|
VDRL with Reflex Titer, CSF
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5364667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VDRL with Reflex Titer, CSF
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5364667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.09
|
| Rate for Payer: Anthem Medicaid |
$4.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Managed Health Services Medicaid |
$4.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.41
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: WMAP Medicaid |
$4.41
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VDRL with Reflex Titer, CSF
|
Professional
|
$89.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5364667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$18.79
|
|
|
VE 1st Order
|
Facility
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
3052559
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$547.68 |
| Max. Negotiated Rate |
$14,272.20 |
| Rate for Payer: Aetna Commercial |
$1,760.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,682.16
|
| Rate for Payer: Aetna Managed Medicare |
$547.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,271.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$938.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.68
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$1,799.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$1,740.84
|
| Rate for Payer: HFN Commercial |
$1,799.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.00
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,799.52
|
| Rate for Payer: Quartz Beloit One Network |
$958.44
|
| Rate for Payer: Quartz Commercial |
$1,271.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,173.60
|
| Rate for Payer: The Alliance Commercial |
$14,272.20
|
| Rate for Payer: WEA Trust Commercial |
$1,075.80
|
| Rate for Payer: WPS Commercial |
$1,448.81
|
|
|
VE 1st Order
|
Facility
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
3052559
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$958.44 |
| Max. Negotiated Rate |
$1,799.52 |
| Rate for Payer: Aetna Commercial |
$1,760.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.68
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$1,799.52
|
| Rate for Payer: Health EOS Commercial |
$1,740.84
|
| Rate for Payer: HFN Commercial |
$1,799.52
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,799.52
|
| Rate for Payer: Quartz Beloit One Network |
$958.44
|
| Rate for Payer: Quartz Commercial |
$1,173.60
|
| Rate for Payer: WEA Trust Commercial |
$1,075.80
|
| Rate for Payer: WPS Commercial |
$1,448.81
|
|
|
VE 2nd Order
|
Facility
IP
|
$2,490.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
3052560
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,220.10 |
| Max. Negotiated Rate |
$2,290.80 |
| Rate for Payer: Aetna Commercial |
$2,241.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.70
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,290.80
|
| Rate for Payer: Health EOS Commercial |
$2,216.10
|
| Rate for Payer: HFN Commercial |
$2,290.80
|
| Rate for Payer: Multiplan Commercial |
$1,992.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,494.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,290.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,220.10
|
| Rate for Payer: Quartz Commercial |
$1,494.00
|
| Rate for Payer: WEA Trust Commercial |
$1,369.50
|
| Rate for Payer: WPS Commercial |
$1,844.34
|
|
|
VE 2nd Order
|
Facility
OP
|
$2,490.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
3052560
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$697.20 |
| Max. Negotiated Rate |
$14,272.20 |
| Rate for Payer: Aetna Commercial |
$2,241.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,141.40
|
| Rate for Payer: Aetna Managed Medicare |
$697.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,618.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,245.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,195.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.70
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,290.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$2,216.10
|
| Rate for Payer: HFN Commercial |
$2,290.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,867.50
|
| Rate for Payer: Multiplan Commercial |
$1,992.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,494.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,290.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,220.10
|
| Rate for Payer: Quartz Commercial |
$1,618.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,494.00
|
| Rate for Payer: The Alliance Commercial |
$14,272.20
|
| Rate for Payer: WEA Trust Commercial |
$1,369.50
|
| Rate for Payer: WPS Commercial |
$1,844.34
|
|
|
VE 3rd Order
|
Facility
OP
|
$2,889.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
3052561
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$808.92 |
| Max. Negotiated Rate |
$14,272.20 |
| Rate for Payer: Aetna Commercial |
$2,600.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,484.54
|
| Rate for Payer: Aetna Managed Medicare |
$808.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,877.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,444.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,386.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,531.17
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cigna Commercial |
$2,657.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$2,571.21
|
| Rate for Payer: HFN Commercial |
$2,657.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,166.75
|
