN Commercial |
$679.33
|
| Rate for Payer: Multiplan Commercial |
$590.72
|
| Rate for Payer: Preferred Network Access Commercial |
$679.33
|
| Rate for Payer: Quartz Beloit One Network |
$361.82
|
| Rate for Payer: Quartz Commercial |
$443.04
|
| Rate for Payer: WEA Trust Commercial |
$406.12
|
| Rate for Payer: WPS Commercial |
$546.91
|
|
|
SWEA 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mu
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
3147674
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$263.46 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$322.61
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
SWEA 12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mu
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 12011
|
| Hospital Charge Code |
3147674
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.09
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$349.49
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
SWEA 26010 Drainage of finger abscess; simple
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
3147798
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
SWEA 26010 Drainage of finger abscess; simple
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 26010
|
| Hospital Charge Code |
3147798
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$211.14 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$372.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.06
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
SWEA 2676554 Open treatment of distal phalangeal fracture, finger or thumb, includes internal
|
Facility
|
OP
|
$2,288.00
|
|
|
Service Code
|
CPT 26765 54
|
| Hospital Charge Code |
3147819
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$666.27 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Aetna Managed Medicare |
$666.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,546.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,784.64
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: NAPHCARE Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,546.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,427.71
|
| Rate for Payer: The Alliance Commercial |
$1,189.76
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
SWEA 2676554 Open treatment of distal phalangeal fracture, finger or thumb, includes internal
|
Facility
|
IP
|
$2,288.00
|
|
|
Service Code
|
CPT 26765 54
|
| Hospital Charge Code |
3147819
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$1,165.96 |
| Max. Negotiated Rate |
$2,189.16 |
| Rate for Payer: Aetna Commercial |
$2,141.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,046.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.15
|
| Rate for Payer: Cash Price |
$686.40
|
| Rate for Payer: Cigna Commercial |
$2,189.16
|
| Rate for Payer: Health EOS Commercial |
$2,117.77
|
| Rate for Payer: HFN Commercial |
$2,189.16
|
| Rate for Payer: Multiplan Commercial |
$1,903.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,189.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.96
|
| Rate for Payer: Quartz Commercial |
$1,427.71
|
| Rate for Payer: WEA Trust Commercial |
$1,308.74
|
| Rate for Payer: WPS Commercial |
$1,762.45
|
|
|
SWEA 28190 Removal of foreign body, foot; subcutaneous
|
Facility
|
IP
|
$1,023.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
3147855
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$521.32 |
| Max. Negotiated Rate |
$978.81 |
| Rate for Payer: Aetna Commercial |
$957.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.88
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$978.81
|
| Rate for Payer: Health EOS Commercial |
$946.89
|
| Rate for Payer: HFN Commercial |
$978.81
|
| Rate for Payer: Multiplan Commercial |
$851.14
|
| Rate for Payer: Preferred Network Access Commercial |
$978.81
|
| Rate for Payer: Quartz Beloit One Network |
$521.32
|
| Rate for Payer: Quartz Commercial |
$638.35
|
| Rate for Payer: WEA Trust Commercial |
$585.16
|
| Rate for Payer: WPS Commercial |
$788.02
|
|
|
SWEA 28190 Removal of foreign body, foot; subcutaneous
|
Facility
|
OP
|
$1,023.00
|
|
|
Service Code
|
CPT 28190
|
| Hospital Charge Code |
3147855
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$510.68 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$957.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$914.97
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$691.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$531.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$510.68
|
| Rate for Payer: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$563.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cash Price |
$306.90
|
| Rate for Payer: Cigna Commercial |
$978.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$946.89
|
| Rate for Payer: HFN Commercial |
$978.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$851.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$978.81
|
| Rate for Payer: Quartz Beloit One Network |
$521.32
|
| Rate for Payer: Quartz Commercial |
$691.55
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: WEA Trust Commercial |
$585.16
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$788.02
|
|
|
SWEA 28490 Closed treatment of fracture great toe, phalanx or phalanges; without manipulati
|
Facility
|
IP
|
$670.00
|
|
|
Service Code
|
CPT 28490
|
| Hospital Charge Code |
3147864
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$341.43 |
| Max. Negotiated Rate |
$641.06 |
| Rate for Payer: Aetna Commercial |
$627.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.30
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$641.06
|
| Rate for Payer: Health EOS Commercial |
$620.15
|
| Rate for Payer: HFN Commercial |
$641.06
|
| Rate for Payer: Multiplan Commercial |
$557.44
|
| Rate for Payer: Preferred Network Access Commercial |
$641.06
|
| Rate for Payer: Quartz Beloit One Network |
$341.43
|
| Rate for Payer: Quartz Commercial |
$418.08
|
| Rate for Payer: WEA Trust Commercial |
$383.24
|
| Rate for Payer: WPS Commercial |
$516.10
|
|
