|
Tramadol Level
|
Facility
OP
|
$240.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
4682606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.20 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.00
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: Quartz Medicare Advantage |
$144.00
|
| Rate for Payer: United Healthcare PPO |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Tramadol , Quantitative Urine
|
Professional
|
$120.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5084606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.00
|
| Rate for Payer: Health EOS Commercial |
$109.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$114.00
|
| Rate for Payer: Quartz Beloit One Network |
$52.80
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Tramadol , Quantitative Urine
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5084606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Aetna Managed Medicare |
$33.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$72.00
|
| Rate for Payer: United Healthcare PPO |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Tramadol , Quantitative Urine
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5084606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
.Tramadol Quant Urine
|
Facility
OP
|
$297.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5088606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.16 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Aetna Managed Medicare |
$83.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$193.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.75
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$178.20
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$193.05
|
| Rate for Payer: Quartz Medicare Advantage |
$178.20
|
| Rate for Payer: United Healthcare PPO |
$222.75
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
.Tramadol Quant Urine
|
Facility
IP
|
$297.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5088606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$178.20
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$178.20
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
.Tramadol Quant Urine
|
Professional
|
$297.00
|
|
|
Service Code
|
CPT 80373
|
| Hospital Charge Code |
5088606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna Commercial |
$282.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$282.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.20
|
| Rate for Payer: Health EOS Commercial |
$270.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$282.15
|
| Rate for Payer: Quartz Beloit One Network |
$130.68
|
| Rate for Payer: Quartz Commercial |
$169.29
|
| Rate for Payer: The Alliance Commercial |
$148.50
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
TRANFIXING PIN 5MM X 300MM 5050-5-300
|
Facility
IP
|
$1,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$661.50 |
| Max. Negotiated Rate |
$1,242.00 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.50
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,242.00
|
| Rate for Payer: Health EOS Commercial |
$1,201.50
|
| Rate for Payer: HFN Commercial |
$1,242.00
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: NAPHCARE Commercial |
$810.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.00
|
| Rate for Payer: Quartz Beloit One Network |
$661.50
|
| Rate for Payer: Quartz Commercial |
$810.00
|
| Rate for Payer: WEA Trust Commercial |
$742.50
|
| Rate for Payer: WPS Commercial |
$999.94
|
|
|
TRANFIXING PIN 5MM X 300MM 5050-5-300
|
Facility
OP
|
$1,350.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$378.00 |
| Max. Negotiated Rate |
$1,242.00 |
| Rate for Payer: Aetna Commercial |
$1,215.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,161.00
|
| Rate for Payer: Aetna Managed Medicare |
$378.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$877.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$675.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$648.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$715.50
|
| Rate for Payer: Cash Price |
$405.00
|
| Rate for Payer: Cigna Commercial |
$1,242.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$755.46
|
| Rate for Payer: Health EOS Commercial |
$1,201.50
|
| Rate for Payer: HFN Commercial |
$1,242.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,012.50
|
| Rate for Payer: Multiplan Commercial |
$1,080.00
|
| Rate for Payer: NAPHCARE Commercial |
$810.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,242.00
|
| Rate for Payer: Quartz Beloit One Network |
$661.50
|
| Rate for Payer: Quartz Commercial |
$877.50
|
| Rate for Payer: Quartz Medicare Advantage |
$810.00
|
| Rate for Payer: WEA Trust Commercial |
$742.50
|
| Rate for Payer: WPS Commercial |
$999.94
|
|
|
Transbronchial - Bronchoscopy Charge
|
Facility
OP
|
$4,954.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
2990186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,427.46 |
| Max. Negotiated Rate |
$13,769.28 |
| Rate for Payer: Aetna Commercial |
$4,458.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,260.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| 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 |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,625.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,557.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Health EOS Commercial |
$4,409.06
|
| Rate for Payer: HFN Commercial |
$4,557.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: Multiplan Commercial |
$3,963.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Preferred Network Access Commercial |
