|
TUNNELER #402
|
Facility
|
OP
|
$4,600.00
|
|
| Hospital Charge Code |
2965003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,339.52 |
| Max. Negotiated Rate |
$4,401.28 |
| Rate for Payer: Aetna Commercial |
$4,305.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,114.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,339.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,109.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,296.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,535.52
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$4,401.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,677.20
|
| Rate for Payer: Health EOS Commercial |
$4,257.76
|
| Rate for Payer: HFN Commercial |
$4,401.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,588.00
|
| Rate for Payer: Multiplan Commercial |
$3,827.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,870.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,401.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,344.16
|
| Rate for Payer: Quartz Commercial |
$3,109.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,870.40
|
| Rate for Payer: The Alliance Commercial |
$2,392.00
|
| Rate for Payer: WEA Trust Commercial |
$2,631.20
|
| Rate for Payer: WPS Commercial |
$3,543.38
|
|
|
TUNNELER HICKMAN 0601930
|
Facility
|
OP
|
$566.00
|
|
| Hospital Charge Code |
2964763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.82 |
| Max. Negotiated Rate |
$541.55 |
| Rate for Payer: Aetna Commercial |
$529.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.23
|
| Rate for Payer: Aetna Managed Medicare |
$164.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$541.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.41
|
| Rate for Payer: Health EOS Commercial |
$523.89
|
| Rate for Payer: HFN Commercial |
$541.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.48
|
| Rate for Payer: Multiplan Commercial |
$470.91
|
| Rate for Payer: NAPHCARE Commercial |
$353.18
|
| Rate for Payer: Preferred Network Access Commercial |
$541.55
|
| Rate for Payer: Quartz Beloit One Network |
$288.43
|
| Rate for Payer: Quartz Commercial |
$382.62
|
| Rate for Payer: Quartz Medicare Advantage |
$353.18
|
| Rate for Payer: The Alliance Commercial |
$294.32
|
| Rate for Payer: WEA Trust Commercial |
$323.75
|
| Rate for Payer: WPS Commercial |
$435.99
|
|
|
TUNNELER HICKMAN 0601930
|
Facility
|
IP
|
$566.00
|
|
| Hospital Charge Code |
2964763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.43 |
| Max. Negotiated Rate |
$541.55 |
| Rate for Payer: Aetna Commercial |
$529.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$541.55
|
| Rate for Payer: Health EOS Commercial |
$523.89
|
| Rate for Payer: HFN Commercial |
$541.55
|
| Rate for Payer: Multiplan Commercial |
$470.91
|
| Rate for Payer: Preferred Network Access Commercial |
$541.55
|
| Rate for Payer: Quartz Beloit One Network |
$288.43
|
| Rate for Payer: Quartz Commercial |
$353.18
|
| Rate for Payer: WEA Trust Commercial |
$323.75
|
| Rate for Payer: WPS Commercial |
$435.99
|
|
|
TURBINOPLASTY/SUBMUCOUS TURBINECTOMY
|
Facility
|
OP
|
$5,934.00
|
|
| Hospital Charge Code |
2960457
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,727.98 |
| Max. Negotiated Rate |
$5,677.65 |
| Rate for Payer: Aetna Commercial |
$5,554.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,307.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,727.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,011.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,085.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,962.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,270.82
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cigna Commercial |
$5,677.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,453.59
|
| Rate for Payer: Health EOS Commercial |
$5,492.51
|
| Rate for Payer: HFN Commercial |
$5,677.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,628.52
|
| Rate for Payer: Multiplan Commercial |
$4,937.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,702.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,677.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,023.97
|
| Rate for Payer: Quartz Commercial |
$4,011.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3,702.82
|
| Rate for Payer: The Alliance Commercial |
$3,085.68
|
| Rate for Payer: WEA Trust Commercial |
$3,394.25
|
| Rate for Payer: WPS Commercial |
$4,570.96
|
|
|
TURBINOPLASTY/SUBMUCOUS TURBINECTOMY
|
Facility
|
IP
|
$5,934.00
|
|
| Hospital Charge Code |
2960457
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,023.97 |
| Max. Negotiated Rate |
$5,677.65 |
| Rate for Payer: Aetna Commercial |
$5,554.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,307.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,270.82
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cigna Commercial |
$5,677.65
|
| Rate for Payer: Health EOS Commercial |
$5,492.51
|
| Rate for Payer: HFN Commercial |
$5,677.65
|
| Rate for Payer: Multiplan Commercial |
$4,937.09
|
| Rate for Payer: Preferred Network Access Commercial |
$5,677.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,023.97
|
| Rate for Payer: Quartz Commercial |
$3,702.82
|
