|
US Left Lower Quadrant
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544915
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,491.65 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Aetna Managed Medicare |
$453.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.32
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,491.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$907.34
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,216.02
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: NAPHCARE Commercial |
$972.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$1,053.88
|
| Rate for Payer: Quartz Medicare Advantage |
$972.82
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
US Left Lower Quadrant
|
Professional
|
Both
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544915
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,540.29 |
| Rate for Payer: Aetna Commercial |
$1,540.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,540.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$810.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,475.44
|
| Rate for Payer: HFN Commercial |
$1,540.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,540.29
|
| Rate for Payer: Quartz Beloit One Network |
$713.40
|
| Rate for Payer: Quartz Commercial |
$924.18
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Left Lower Quadrant
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711775
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Left Lower Quadrant
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544915
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$794.47 |
| Max. Negotiated Rate |
$1,491.65 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.32
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,491.65
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$972.82
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
US Left Upper Quadrant
|
Facility
|
IP
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$794.47 |
| Max. Negotiated Rate |
$1,491.65 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.32
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,491.65
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$972.82
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
US Left Upper Quadrant
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711776
|
| Min. Negotiated Rate |
$763.89 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$935.38
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Left Upper Quadrant
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711776
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Left Upper Quadrant
|
Professional
|
Both
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,540.29 |
| Rate for Payer: Aetna Commercial |
$1,540.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,540.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$810.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,475.44
|
| Rate for Payer: HFN Commercial |
$1,540.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,540.29
|
| Rate for Payer: Quartz Beloit One Network |
$713.40
|
| Rate for Payer: Quartz Commercial |
$924.18
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Left Upper Quadrant
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
711776
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,481.01 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$779.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US Left Upper Quadrant
|
Facility
|
OP
|
$1,559.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2544918
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,491.65 |
| Rate for Payer: Aetna Commercial |
$1,459.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.37
|
| Rate for Payer: Aetna Managed Medicare |
$453.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.32
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cash Price |
$467.70
|
| Rate for Payer: Cigna Commercial |
$1,491.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$907.34
|
| Rate for Payer: Health EOS Commercial |
$1,443.01
|
| Rate for Payer: HFN Commercial |
$1,491.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,216.02
|
| Rate for Payer: Multiplan Commercial |
$1,297.09
|
| Rate for Payer: NAPHCARE Commercial |
$972.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,491.65
|
| Rate for Payer: Quartz Beloit One Network |
$794.47
|
| Rate for Payer: Quartz Commercial |
$1,053.88
|
| Rate for Payer: Quartz Medicare Advantage |
$972.82
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$891.75
|
| Rate for Payer: WPS Commercial |
$1,200.90
|
|
|
US Liver
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552807
|
| Min. Negotiated Rate |
$763.89 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$935.38
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Liver
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587172
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,741.84 |
| Rate for Payer: Aetna Commercial |
$1,741.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,741.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$916.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,668.50
|
| Rate for Payer: HFN Commercial |
$1,741.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,741.84
|
| Rate for Payer: Quartz Beloit One Network |
$806.75
|
| Rate for Payer: Quartz Commercial |
$1,045.11
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Liver
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552807
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Liver
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587172
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Liver
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
2552807
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,481.01 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$779.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
|
US Liver
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2587172
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Lower Extremity Non-Vascular Bilat
|
Facility
|
OP
|
$1,128.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544921
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$328.47 |
| Max. Negotiated Rate |
$1,079.27 |
| Rate for Payer: Aetna Commercial |
$1,055.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,008.88
|
| Rate for Payer: Aetna Managed Medicare |
$328.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.75
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$1,079.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$656.50
|
| Rate for Payer: Health EOS Commercial |
$1,044.08
|
| Rate for Payer: HFN Commercial |
$1,079.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$879.84
|
| Rate for Payer: Multiplan Commercial |
$938.50
|
| Rate for Payer: NAPHCARE Commercial |
$703.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,079.27
|
| Rate for Payer: Quartz Beloit One Network |
