|
BCE NG Tube Placement
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 43752 TC
|
| Hospital Charge Code |
5442668
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$254.29 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$311.38
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
BCE NM Brain Spect
|
Professional
|
Both
|
$10,997.00
|
|
| Hospital Charge Code |
5709723
|
| Min. Negotiated Rate |
$5,032.23 |
| Max. Negotiated Rate |
$10,865.04 |
| Rate for Payer: Aetna Commercial |
$10,865.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,835.72
|
| Rate for Payer: Cash Price |
$3,299.10
|
| Rate for Payer: Cigna Commercial |
$10,865.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,718.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,862.13
|
| Rate for Payer: Health EOS Commercial |
$10,407.56
|
| Rate for Payer: HFN Commercial |
$10,865.04
|
| Rate for Payer: Multiplan Commercial |
$9,149.50
|
| Rate for Payer: Preferred Network Access Commercial |
$10,865.04
|
| Rate for Payer: Quartz Beloit One Network |
$5,032.23
|
| Rate for Payer: Quartz Commercial |
$6,519.02
|
| Rate for Payer: The Alliance Commercial |
$5,718.44
|
| Rate for Payer: WEA Trust Commercial |
$6,290.28
|
| Rate for Payer: WPS Commercial |
$8,470.99
|
|
|
BCE Nuclear Acquisition Treadmill/Chemical
|
Professional
|
Both
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5410684
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$425.66 |
| Max. Negotiated Rate |
$7,380.36 |
| Rate for Payer: Aetna Commercial |
$7,380.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,681.17
|
| Rate for Payer: Aetna Managed Medicare |
$425.66
|
| Rate for Payer: Anthem Medicare Advantage |
$425.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$425.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$425.66
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$7,380.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,884.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.66
|
| Rate for Payer: Health EOS Commercial |
$7,069.61
|
| Rate for Payer: HFN Commercial |
$7,380.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,685.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,685.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$425.66
|
| Rate for Payer: Multiplan Commercial |
$6,215.04
|
| Rate for Payer: NAPHCARE Commercial |
$638.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,380.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,418.27
|
| Rate for Payer: Quartz Commercial |
$4,428.22
|
| Rate for Payer: Quartz Medicare Advantage |
$425.66
|
| Rate for Payer: The Alliance Commercial |
$1,617.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$425.66
|
| Rate for Payer: WEA Trust Commercial |
$4,272.84
|
| Rate for Payer: WPS Commercial |
$2,128.31
|
|
|
BCE Nuclear Acquisition Treadmill/Chemical
|
Facility
|
IP
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5410684
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$3,806.71 |
| Max. Negotiated Rate |
$7,147.30 |
| Rate for Payer: Aetna Commercial |
$6,991.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,681.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,117.46
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$7,147.30
|
| Rate for Payer: Health EOS Commercial |
$6,914.23
|
| Rate for Payer: HFN Commercial |
$7,147.30
|
| Rate for Payer: Multiplan Commercial |
$6,215.04
|
| Rate for Payer: Preferred Network Access Commercial |
$7,147.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,806.71
|
| Rate for Payer: Quartz Commercial |
$4,661.28
|
| Rate for Payer: WEA Trust Commercial |
$4,272.84
|
| Rate for Payer: WPS Commercial |
$5,754.14
|
|
|
BCE Nuclear Acquisition Treadmill/Chemical
|
Facility
|
OP
|
$7,470.00
|
|
|
Service Code
|
CPT 78452
|
| Hospital Charge Code |
5410684
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,362.47 |
| Max. Negotiated Rate |
$7,147.30 |
| Rate for Payer: Aetna Commercial |
$6,991.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,681.17
|
| Rate for Payer: Aetna Managed Medicare |
$1,362.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,473.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,378.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,159.97
|
| Rate for Payer: Anthem Medicare Advantage |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,117.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,362.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,362.47
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cash Price |
$2,241.00
|
| Rate for Payer: Cigna Commercial |
$7,147.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,362.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,347.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,362.47
|
| Rate for Payer: Health EOS Commercial |
$6,914.23
|
| Rate for Payer: HFN Commercial |
$7,147.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,068.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,362.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,362.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,362.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,362.47
|
| Rate for Payer: Multiplan Commercial |
$6,215.04
|
| Rate for Payer: NAPHCARE Commercial |
$2,043.71
|
| Rate for Payer: Preferred Network Access Commercial |
$7,147.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,806.71
|
| Rate for Payer: Quartz Commercial |
$5,049.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.47
|
| Rate for Payer: The Alliance Commercial |
$5,449.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,362.47
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$4,272.84
|
| Rate for Payer: Wellcare Medicare |
