|
XR Spine Scoliosis Study Standing
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 72081
|
| Hospital Charge Code |
630017
|
| Min. Negotiated Rate |
$306.27 |
| Max. Negotiated Rate |
$575.04 |
| Rate for Payer: Aetna Commercial |
$562.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$537.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.27
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$575.04
|
| Rate for Payer: Health EOS Commercial |
$556.29
|
| Rate for Payer: HFN Commercial |
$575.04
|
| Rate for Payer: Multiplan Commercial |
$500.03
|
| Rate for Payer: Preferred Network Access Commercial |
$575.04
|
| Rate for Payer: Quartz Beloit One Network |
$306.27
|
| Rate for Payer: Quartz Commercial |
$375.02
|
| Rate for Payer: WEA Trust Commercial |
$343.77
|
| Rate for Payer: WPS Commercial |
$462.95
|
|
|
XR Spine Single View Specify Level
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630006
|
| Min. Negotiated Rate |
$23.41 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna Commercial |
$424.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$23.41
|
| Rate for Payer: Anthem Medicare Advantage |
$23.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.41
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$424.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.41
|
| Rate for Payer: Health EOS Commercial |
$406.95
|
| Rate for Payer: HFN Commercial |
$424.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.41
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$35.12
|
| Rate for Payer: Preferred Network Access Commercial |
$424.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.77
|
| Rate for Payer: Quartz Commercial |
$254.90
|
| Rate for Payer: Quartz Medicare Advantage |
$23.41
|
| Rate for Payer: The Alliance Commercial |
$88.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.41
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$117.05
|
|
|
XR Spine Single View Specify Level
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537359
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
XR Spine Single View Specify Level
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537359
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$130.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.15
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.66
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$278.93
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| Rate for Payer: Quartz Medicare Advantage |
$278.93
|
| Rate for Payer: The Alliance Commercial |
$62.98
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
XR Spine Single View Specify Level
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
CPT 72020 TC
|
| Hospital Charge Code |
1537359
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$441.64 |
| Rate for Payer: Aetna Commercial |
$441.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$15.75
|
| Rate for Payer: Anthem Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.75
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$441.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.75
|
| Rate for Payer: Health EOS Commercial |
$423.04
|
| Rate for Payer: HFN Commercial |
$441.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$23.62
|
| Rate for Payer: Preferred Network Access Commercial |
$441.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.55
|
| Rate for Payer: Quartz Commercial |
$264.98
|
| Rate for Payer: Quartz Medicare Advantage |
$15.75
|
| Rate for Payer: The Alliance Commercial |
$59.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$78.73
|
|
|
XR Spine Single View Specify Level
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630006
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.66
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$290.68
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
XR Spine Single View Specify Level
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 72020
|
| Hospital Charge Code |
630006
|
| Min. Negotiated Rate |
$219.13 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$268.32
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
OP
|
$593.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
630002
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$567.38 |
| Rate for Payer: Aetna Commercial |
$555.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$530.38
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$400.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$308.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$296.03
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.86
|
| 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 |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$567.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$345.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$548.88