| Rate for Payer: Multiplan Commercial |
$2,311.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,733.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,657.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,415.61
|
| Rate for Payer: Quartz Commercial |
$1,877.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,733.40
|
| Rate for Payer: The Alliance Commercial |
$14,272.20
|
| Rate for Payer: WEA Trust Commercial |
$1,588.95
|
| Rate for Payer: WPS Commercial |
$2,139.88
|
|
|
VE 3rd Order
|
Facility
IP
|
$2,889.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
3052561
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,415.61 |
| Max. Negotiated Rate |
$2,657.88 |
| Rate for Payer: Aetna Commercial |
$2,600.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,531.17
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cigna Commercial |
$2,657.88
|
| Rate for Payer: Health EOS Commercial |
$2,571.21
|
| Rate for Payer: HFN Commercial |
$2,657.88
|
| Rate for Payer: Multiplan Commercial |
$2,311.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,733.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,657.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,415.61
|
| Rate for Payer: Quartz Commercial |
$1,733.40
|
| Rate for Payer: WEA Trust Commercial |
$1,588.95
|
| Rate for Payer: WPS Commercial |
$2,139.88
|
|
|
VE Add Vessel +
|
Facility
IP
|
$618.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
4125621
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$302.82 |
| Max. Negotiated Rate |
$568.56 |
| Rate for Payer: Aetna Commercial |
$556.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.54
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$568.56
|
| Rate for Payer: Health EOS Commercial |
$550.02
|
| Rate for Payer: HFN Commercial |
$568.56
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: NAPHCARE Commercial |
$370.80
|
| Rate for Payer: Preferred Network Access Commercial |
$568.56
|
| Rate for Payer: Quartz Beloit One Network |
$302.82
|
| Rate for Payer: Quartz Commercial |
$370.80
|
| Rate for Payer: WEA Trust Commercial |
$339.90
|
| Rate for Payer: WPS Commercial |
$457.75
|
|
|
VE Add Vessel +
|
Facility
OP
|
$618.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
4125621
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$173.04 |
| Max. Negotiated Rate |
$26,084.76 |
| Rate for Payer: Aetna Commercial |
$556.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.48
|
| Rate for Payer: Aetna Managed Medicare |
$173.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$401.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$296.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.54
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$568.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$550.02
|
| Rate for Payer: HFN Commercial |
$568.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$463.50
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: NAPHCARE Commercial |
$370.80
|
| Rate for Payer: Preferred Network Access Commercial |
$568.56
|
| Rate for Payer: Quartz Beloit One Network |
$302.82
|
| Rate for Payer: Quartz Commercial |
$401.70
|
| Rate for Payer: Quartz Medicare Advantage |
$370.80
|
| Rate for Payer: The Alliance Commercial |
$26,084.76
|
| Rate for Payer: WEA Trust Commercial |
$339.90
|
| Rate for Payer: WPS Commercial |
$457.75
|
|
|
Vectibix 5 mg Charge
|
Facility
IP
|
$207.00
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
2958964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$190.44 |
| Rate for Payer: Aetna Commercial |
$186.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.71
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$190.44
|
| Rate for Payer: Health EOS Commercial |
$184.23
|
| Rate for Payer: HFN Commercial |
$190.44
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: NAPHCARE Commercial |
$124.20
|
| Rate for Payer: Preferred Network Access Commercial |
$190.44
|
| Rate for Payer: Quartz Beloit One Network |
$101.43
|
| Rate for Payer: Quartz Commercial |
$124.20
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
Vectibix 5 mg Charge
|
Professional
|
$207.00
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
2958964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$91.08 |
| Max. Negotiated Rate |
$411.70 |
| Rate for Payer: Aetna Commercial |
$196.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Aetna Managed Medicare |
$149.71
|
| Rate for Payer: Anthem Medicare Advantage |
$149.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$149.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$149.71
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$196.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.24
|
| Rate for Payer: Health EOS Commercial |
$188.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$149.71
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$196.65
|
| Rate for Payer: Quartz Beloit One Network |
$91.08
|
| Rate for Payer: Quartz Commercial |
$117.99
|
| Rate for Payer: Quartz Medicare Advantage |
$149.71
|
| Rate for Payer: The Alliance Commercial |
$411.70
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$149.71
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$378.10
|
|
|
Vectibix 5 mg Charge
|
Facility
OP
|
$207.00
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
2958964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.36 |
| Max. Negotiated Rate |
$1,196.24 |
| Rate for Payer: Aetna Commercial |
$186.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Aetna Managed Medicare |