| Rate for Payer: WEA Trust Commercial |
$3,394.25
|
| Rate for Payer: WPS Commercial |
$4,570.96
|
|
|
TURBOHAWK DEVICE LS-M
|
Facility
|
OP
|
$18,884.00
|
|
| Hospital Charge Code |
2973923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,499.02 |
| Max. Negotiated Rate |
$18,068.21 |
| Rate for Payer: Aetna Commercial |
$17,675.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,889.85
|
| Rate for Payer: Aetna Managed Medicare |
$5,499.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,765.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,819.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,426.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,408.86
|
| Rate for Payer: Cash Price |
$5,665.20
|
| Rate for Payer: Cigna Commercial |
$18,068.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,990.49
|
| Rate for Payer: Health EOS Commercial |
$17,479.03
|
| Rate for Payer: HFN Commercial |
$18,068.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,729.52
|
| Rate for Payer: Multiplan Commercial |
$15,711.49
|
| Rate for Payer: NAPHCARE Commercial |
$11,783.62
|
| Rate for Payer: Preferred Network Access Commercial |
$18,068.21
|
| Rate for Payer: Quartz Beloit One Network |
$9,623.29
|
| Rate for Payer: Quartz Commercial |
$12,765.58
|
| Rate for Payer: Quartz Medicare Advantage |
$11,783.62
|
| Rate for Payer: The Alliance Commercial |
$9,819.68
|
| Rate for Payer: WEA Trust Commercial |
$10,801.65
|
| Rate for Payer: WPS Commercial |
$14,546.35
|
|
|
TURBOHAWK DEVICE LS-M
|
Facility
|
IP
|
$18,884.00
|
|
| Hospital Charge Code |
2973923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,623.29 |
| Max. Negotiated Rate |
$18,068.21 |
| Rate for Payer: Aetna Commercial |
$17,675.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,889.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,408.86
|
| Rate for Payer: Cash Price |
$5,665.20
|
| Rate for Payer: Cigna Commercial |
$18,068.21
|
| Rate for Payer: Health EOS Commercial |
$17,479.03
|
| Rate for Payer: HFN Commercial |
$18,068.21
|
| Rate for Payer: Multiplan Commercial |
$15,711.49
|
| Rate for Payer: Preferred Network Access Commercial |
$18,068.21
|
| Rate for Payer: Quartz Beloit One Network |
$9,623.29
|
| Rate for Payer: Quartz Commercial |
$11,783.62
|
| Rate for Payer: WEA Trust Commercial |
$10,801.65
|
| Rate for Payer: WPS Commercial |
$14,546.35
|
|
|
TURBOHAWK PLAQUE EXCISION
|
Facility
|
IP
|
$12,963.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,605.94 |
| Max. Negotiated Rate |
$12,403.00 |
| Rate for Payer: Aetna Commercial |
$12,133.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,594.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,145.21
|
| Rate for Payer: Cash Price |
$3,888.90
|
| Rate for Payer: Cigna Commercial |
$12,403.00
|
| Rate for Payer: Health EOS Commercial |
$11,998.55
|
| Rate for Payer: HFN Commercial |
$12,403.00
|
| Rate for Payer: Multiplan Commercial |
$10,785.22
|
| Rate for Payer: Preferred Network Access Commercial |
$12,403.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,605.94
|
| Rate for Payer: Quartz Commercial |
$8,088.91
|
| Rate for Payer: WEA Trust Commercial |
$7,414.84
|
| Rate for Payer: WPS Commercial |
$9,985.40
|
|
|
TURBOHAWK PLAQUE EXCISION
|
Facility
|
OP
|
$12,963.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,774.83 |
| Max. Negotiated Rate |
$12,403.00 |
| Rate for Payer: Aetna Commercial |
$12,133.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,594.11
|
| Rate for Payer: Aetna Managed Medicare |
$3,774.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,762.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,740.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,471.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,145.21
|
| Rate for Payer: Cash Price |
$3,888.90
|
| Rate for Payer: Cigna Commercial |
$12,403.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,544.47
|
| Rate for Payer: Health EOS Commercial |
$11,998.55
|
| Rate for Payer: HFN Commercial |
$12,403.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,111.14
|
| Rate for Payer: Multiplan Commercial |
$10,785.22
|
| Rate for Payer: NAPHCARE Commercial |
$8,088.91
|
| Rate for Payer: Preferred Network Access Commercial |
$12,403.00
|
| Rate for Payer: Quartz Beloit One Network |
$6,605.94
|
| Rate for Payer: Quartz Commercial |
$8,762.99
|
| Rate for Payer: Quartz Medicare Advantage |
$8,088.91
|
| Rate for Payer: The Alliance Commercial |
$6,740.76
|
| Rate for Payer: WEA Trust Commercial |
$7,414.84
|
| Rate for Payer: WPS Commercial |
$9,985.40
|
|
|
T vulgaris
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
T vulgaris
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
T vulgaris
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$103.74 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
TWIST LOCK CABLE EXTERNAL INTERSTIM 357625
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5384684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$745.04 |
| Max. Negotiated Rate |
$1,398.84 |
| Rate for Payer: Aetna Commercial |
$1,368.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.85
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,398.84
|
| Rate for Payer: Health EOS Commercial |