$574.83
|
| Rate for Payer: Quartz Commercial |
$762.53
|
| Rate for Payer: Quartz Medicare Advantage |
$703.87
|
| Rate for Payer: The Alliance Commercial |
$586.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$645.22
|
| Rate for Payer: WPS Commercial |
$868.90
|
|
|
US Lower Extremity Non-Vascular Bilat
|
Facility
|
IP
|
$1,128.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544921
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$574.83 |
| Max. Negotiated Rate |
$1,079.27 |
| Rate for Payer: Aetna Commercial |
$1,055.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,008.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$621.75
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$1,079.27
|
| Rate for Payer: Health EOS Commercial |
$1,044.08
|
| Rate for Payer: HFN Commercial |
$1,079.27
|
| Rate for Payer: Multiplan Commercial |
$938.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,079.27
|
| Rate for Payer: Quartz Beloit One Network |
$574.83
|
| Rate for Payer: Quartz Commercial |
$703.87
|
| Rate for Payer: WEA Trust Commercial |
$645.22
|
| Rate for Payer: WPS Commercial |
$868.90
|
|
|
US Lower Extremity Non-Vascular Bilat
|
Professional
|
Both
|
$1,128.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544921
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.26 |
| Max. Negotiated Rate |
$1,114.46 |
| Rate for Payer: Aetna Commercial |
$1,114.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,008.88
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cash Price |
$338.40
|
| Rate for Payer: Cigna Commercial |
$1,114.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$586.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$703.87
|
| Rate for Payer: Health EOS Commercial |
$1,067.54
|
| Rate for Payer: HFN Commercial |
$1,114.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.26
|
| Rate for Payer: Multiplan Commercial |
$938.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,114.46
|
| Rate for Payer: Quartz Beloit One Network |
$516.17
|
| Rate for Payer: Quartz Commercial |
$668.68
|
| Rate for Payer: The Alliance Commercial |
$586.56
|
| Rate for Payer: WEA Trust Commercial |
$645.22
|
| Rate for Payer: WPS Commercial |
$868.90
|
|
|
US Lower Extremity Non-Vascular Left
|
Professional
|
Both
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544924
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.26 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna Commercial |
$1,089.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,089.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$573.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$688.27
|
| Rate for Payer: Health EOS Commercial |
$1,043.88
|
| Rate for Payer: HFN Commercial |
$1,089.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.26
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.76
|
| Rate for Payer: Quartz Beloit One Network |
$504.73
|
| Rate for Payer: Quartz Commercial |
$653.86
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Lower Extremity Non-Vascular Left
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544924
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$562.09 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$688.27
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Lower Extremity Non-Vascular Left
|
Facility
|
OP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 LT,TC
|
| Hospital Charge Code |
2544924
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$321.19 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Aetna Managed Medicare |
$321.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.95
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$860.34
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: NAPHCARE Commercial |
$688.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$745.63
|
| Rate for Payer: Quartz Medicare Advantage |
$688.27
|
| Rate for Payer: The Alliance Commercial |
$573.56
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Lower Extremity Non-Vascular Right
|
Facility
|
OP
|
$1,043.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
5585844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$303.72 |
| Max. Negotiated Rate |
$997.94 |
| Rate for Payer: Aetna Commercial |
$976.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Aetna Managed Medicare |
$303.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$997.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$607.03
|
| Rate for Payer: Health EOS Commercial |
$965.40
|
| Rate for Payer: HFN Commercial |
$997.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.54
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: NAPHCARE Commercial |
$650.83
|
| Rate for Payer: Preferred Network Access Commercial |
$997.94
|
| Rate for Payer: Quartz Beloit One Network |
$531.51
|
| Rate for Payer: Quartz Commercial |
$705.07
|
| Rate for Payer: Quartz Medicare Advantage |
$650.83
|
| Rate for Payer: The Alliance Commercial |
$542.36
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
|
US Lower Extremity Non-Vascular Right
|
Facility
|
IP
|
$1,103.00
|
|
|
Service Code
|
CPT 76882 RT,TC
|
| Hospital Charge Code |
2544927
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$562.09 |
| Max. Negotiated Rate |
$1,055.35 |
| Rate for Payer: Aetna Commercial |
$1,032.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.97
|
| Rate for Payer: Cash Price |
$330.90
|
| Rate for Payer: Cigna Commercial |
$1,055.35
|
| Rate for Payer: Health EOS Commercial |
$1,020.94
|
| Rate for Payer: HFN Commercial |
$1,055.35
|
| Rate for Payer: Multiplan Commercial |
$917.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.35
|
| Rate for Payer: Quartz Beloit One Network |
$562.09
|
| Rate for Payer: Quartz Commercial |
$688.27
|
| Rate for Payer: WEA Trust Commercial |
$630.92
|
| Rate for Payer: WPS Commercial |
$849.64
|
|
|
US Lower Extremity Non-Vascular Right
|
Professional
|
Both
|
$1,043.00
|
|
|
Service Code
|
CPT 76882 TC,RT
|
| Hospital Charge Code |
5585844
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$200.26 |
| Max. Negotiated Rate |
$1,030.48 |
| Rate for Payer: Aetna Commercial |
$1,030.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.86
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cash Price |
$312.90
|
| Rate for Payer: Cigna Commercial |
$1,030.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$542.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$650.83
|
| Rate for Payer: Health EOS Commercial |
$987.10
|
| Rate for Payer: HFN Commercial |
$1,030.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.26
|
| Rate for Payer: Multiplan Commercial |
$867.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.48
|
| Rate for Payer: Quartz Beloit One Network |
$477.28
|
| Rate for Payer: Quartz Commercial |
$618.29
|
| Rate for Payer: The Alliance Commercial |
$542.36
|
| Rate for Payer: WEA Trust Commercial |
$596.60
|
| Rate for Payer: WPS Commercial |
$803.42
|
|