|
| Rate for Payer: HFN Commercial |
$567.38
|
| 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 |
$493.38
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$567.38
|
| Rate for Payer: Quartz Beloit One Network |
$302.19
|
| Rate for Payer: Quartz Commercial |
$400.87
|
| 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 |
$339.20
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$456.79
|
|
|
XR Spine Thoracic 2 Views
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
5510673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$633.31 |
| Rate for Payer: Aetna Commercial |
$633.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.31
|
| Rate for Payer: Aetna Managed Medicare |
$23.07
|
| Rate for Payer: Anthem Medicare Advantage |
$23.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.07
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$633.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$333.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.07
|
| Rate for Payer: Health EOS Commercial |
$606.64
|
| Rate for Payer: HFN Commercial |
$633.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.07
|
| Rate for Payer: Multiplan Commercial |
$533.31
|
| Rate for Payer: NAPHCARE Commercial |
$34.60
|
| Rate for Payer: Preferred Network Access Commercial |
$633.31
|
| Rate for Payer: Quartz Beloit One Network |
$293.32
|
| Rate for Payer: Quartz Commercial |
$379.98
|
| Rate for Payer: Quartz Medicare Advantage |
$23.07
|
| Rate for Payer: The Alliance Commercial |
$87.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.07
|
| Rate for Payer: WEA Trust Commercial |
$366.65
|
| Rate for Payer: WPS Commercial |
$115.34
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
IP
|
$593.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
630002
|
| Min. Negotiated Rate |
$302.19 |
| Max. Negotiated Rate |
$567.38 |
| Rate for Payer: Aetna Commercial |
$555.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$530.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.86
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$567.38
|
| Rate for Payer: Health EOS Commercial |
$548.88
|
| Rate for Payer: HFN Commercial |
$567.38
|
| Rate for Payer: Multiplan Commercial |
$493.38
|
| Rate for Payer: Preferred Network Access Commercial |
$567.38
|
| Rate for Payer: Quartz Beloit One Network |
$302.19
|
| Rate for Payer: Quartz Commercial |
$370.03
|
| Rate for Payer: WEA Trust Commercial |
$339.20
|
| Rate for Payer: WPS Commercial |
$456.79
|
|
|
XR Spine Thoracic 2 Views
|
Professional
|
Both
|
$593.00
|
|
|
Service Code
|
CPT 72070
|
| Hospital Charge Code |
630002
|
| Min. Negotiated Rate |
$32.78 |
| Max. Negotiated Rate |
$585.88 |
| Rate for Payer: Aetna Commercial |
$585.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$530.38
|
| Rate for Payer: Aetna Managed Medicare |
$32.78
|
| Rate for Payer: Anthem Medicare Advantage |
$32.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.78
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cash Price |
$177.90
|
| Rate for Payer: Cigna Commercial |
$585.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$308.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.78
|
| Rate for Payer: Health EOS Commercial |
$561.22
|
| Rate for Payer: HFN Commercial |
$585.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.78
|
| Rate for Payer: Multiplan Commercial |
$493.38
|
| Rate for Payer: NAPHCARE Commercial |
$49.17
|
| Rate for Payer: Preferred Network Access Commercial |
$585.88
|
| Rate for Payer: Quartz Beloit One Network |
$271.36
|
| Rate for Payer: Quartz Commercial |
$351.53
|
| Rate for Payer: Quartz Medicare Advantage |
$32.78
|
| Rate for Payer: The Alliance Commercial |
$124.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.78
|
| Rate for Payer: WEA Trust Commercial |
$339.20
|
| Rate for Payer: WPS Commercial |
$163.90
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
1537361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.65 |
| Max. Negotiated Rate |
$613.31 |
| Rate for Payer: Aetna Commercial |
$599.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.32
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$613.31
|
| Rate for Payer: Health EOS Commercial |
$593.31
|
| Rate for Payer: HFN Commercial |
$613.31
|
| Rate for Payer: Multiplan Commercial |
$533.31
|
| Rate for Payer: Preferred Network Access Commercial |
$613.31
|
| Rate for Payer: Quartz Beloit One Network |
$326.65
|
| Rate for Payer: Quartz Commercial |
$399.98
|
| Rate for Payer: WEA Trust Commercial |
$366.65
|
| Rate for Payer: WPS Commercial |
$493.76
|
|
|
XR Spine Thoracic 2 Views
|
Professional