$1,353.23
|
| Rate for Payer: HFN Commercial |
$1,398.84
|
| Rate for Payer: Multiplan Commercial |
$1,216.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.84
|
| Rate for Payer: Quartz Beloit One Network |
$745.04
|
| Rate for Payer: Quartz Commercial |
$912.29
|
| Rate for Payer: WEA Trust Commercial |
$836.26
|
| Rate for Payer: WPS Commercial |
$1,126.18
|
|
|
TWIST LOCK CABLE EXTERNAL INTERSTIM 357625
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5384684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$425.73 |
| Max. Negotiated Rate |
$1,398.84 |
| Rate for Payer: Aetna Commercial |
$1,368.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.61
|
| Rate for Payer: Aetna Managed Medicare |
$425.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$988.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$760.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$729.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.85
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,398.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$850.88
|
| Rate for Payer: Health EOS Commercial |
$1,353.23
|
| Rate for Payer: HFN Commercial |
$1,398.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,140.36
|
| Rate for Payer: Multiplan Commercial |
$1,216.38
|
| Rate for Payer: NAPHCARE Commercial |
$912.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.84
|
| Rate for Payer: Quartz Beloit One Network |
$745.04
|
| Rate for Payer: Quartz Commercial |
$988.31
|
| Rate for Payer: Quartz Medicare Advantage |
$912.29
|
| Rate for Payer: The Alliance Commercial |
$760.24
|
| Rate for Payer: WEA Trust Commercial |
$836.26
|
| Rate for Payer: WPS Commercial |
$1,126.18
|
|
|
Tx Devices Design-Complex 7733426
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
CPT 77334 26
|
| Hospital Charge Code |
5258640
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$445.59 |
| Rate for Payer: Aetna Commercial |
$445.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$403.37
|
| Rate for Payer: Aetna Managed Medicare |
$60.40
|
| Rate for Payer: Anthem Medicare Advantage |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.40
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$445.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$234.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.40
|
| Rate for Payer: Health EOS Commercial |
$426.83
|
| Rate for Payer: HFN Commercial |
$445.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$215.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.40
|
| Rate for Payer: Multiplan Commercial |
$375.23
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$445.59
|
| Rate for Payer: Quartz Beloit One Network |
$206.38
|
| Rate for Payer: Quartz Commercial |
$267.35
|
| Rate for Payer: Quartz Medicare Advantage |
$60.40
|
| Rate for Payer: The Alliance Commercial |
$229.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.40
|
| Rate for Payer: WEA Trust Commercial |
$257.97
|
| Rate for Payer: WPS Commercial |
$302.02
|
|
|
Tx Devices Design-Intermediate 7733326
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
CPT 77333 26
|
| Hospital Charge Code |
5258639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.32 |
| Max. Negotiated Rate |
$466.34 |
| Rate for Payer: Aetna Commercial |
$466.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.16
|
| Rate for Payer: Aetna Managed Medicare |
$39.32
|
| Rate for Payer: Anthem Medicare Advantage |
$39.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.32
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$466.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$245.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.32
|
| Rate for Payer: Health EOS Commercial |
$446.70
|
| Rate for Payer: HFN Commercial |
$466.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.32
|
| Rate for Payer: Multiplan Commercial |
$392.70
|
| Rate for Payer: NAPHCARE Commercial |
$58.98
|
| Rate for Payer: Preferred Network Access Commercial |
$466.34
|
| Rate for Payer: Quartz Beloit One Network |
$215.99
|
| Rate for Payer: Quartz Commercial |
$279.80
|
| Rate for Payer: Quartz Medicare Advantage |
$39.32
|
| Rate for Payer: The Alliance Commercial |
$149.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.32
|
| Rate for Payer: WEA Trust Commercial |
$269.98
|
| Rate for Payer: WPS Commercial |
$196.61
|
|
|
Tx Devices Design-Simple 7733226
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 77332 26
|
| Hospital Charge Code |
5258634
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.82 |
| Max. Negotiated Rate |
$324.06 |
| Rate for Payer: Aetna Commercial |
$324.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$23.82
|
| Rate for Payer: Anthem Medicare Advantage |
$23.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.82
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$324.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.82
|
| Rate for Payer: Health EOS Commercial |
$310.42
|
| Rate for Payer: HFN Commercial |
$324.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.82
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$35.72
|
| Rate for Payer: Preferred Network Access Commercial |
$324.06
|
| Rate for Payer: Quartz Beloit One Network |