$150.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$134.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$103.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.36
|
| Rate for Payer: Anthem Medicare Advantage |
$150.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.66
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$190.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$150.66
|
| Rate for Payer: Health EOS Commercial |
$184.23
|
| Rate for Payer: HFN Commercial |
$190.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$150.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$150.66
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: NAPHCARE Commercial |
$225.99
|
| Rate for Payer: Preferred Network Access Commercial |
$190.44
|
| Rate for Payer: Quartz Beloit One Network |
$101.43
|
| Rate for Payer: Quartz Commercial |
$134.55
|
| Rate for Payer: Quartz Medicare Advantage |
$150.66
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: Wellcare Medicare |
$150.66
|
| Rate for Payer: WPS Commercial |
$378.10
|
|
|
Vedolizumab Antibody Quantitation
|
Facility
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
5619661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$564.48 |
| Max. Negotiated Rate |
$1,059.84 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$691.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$691.20
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
Vedolizumab Antibody Quantitation
|
Facility
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
5619661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.85 |
| Max. Negotiated Rate |
$4,608.00 |
| Rate for Payer: Aetna Commercial |
$1,036.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$38.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.03
|
| Rate for Payer: Anthem Medicaid |
$30.85
|
| Rate for Payer: Anthem Medicare Advantage |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$610.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.57
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,059.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.85
|
| Rate for Payer: Dean Health Medicaid |
$30.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.57
|
| Rate for Payer: Health EOS Commercial |
$1,025.28
|
| Rate for Payer: HFN Commercial |
$1,059.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.57
|
| Rate for Payer: Managed Health Services Medicaid |
$32.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.57
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: NAPHCARE Commercial |
$57.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,059.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.85
|
| Rate for Payer: Quartz Beloit One Network |
$564.48
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: Quartz Medicare Advantage |
$38.57
|
| Rate for Payer: The Alliance Commercial |
$4,608.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: United Healthcare PPO |
$864.00
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: Wellcare Medicare |
$38.57
|
| Rate for Payer: WMAP Medicaid |
$30.85
|
| Rate for Payer: WPS Commercial |
$853.29
|
|
|
Vedolizumab Antibody Quantitation
|
Professional
|
$1,152.00
|
|
|
Service Code
|
CPT 80280
|
| Hospital Charge Code |
5619661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.57 |
| Max. Negotiated Rate |
$1,094.40 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.72
|
| Rate for Payer: Aetna Managed Medicare |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.57
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,094.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$576.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.57
|
| Rate for Payer: Health EOS Commercial |
$1,048.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.57
|
| Rate for Payer: Multiplan Commercial |
$921.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.40
|
| Rate for Payer: Quartz Beloit One Network |
$506.88
|
| Rate for Payer: Quartz Commercial |
$656.64
|
| Rate for Payer: Quartz Medicare Advantage |
$38.57
|
| Rate for Payer: The Alliance Commercial |
$152.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.57
|
| Rate for Payer: WEA Trust Commercial |
$633.60
|
| Rate for Payer: WPS Commercial |
$169.71
|
|
|
VEGA TOTAL KNEE IMPLANTS (FEMUR,TIBIA PLATEAU,PATELLA,GLIDING SURFACE- CONSTRUCT)
|
Facility
IP
|
$29,506.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,457.94 |
| Max. Negotiated Rate |
$27,145.52 |
| Rate for Payer: Aetna Commercial |
$26,555.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,638.18
|
| Rate for Payer: Cash Price |
$8,851.80
|
| Rate for Payer: Cigna Commercial |
$27,145.52
|
| Rate for Payer: Health EOS Commercial |
$26,260.34
|
| Rate for Payer: HFN Commercial |
$27,145.52
|
| Rate for Payer: Multiplan Commercial |
$23,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$17,703.60
|
| Rate for Payer: Preferred Network Access Commercial |
$27,145.52
|
| Rate for Payer: Quartz Beloit One Network |
$14,457.94
|
| Rate for Payer: Quartz Commercial |
$17,703.60
|
| Rate for Payer: WEA Trust Commercial |
$16,228.30
|
| Rate for Payer: WPS Commercial |
$21,855.09
|
|
|
VEGA TOTAL KNEE IMPLANTS (FEMUR,TIBIA PLATEAU,PATELLA,GLIDING SURFACE- CONSTRUCT)
|
Facility
OP
|
$29,506.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5659643
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,261.68 |
| Max. Negotiated Rate |
$27,145.52 |
| Rate for Payer: Aetna Commercial |
$26,555.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,375.16
|
| Rate for Payer: Aetna Managed Medicare |