$1,362.47
|
| Rate for Payer: WPS Commercial |
$5,754.14
|
|
|
BCE Peritoneal Cath
|
Facility
|
IP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5360638
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$1,369.30 |
| Max. Negotiated Rate |
$2,570.92 |
| Rate for Payer: Aetna Commercial |
$2,515.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,403.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,481.07
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,570.92
|
| Rate for Payer: Health EOS Commercial |
$2,487.09
|
| Rate for Payer: HFN Commercial |
$2,570.92
|
| Rate for Payer: Multiplan Commercial |
$2,235.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,570.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,369.30
|
| Rate for Payer: Quartz Commercial |
$1,676.69
|
| Rate for Payer: WEA Trust Commercial |
$1,536.96
|
| Rate for Payer: WPS Commercial |
$2,069.80
|
|
|
BCE Peritoneal Cath
|
Facility
|
OP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5360638
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$782.45 |
| Max. Negotiated Rate |
$2,570.92 |
| Rate for Payer: Aetna Commercial |
$2,515.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,403.25
|
| Rate for Payer: Aetna Managed Medicare |
$782.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,816.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,397.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,341.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,481.07
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,570.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,563.83
|
| Rate for Payer: Health EOS Commercial |
$2,487.09
|
| Rate for Payer: HFN Commercial |
$2,570.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,095.86
|
| Rate for Payer: Multiplan Commercial |
$2,235.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,676.69
|
| Rate for Payer: Preferred Network Access Commercial |
$2,570.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,369.30
|
| Rate for Payer: Quartz Commercial |
$1,816.41
|
| Rate for Payer: Quartz Medicare Advantage |
$1,676.69
|
| Rate for Payer: The Alliance Commercial |
$1,397.24
|
| Rate for Payer: WEA Trust Commercial |
$1,536.96
|
| Rate for Payer: WPS Commercial |
$2,069.80
|
|
|
BCE Placement Of Soft-Tissue Localization Device
|
Professional
|
Both
|
$2,137.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
5793693
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$69.46 |
| Max. Negotiated Rate |
$2,111.36 |
| Rate for Payer: Aetna Commercial |
$2,111.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,911.33
|
| Rate for Payer: Aetna Managed Medicare |
$69.46
|
| Rate for Payer: Anthem Medicare Advantage |
$69.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.46
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$2,111.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$432.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.46
|
| Rate for Payer: Health EOS Commercial |
$2,022.46
|
| Rate for Payer: HFN Commercial |
$2,111.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$297.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.46
|
| Rate for Payer: Multiplan Commercial |
$1,777.98
|
| Rate for Payer: NAPHCARE Commercial |
$104.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,111.36
|
| Rate for Payer: Quartz Beloit One Network |
$977.89
|
| Rate for Payer: Quartz Commercial |
$1,266.81
|
| Rate for Payer: Quartz Medicare Advantage |
$69.46
|
| Rate for Payer: The Alliance Commercial |
$295.21
|
| Rate for Payer: United Healthcare Medicaid |
$432.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.46
|
| Rate for Payer: WEA Trust Commercial |
$1,222.36
|
| Rate for Payer: WPS Commercial |
$312.58
|
|
|
BCE Placement Of Soft-Tissue Localization Device
|
Facility
|
OP
|
$2,137.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
5793693
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$596.96 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$2,000.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,911.33
|
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| 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: Anthem Medicare Advantage |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,177.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$2,044.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Health EOS Commercial |
$1,978.01
|
| Rate for Payer: HFN Commercial |
$2,044.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: Multiplan Commercial |
$1,777.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Preferred Network Access Commercial |
$2,044.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,089.02
|
| Rate for Payer: Quartz Commercial |
$1,444.61
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,222.36
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
| Rate for Payer: WPS Commercial |
$1,646.13
|
|
|
BCE Placement Of Soft-Tissue Localization Device
|
Facility
|
IP
|
$2,137.00
|
|
|
Service Code
|
CPT 10035
|
| Hospital Charge Code |
5793693
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$1,089.02 |
| Max. Negotiated Rate |
$2,044.68 |
| Rate for Payer: Aetna Commercial |
$2,000.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,911.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,177.91
|
| Rate for Payer: Cash Price |
$641.10
|
| Rate for Payer: Cigna Commercial |
$2,044.68
|
| Rate for Payer: Health EOS Commercial |
$1,978.01
|
| Rate for Payer: HFN Commercial |
$2,044.68
|
| Rate for Payer: Multiplan Commercial |
$1,777.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,044.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,089.02
|
| Rate for Payer: Quartz Commercial |