$150.09
|
| Rate for Payer: Quartz Commercial |
$194.44
|
| Rate for Payer: Quartz Medicare Advantage |
$23.82
|
| Rate for Payer: The Alliance Commercial |
$90.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.82
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$119.08
|
|
|
Tymp And Art
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
3203502
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$21.91 |
| Max. Negotiated Rate |
$259.84 |
| Rate for Payer: Aetna Commercial |
$259.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Managed Medicare |
$21.91
|
| Rate for Payer: Anthem Medicare Advantage |
$21.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.91
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$259.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.91
|
| Rate for Payer: Health EOS Commercial |
$248.90
|
| Rate for Payer: HFN Commercial |
$259.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.91
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: NAPHCARE Commercial |
$32.87
|
| Rate for Payer: Preferred Network Access Commercial |
$259.84
|
| Rate for Payer: Quartz Beloit One Network |
$120.35
|
| Rate for Payer: Quartz Commercial |
$155.91
|
| Rate for Payer: Quartz Medicare Advantage |
$21.91
|
| Rate for Payer: The Alliance Commercial |
$54.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.91
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$87.65
|
|
|
Tymp And Art
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
3203502
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$136.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.29
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$177.79
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$205.14
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
Tymp And Art
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
3203502
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$164.11
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
Tympanic Membrane Repair
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
1152802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.22 |
| Max. Negotiated Rate |
$1,084.26 |
| Rate for Payer: Aetna Commercial |
$664.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$601.93
|
| Rate for Payer: Aetna Managed Medicare |
$240.95
|
| Rate for Payer: Anthem Medicare Advantage |
$240.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$240.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$240.95
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$664.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.95
|
| Rate for Payer: Health EOS Commercial |
$636.93
|
| Rate for Payer: HFN Commercial |
$664.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$991.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$240.95
|
| Rate for Payer: Multiplan Commercial |
$559.94
|
| Rate for Payer: NAPHCARE Commercial |
$361.42
|
| Rate for Payer: Preferred Network Access Commercial |
$664.92
|
| Rate for Payer: Quartz Beloit One Network |
$307.96
|
| Rate for Payer: Quartz Commercial |
$398.95
|
| Rate for Payer: Quartz Medicare Advantage |
$240.95
|
| Rate for Payer: The Alliance Commercial |
$1,024.03
|
| Rate for Payer: United Healthcare Medicaid |
$49.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$240.95
|
| Rate for Payer: WEA Trust Commercial |
$384.96
|
| Rate for Payer: WPS Commercial |
$1,084.26
|
|
|
Tympanometry
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
1152820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Tympanometry
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
1152820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$8.72
|
| Rate for Payer: Anthem Medicare Advantage |
$8.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.72
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.72
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.72
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$13.07
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8.72
|
| Rate for Payer: The Alliance Commercial |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.72
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$34.86
|
|
|
Tympanometry
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
1152820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Tympanometry 9256750
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 92567 50
|
| Hospital Charge Code |
3301638
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.59 |
| Max. Negotiated Rate |
$128.44 |
| Rate for Payer: Aetna Commercial |
$128.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.27
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$128.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.12
|
| Rate for Payer: Health EOS Commercial |
$123.03
|
| Rate for Payer: HFN Commercial |
$128.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.59
|
| Rate for Payer: Multiplan Commercial |
$108.16
|
| Rate for Payer: Preferred Network Access Commercial |
$128.44
|
| Rate for Payer: Quartz Beloit One Network |
$59.49
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: The Alliance Commercial |
$67.60
|
| Rate for Payer: WEA Trust Commercial |
$74.36
|
| Rate for Payer: WPS Commercial |
$100.14
|
|