$8,261.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,178.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,753.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,162.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,638.18
|
| Rate for Payer: Cash Price |
$8,851.80
|
| Rate for Payer: Cigna Commercial |
$27,145.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,511.56
|
| Rate for Payer: Health EOS Commercial |
$26,260.34
|
| Rate for Payer: HFN Commercial |
$27,145.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,129.50
|
| Rate for Payer: Multiplan Commercial |
$23,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$17,703.60
|
| Rate for Payer: Preferred Network Access Commercial |
$27,145.52
|
| Rate for Payer: Quartz Beloit One Network |
$14,457.94
|
| Rate for Payer: Quartz Commercial |
$19,178.90
|
| Rate for Payer: Quartz Medicare Advantage |
$17,703.60
|
| Rate for Payer: WEA Trust Commercial |
$16,228.30
|
| Rate for Payer: WPS Commercial |
$21,855.09
|
|
|
VEIN ACCESS CUTDOWN OVER 1 YR 36425
|
Professional
|
$226.00
|
|
|
Service Code
|
CPT 36425
|
| Hospital Charge Code |
3014524
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.80 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Aetna Commercial |
$214.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.36
|
| Rate for Payer: Aetna Managed Medicare |
$36.80
|
| Rate for Payer: Anthem Medicare Advantage |
$36.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$214.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.80
|
| Rate for Payer: Health EOS Commercial |
$205.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$134.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.70
|
| Rate for Payer: Quartz Beloit One Network |
$99.44
|
| Rate for Payer: Quartz Commercial |
$128.82
|
| Rate for Payer: Quartz Medicare Advantage |
$36.80
|
| Rate for Payer: The Alliance Commercial |
$156.40
|
| Rate for Payer: United Healthcare Medicaid |
$40.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.80
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: WPS Commercial |
$165.60
|
|
|
VEIN LIGATION AND STRIPPING
|
Facility
IP
|
$75,431.00
|
|
|
Service Code
|
MS-DRG 263
|
| Min. Negotiated Rate |
$27,133.49 |
| Max. Negotiated Rate |
$75,431.00 |
| Rate for Payer: Aetna Managed Medicare |
$27,133.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59,373.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,509.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,236.74
|
| Rate for Payer: Anthem Medicare Advantage |
$27,133.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,133.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,133.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,133.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47,996.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,133.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55,091.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,133.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,133.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,133.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,133.49
|
| Rate for Payer: NAPHCARE Commercial |
$40,700.24
|
| Rate for Payer: Quartz Medicare Advantage |
$27,133.49
|
| Rate for Payer: The Alliance Commercial |
$75,431.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,133.49
|
| Rate for Payer: United Healthcare PPO |
$42,889.36
|
| Rate for Payer: Wellcare Medicare |
$27,133.49
|
|
|
VEIN STRIPPER DORMO-STRIP SYMMETRY DISP STERILE VE-022
|
Facility
OP
|
$157.00
|
|
| Hospital Charge Code |
5178752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
VEIN STRIPPER DORMO-STRIP SYMMETRY DISP STERILE VE-022
|
Facility
IP
|
$157.00
|
|
| Hospital Charge Code |
5178752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
VEIN X-RAY, ARM/LEG 7582026
|
Professional
|
$1,144.00
|
|
|
Service Code
|
CPT 75820 26
|
| Hospital Charge Code |
3015293
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$1,086.80 |
| Rate for Payer: Aetna Commercial |
$1,086.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$983.84
|
| Rate for Payer: Aetna Managed Medicare |
$47.06
|
| Rate for Payer: Anthem Medicare Advantage |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.06
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cash Price |
$343.20
|
| Rate for Payer: Cigna Commercial |
$1,086.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$572.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.06
|
| Rate for Payer: Health EOS Commercial |
$1,041.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.06
|
| Rate for Payer: Multiplan Commercial |
$915.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,086.80
|
| Rate for Payer: Quartz Beloit One Network |
$503.36
|
| Rate for Payer: Quartz Commercial |
$652.08
|
| Rate for Payer: Quartz Medicare Advantage |
$47.06
|
| Rate for Payer: The Alliance Commercial |
$178.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.06
|
| Rate for Payer: WEA Trust Commercial |
$629.20
|
| Rate for Payer: WPS Commercial |
$235.30
|
|
|
Velban 1 mg Charge
|
Professional
|
$10.00
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
2958983
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$12.56 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.02
|
| Rate for Payer: Health EOS Commercial |
$9.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.50
|
| Rate for Payer: Quartz Beloit One Network |
$4.40
|
| Rate for Payer: Quartz Commercial |
$5.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$10.87
|
| Rate for Payer: United Healthcare Medicaid |
$4.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$12.56
|
|