|
Both
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
1537361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$23.07 |
| Max. Negotiated Rate |
$633.31 |
| Rate for Payer: Aetna Commercial |
$633.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.31
|
| Rate for Payer: Aetna Managed Medicare |
$23.07
|
| Rate for Payer: Anthem Medicare Advantage |
$23.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.07
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$633.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$333.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.07
|
| Rate for Payer: Health EOS Commercial |
$606.64
|
| Rate for Payer: HFN Commercial |
$633.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.07
|
| Rate for Payer: Multiplan Commercial |
$533.31
|
| Rate for Payer: NAPHCARE Commercial |
$34.60
|
| Rate for Payer: Preferred Network Access Commercial |
$633.31
|
| Rate for Payer: Quartz Beloit One Network |
$293.32
|
| Rate for Payer: Quartz Commercial |
$379.98
|
| Rate for Payer: Quartz Medicare Advantage |
$23.07
|
| Rate for Payer: The Alliance Commercial |
$87.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.07
|
| Rate for Payer: WEA Trust Commercial |
$366.65
|
| Rate for Payer: WPS Commercial |
$115.34
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
1537361
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$613.31 |
| Rate for Payer: Aetna Commercial |
$599.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.31
|
| Rate for Payer: Aetna Managed Medicare |
$186.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.32
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$613.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.06
|
| Rate for Payer: Health EOS Commercial |
$593.31
|
| Rate for Payer: HFN Commercial |
$613.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$499.98
|
| Rate for Payer: Multiplan Commercial |
$533.31
|
| Rate for Payer: NAPHCARE Commercial |
$399.98
|
| Rate for Payer: Preferred Network Access Commercial |
$613.31
|
| Rate for Payer: Quartz Beloit One Network |
$326.65
|
| Rate for Payer: Quartz Commercial |
$433.32
|
| Rate for Payer: Quartz Medicare Advantage |
$399.98
|
| Rate for Payer: The Alliance Commercial |
$92.27
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$366.65
|
| Rate for Payer: WPS Commercial |
$493.76
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
OP
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
5510673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$92.27 |
| Max. Negotiated Rate |
$613.31 |
| Rate for Payer: Aetna Commercial |
$599.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.31
|
| Rate for Payer: Aetna Managed Medicare |
$186.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.32
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$613.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.06
|
| Rate for Payer: Health EOS Commercial |
$593.31
|
| Rate for Payer: HFN Commercial |
$613.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$499.98
|
| Rate for Payer: Multiplan Commercial |
$533.31
|
| Rate for Payer: NAPHCARE Commercial |
$399.98
|
| Rate for Payer: Preferred Network Access Commercial |
$613.31
|
| Rate for Payer: Quartz Beloit One Network |
$326.65
|
| Rate for Payer: Quartz Commercial |
$433.32
|
| Rate for Payer: Quartz Medicare Advantage |
$399.98
|
| Rate for Payer: The Alliance Commercial |
$92.27
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$366.65
|
| Rate for Payer: WPS Commercial |
$493.76
|
|
|
XR Spine Thoracic 2 Views
|
Facility
|
IP
|
$641.00
|
|
|
Service Code
|
CPT 72070 TC
|
| Hospital Charge Code |
5510673
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$326.65 |
| Max. Negotiated Rate |
$613.31 |
| Rate for Payer: Aetna Commercial |
$599.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$573.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$353.32
|
| Rate for Payer: Cash Price |
$192.30
|
| Rate for Payer: Cigna Commercial |
$613.31
|
| Rate for Payer: Health EOS Commercial |
$593.31
|
| Rate for Payer: HFN Commercial |
$613.31
|
| Rate for Payer: Multiplan Commercial |
$533.31
|
| Rate for Payer: Preferred Network Access Commercial |
$613.31
|
| Rate for Payer: Quartz Beloit One Network |
$326.65
|
| Rate for Payer: Quartz Commercial |
$399.98
|
| Rate for Payer: WEA Trust Commercial |
$366.65
|
| Rate for Payer: WPS Commercial |
$493.76
|
|
|
XR Spine Thoracic 3 Views
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
629997
|
| Min. Negotiated Rate |
$375.58 |
| Max. Negotiated Rate |
$705.16 |
| Rate for Payer: Aetna Commercial |
$689.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$659.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.23