$4,557.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,427.46
|
| Rate for Payer: Quartz Commercial |
$3,220.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$2,603.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$2,724.70
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
| Rate for Payer: WPS Commercial |
$3,669.43
|
|
|
Transbronchial - Bronchoscopy Charge
|
Facility
IP
|
$4,954.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
2990186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,427.46 |
| Max. Negotiated Rate |
$4,557.68 |
| Rate for Payer: Aetna Commercial |
$4,458.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,625.62
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,557.68
|
| Rate for Payer: Health EOS Commercial |
$4,409.06
|
| Rate for Payer: HFN Commercial |
$4,557.68
|
| Rate for Payer: Multiplan Commercial |
$3,963.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,972.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,557.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,427.46
|
| Rate for Payer: Quartz Commercial |
$2,972.40
|
| Rate for Payer: WEA Trust Commercial |
$2,724.70
|
| Rate for Payer: WPS Commercial |
$3,669.43
|
|
|
TRANSCATH IV STENT/PERC ADDL 37206
|
Professional
|
$3,011.00
|
|
| Hospital Charge Code |
3014548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,324.84 |
| Max. Negotiated Rate |
$2,860.45 |
| Rate for Payer: Aetna Commercial |
$2,860.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,589.46
|
| Rate for Payer: Cash Price |
$903.30
|
| Rate for Payer: Cigna Commercial |
$2,860.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,505.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,806.60
|
| Rate for Payer: Health EOS Commercial |
$2,740.01
|
| Rate for Payer: Multiplan Commercial |
$2,408.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,860.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,324.84
|
| Rate for Payer: Quartz Commercial |
$1,716.27
|
| Rate for Payer: The Alliance Commercial |
$1,505.50
|
| Rate for Payer: WEA Trust Commercial |
$1,656.05
|
| Rate for Payer: WPS Commercial |
$2,230.25
|
|
|
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)
|
Facility
OP
|
$26,304.57
|
|
|
Service Code
|
CPT 27691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,125.32 |
| Max. Negotiated Rate |
$26,304.57 |
| 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 |
$6,125.32
|
| 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
|
|
|
Transferrin
|
Facility
OP
|
$179.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
633851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.18
|
| Rate for Payer: Anthem Medicaid |
$13.18
|
| Rate for Payer: Anthem Medicare Advantage |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.76
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.18
|
| Rate for Payer: Dean Health Medicaid |
$13.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.76
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.76
|
| Rate for Payer: Managed Health Services Medicaid |
$13.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.76
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.18
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$116.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12.76
|
| Rate for Payer: The Alliance Commercial |
$716.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: United Healthcare PPO |
$134.25
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: Wellcare Medicare |
$12.76
|
| Rate for Payer: WMAP Medicaid |
$13.18
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
Transferrin
|
Facility
IP
|
$179.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
633851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$107.40
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
Transferrin
|
Professional
|
$179.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
633851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna Commercial |
$170.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.76
|
| Rate for Payer: Anthem Medicare Advantage |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.76
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$170.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.76
|
| Rate for Payer: Health EOS Commercial |
$162.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.76
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Preferred Network Access Commercial |
$170.05
|
| Rate for Payer: Quartz Beloit One Network |
$78.76
|
| Rate for Payer: Quartz Commercial |
$102.03
|
| Rate for Payer: Quartz Medicare Advantage |
$12.76
|
| Rate for Payer: The Alliance Commercial |
$50.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$56.14
|
|
|
Transferrin (CDT)
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
5528754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Transferrin (CDT)
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
5528754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$12.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.33
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.18
|
| Rate for Payer: Anthem Medicaid |
$13.18
|
| Rate for Payer: Anthem Medicare Advantage |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.76
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.18
|
| Rate for Payer: Dean Health Medicaid |
$13.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.76
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.76
|
| Rate for Payer: Managed Health Services Medicaid |
$13.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.76
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.18