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$705.16
|
| Rate for Payer: Health EOS Commercial |
$682.17
|
| Rate for Payer: HFN Commercial |
$705.16
|
| Rate for Payer: Multiplan Commercial |
$613.18
|
| Rate for Payer: Preferred Network Access Commercial |
$705.16
|
| Rate for Payer: Quartz Beloit One Network |
$375.58
|
| Rate for Payer: Quartz Commercial |
$459.89
|
| Rate for Payer: WEA Trust Commercial |
$421.56
|
| Rate for Payer: WPS Commercial |
$567.71
|
|
|
XR Spine Thoracic 3 Views
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
629997
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$705.16 |
| Rate for Payer: Aetna Commercial |
$689.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$659.17
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$498.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$383.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$367.91
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.23
|
| 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 |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$705.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$682.17
|
| Rate for Payer: HFN Commercial |
$705.16
|
| 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 |
$613.18
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$705.16
|
| Rate for Payer: Quartz Beloit One Network |
$375.58
|
| Rate for Payer: Quartz Commercial |
$498.21
|
| 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 |
$421.56
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$567.71
|
|
|
XR Spine Thoracic 3 Views
|
Professional
|
Both
|
$785.00
|
|
|
Service Code
|
CPT 72072 TC
|
| Hospital Charge Code |
1537363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$28.06 |
| Max. Negotiated Rate |
$775.58 |
| Rate for Payer: Aetna Commercial |
$775.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.10
|
| Rate for Payer: Aetna Managed Medicare |
$28.06
|
| Rate for Payer: Anthem Medicare Advantage |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.06
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$775.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$408.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.06
|
| Rate for Payer: Health EOS Commercial |
$742.92
|
| Rate for Payer: HFN Commercial |
$775.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.06
|
| Rate for Payer: Multiplan Commercial |
$653.12
|
| Rate for Payer: NAPHCARE Commercial |
$42.09
|
| Rate for Payer: Preferred Network Access Commercial |
$775.58
|
| Rate for Payer: Quartz Beloit One Network |
$359.22
|
| Rate for Payer: Quartz Commercial |
$465.35
|
| Rate for Payer: Quartz Medicare Advantage |
$28.06
|
| Rate for Payer: The Alliance Commercial |
$106.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.06
|
| Rate for Payer: WEA Trust Commercial |
$449.02
|
| Rate for Payer: WPS Commercial |
$140.30
|
|
|
XR Spine Thoracic 3 Views
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
CPT 72072
|
| Hospital Charge Code |
629997
|
| Min. Negotiated Rate |
$38.47 |
| Max. Negotiated Rate |
$728.16 |
| Rate for Payer: Aetna Commercial |
$728.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$659.17
|
| Rate for Payer: Aetna Managed Medicare |
$38.47
|
| Rate for Payer: Anthem Medicare Advantage |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.47
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$728.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$383.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.47
|
| Rate for Payer: Health EOS Commercial |
$697.50
|
| Rate for Payer: HFN Commercial |
$728.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.47
|
| Rate for Payer: Multiplan Commercial |
$613.18
|
| Rate for Payer: NAPHCARE Commercial |
$57.70
|
| Rate for Payer: Preferred Network Access Commercial |
$728.16
|
| Rate for Payer: Quartz Beloit One Network |
$337.25
|
| Rate for Payer: Quartz Commercial |
$436.89
|
| Rate for Payer: Quartz Medicare Advantage |
$38.47
|
| Rate for Payer: The Alliance Commercial |
$146.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.47
|
| Rate for Payer: WEA Trust Commercial |
$421.56
|
| Rate for Payer: WPS Commercial |
$192.35
|
|
|
XR Spine Thoracic 3 Views
|
Facility
|
OP
|
$785.00
|
|
|
Service Code
|
CPT 72072 TC
|
| Hospital Charge Code |
1537363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$112.24 |
| Max. Negotiated Rate |
$751.09 |
| Rate for Payer: Aetna Commercial |
$734.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.10
|
| Rate for Payer: Aetna Managed Medicare |
$228.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.69
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$751.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.87
|