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12.76
|
| Rate for Payer: The Alliance Commercial |
$304.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: United Healthcare PPO |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: Wellcare Medicare |
$12.76
|
| Rate for Payer: WMAP Medicaid |
$13.18
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Transferrin (CDT)
|
Professional
|
$76.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
5528754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$12.76
|
| Rate for Payer: Anthem Medicare Advantage |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.76
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.76
|
| Rate for Payer: Health EOS Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.76
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Preferred Network Access Commercial |
$72.20
|
| Rate for Payer: Quartz Beloit One Network |
$33.44
|
| Rate for Payer: Quartz Commercial |
$43.32
|
| Rate for Payer: Quartz Medicare Advantage |
$12.76
|
| Rate for Payer: The Alliance Commercial |
$50.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.76
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.14
|
|
|
TRANSFIX 3x50 BONE TENDON BONE
|
Facility
IP
|
$5,039.00
|
|
| Hospital Charge Code |
2964707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,469.11 |
| Max. Negotiated Rate |
$4,635.88 |
| Rate for Payer: Aetna Commercial |
$4,535.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,670.67
|
| Rate for Payer: Cash Price |
$1,511.70
|
| Rate for Payer: Cigna Commercial |
$4,635.88
|
| Rate for Payer: Health EOS Commercial |
$4,484.71
|
| Rate for Payer: HFN Commercial |
$4,635.88
|
| Rate for Payer: Multiplan Commercial |
$4,031.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,023.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,635.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,469.11
|
| Rate for Payer: Quartz Commercial |
$3,023.40
|
| Rate for Payer: WEA Trust Commercial |
$2,771.45
|
| Rate for Payer: WPS Commercial |
$3,732.39
|
|
|
TRANSFIX 3x50 BONE TENDON BONE
|
Facility
OP
|
$5,039.00
|
|
| Hospital Charge Code |
2964707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,410.92 |
| Max. Negotiated Rate |
$20,156.00 |
| Rate for Payer: Aetna Commercial |
$4,535.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,333.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,410.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,275.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,519.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,418.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,670.67
|
| Rate for Payer: Cash Price |
$1,511.70
|
| Rate for Payer: Cigna Commercial |
$4,635.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,819.82
|
| Rate for Payer: Health EOS Commercial |
$4,484.71
|
| Rate for Payer: HFN Commercial |
$4,635.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,779.25
|
| Rate for Payer: Multiplan Commercial |
$4,031.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,023.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,635.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,469.11
|
| Rate for Payer: Quartz Commercial |
$3,275.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,023.40
|
| Rate for Payer: The Alliance Commercial |
$20,156.00
|
| Rate for Payer: WEA Trust Commercial |
$2,771.45
|
| Rate for Payer: WPS Commercial |
$3,732.39
|
|
|
Transfusion Reaction Culture
|
Facility
OP
|
$275.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
983498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$1,100.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Aetna Managed Medicare |
$10.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$10.66
|
| Rate for Payer: Anthem Medicare Advantage |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.32
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.66
|
| Rate for Payer: Dean Health Medicaid |
$10.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.32
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.32
|
| Rate for Payer: Managed Health Services Medicaid |
$11.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.48
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.66
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$178.75
|
| Rate for Payer: Quartz Medicare Advantage |
$10.32
|
| Rate for Payer: The Alliance Commercial |
$1,100.00
|
| Rate for Payer: United Healthcare Medicaid |
$10.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare PPO |
$206.25
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: Wellcare Medicare |
$10.32
|
| Rate for Payer: WMAP Medicaid |
$10.66
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
Transfusion Reaction Culture
|
Professional
|
$275.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
983498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Aetna Commercial |
$261.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Aetna Managed Medicare |
$10.32
|
| Rate for Payer: Anthem Medicare Advantage |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.32
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$261.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.32
|
| Rate for Payer: Health EOS Commercial |
$250.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: Preferred Network Access Commercial |
$261.25
|
| Rate for Payer: Quartz Beloit One Network |
$121.00
|
| Rate for Payer: Quartz Commercial |
$156.75
|
| Rate for Payer: Quartz Medicare Advantage |
$10.32
|
| Rate for Payer: The Alliance Commercial |
$40.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$45.41
|
|