| Rate for Payer: Health EOS Commercial |
$726.60
|
| Rate for Payer: HFN Commercial |
$751.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.30
|
| Rate for Payer: Multiplan Commercial |
$653.12
|
| Rate for Payer: NAPHCARE Commercial |
$489.84
|
| Rate for Payer: Preferred Network Access Commercial |
$751.09
|
| Rate for Payer: Quartz Beloit One Network |
$400.04
|
| Rate for Payer: Quartz Commercial |
$530.66
|
| Rate for Payer: Quartz Medicare Advantage |
$489.84
|
| Rate for Payer: The Alliance Commercial |
$112.24
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$449.02
|
| Rate for Payer: WPS Commercial |
$604.69
|
|
|
XR Spine Thoracic 3 Views
|
Facility
|
IP
|
$785.00
|
|
|
Service Code
|
CPT 72072 TC
|
| Hospital Charge Code |
1537363
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$400.04 |
| Max. Negotiated Rate |
$751.09 |
| Rate for Payer: Aetna Commercial |
$734.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.69
|
| Rate for Payer: Cash Price |
$235.50
|
| Rate for Payer: Cigna Commercial |
$751.09
|
| Rate for Payer: Health EOS Commercial |
$726.60
|
| Rate for Payer: HFN Commercial |
$751.09
|
| Rate for Payer: Multiplan Commercial |
$653.12
|
| Rate for Payer: Preferred Network Access Commercial |
$751.09
|
| Rate for Payer: Quartz Beloit One Network |
$400.04
|
| Rate for Payer: Quartz Commercial |
$489.84
|
| Rate for Payer: WEA Trust Commercial |
$449.02
|
| Rate for Payer: WPS Commercial |
$604.69
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Facility
|
OP
|
$759.00
|
|
|
Service Code
|
CPT 72074 TC
|
| Hospital Charge Code |
1537365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$129.54 |
| Max. Negotiated Rate |
$726.21 |
| Rate for Payer: Aetna Commercial |
$710.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.85
|
| Rate for Payer: Aetna Managed Medicare |
$221.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.36
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$726.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.74
|
| Rate for Payer: Health EOS Commercial |
$702.53
|
| Rate for Payer: HFN Commercial |
$726.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$592.02
|
| Rate for Payer: Multiplan Commercial |
$631.49
|
| Rate for Payer: NAPHCARE Commercial |
$473.62
|
| Rate for Payer: Preferred Network Access Commercial |
$726.21
|
| Rate for Payer: Quartz Beloit One Network |
$386.79
|
| Rate for Payer: Quartz Commercial |
$513.08
|
| Rate for Payer: Quartz Medicare Advantage |
$473.62
|
| Rate for Payer: The Alliance Commercial |
$129.54
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$434.15
|
| Rate for Payer: WPS Commercial |
$584.66
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Professional
|
Both
|
$759.00
|
|
|
Service Code
|
CPT 72074 TC
|
| Hospital Charge Code |
1537365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$749.89 |
| Rate for Payer: Aetna Commercial |
$749.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.85
|
| Rate for Payer: Aetna Managed Medicare |
$32.39
|
| Rate for Payer: Anthem Medicare Advantage |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.39
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$749.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$394.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.39
|
| Rate for Payer: Health EOS Commercial |
$718.32
|
| Rate for Payer: HFN Commercial |
$749.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.39
|
| Rate for Payer: Multiplan Commercial |
$631.49
|
| Rate for Payer: NAPHCARE Commercial |
$48.58
|
| Rate for Payer: Preferred Network Access Commercial |
$749.89
|
| Rate for Payer: Quartz Beloit One Network |
$347.32
|
| Rate for Payer: Quartz Commercial |
$449.94
|
| Rate for Payer: Quartz Medicare Advantage |
$32.39
|
| Rate for Payer: The Alliance Commercial |
$123.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$434.15
|
| Rate for Payer: WPS Commercial |
$161.93
|
|
|
XR Spine Thoracic Minimum 4 Views
|
Facility
|
IP
|
$759.00
|
|
|
Service Code
|
CPT 72074 TC
|
| Hospital Charge Code |
1537365
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$386.79 |
| Max. Negotiated Rate |
$726.21 |
| Rate for Payer: Aetna Commercial |
$710.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.36
|
| Rate for Payer: Cash Price |
$227.70
|
| Rate for Payer: Cigna Commercial |
$726.21
|
| Rate for Payer: Health EOS Commercial |
$702.53
|
| Rate for Payer: HFN Commercial |
$726.21
|
| Rate for Payer: Multiplan Commercial |
$631.49
|
| Rate for Payer: Preferred Network Access Commercial |
$726.21
|
| Rate for Payer: Quartz Beloit One Network |
$386.79
|
| Rate for Payer: Quartz Commercial |
$473.62
|
| Rate for Payer: WEA Trust Commercial |
$434.15
|
| Rate for Payer: WPS Commercial |
$584.66
|
|