$1,333.49
|
| Rate for Payer: WEA Trust Commercial |
$1,222.36
|
| Rate for Payer: WPS Commercial |
$1,646.13
|
|
|
BCE Plueral Cath
|
Facility
|
IP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5228671
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$1,369.30 |
| Max. Negotiated Rate |
$2,570.92 |
| Rate for Payer: Aetna Commercial |
$2,515.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,403.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,481.07
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,570.92
|
| Rate for Payer: Health EOS Commercial |
$2,487.09
|
| Rate for Payer: HFN Commercial |
$2,570.92
|
| Rate for Payer: Multiplan Commercial |
$2,235.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,570.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,369.30
|
| Rate for Payer: Quartz Commercial |
$1,676.69
|
| Rate for Payer: WEA Trust Commercial |
$1,536.96
|
| Rate for Payer: WPS Commercial |
$2,069.80
|
|
|
BCE Plueral Cath
|
Facility
|
OP
|
$2,687.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5228671
|
|
Hospital Revenue Code
|
621
|
| Min. Negotiated Rate |
$782.45 |
| Max. Negotiated Rate |
$2,570.92 |
| Rate for Payer: Aetna Commercial |
$2,515.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,403.25
|
| Rate for Payer: Aetna Managed Medicare |
$782.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,816.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,397.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,341.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,481.07
|
| Rate for Payer: Cash Price |
$806.10
|
| Rate for Payer: Cigna Commercial |
$2,570.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,563.83
|
| Rate for Payer: Health EOS Commercial |
$2,487.09
|
| Rate for Payer: HFN Commercial |
$2,570.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,095.86
|
| Rate for Payer: Multiplan Commercial |
$2,235.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,676.69
|
| Rate for Payer: Preferred Network Access Commercial |
$2,570.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,369.30
|
| Rate for Payer: Quartz Commercial |
$1,816.41
|
| Rate for Payer: Quartz Medicare Advantage |
$1,676.69
|
| Rate for Payer: The Alliance Commercial |
$1,397.24
|
| Rate for Payer: WEA Trust Commercial |
$1,536.96
|
| Rate for Payer: WPS Commercial |
$2,069.80
|
|
|
BCE Protein/Creatinine Ratio Urine
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3119367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
BCE Protein/Creatinine Ratio Urine
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3119367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
BCE Protein/Creatinine Ratio Urine
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
3119367
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$79.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$75.71
|
| Rate for Payer: HFN Commercial |
$79.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$79.04
|
| Rate for Payer: Quartz Beloit One Network |
$36.61
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
BCE Puncture Aspiration Abscess hematoma Bulla/Cyst
|
Facility
|
IP
|
$602.00
|
|
|
Service Code
|
CPT 10160 TC
|
| Hospital Charge Code |
5439090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$306.78 |
| Max. Negotiated Rate |
$575.99 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$375.65
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
BCE Puncture Aspiration Abscess hematoma Bulla/Cyst
|
Professional
|
Both
|
$602.00
|
|
|
Service Code
|
CPT 10160 TC
|
| Hospital Charge Code |
5439090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$594.78 |
| Rate for Payer: Aetna Commercial |
$594.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$594.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.65
|
| Rate for Payer: Health EOS Commercial |
$569.73
|
| Rate for Payer: HFN Commercial |
$594.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$331.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$331.15
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: Preferred Network Access Commercial |
$594.78
|
| Rate for Payer: Quartz Beloit One Network |
$275.48
|
| Rate for Payer: Quartz Commercial |
$356.87
|
| Rate for Payer: The Alliance Commercial |
$313.04
|
| Rate for Payer: United Healthcare Medicaid |
$31.38
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
BCE Puncture Aspiration Abscess hematoma Bulla/Cyst
|
Facility
|
OP
|
$602.00
|
|
|
Service Code
|
CPT 10160 TC
|
| Hospital Charge Code |
5439090
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$563.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.43
|
| Rate for Payer: Aetna Managed Medicare |
$175.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.82
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cash Price |
$180.60
|
| Rate for Payer: Cigna Commercial |
$575.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$557.21
|
| Rate for Payer: HFN Commercial |
$575.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.56
|
| Rate for Payer: Multiplan Commercial |
$500.86
|
| Rate for Payer: NAPHCARE Commercial |
$375.65
|
| Rate for Payer: Preferred Network Access Commercial |
$575.99
|
| Rate for Payer: Quartz Beloit One Network |
$306.78
|
| Rate for Payer: Quartz Commercial |
$406.95
|
| Rate for Payer: Quartz Medicare Advantage |
$375.65
|
| Rate for Payer: The Alliance Commercial |
$313.04
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$344.34
|
| Rate for Payer: WPS Commercial |
$463.72
|
|
|
BCE Renal Biopsy
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
5418644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$929.51 |
| Max. Negotiated Rate |
$1,745.20 |
| Rate for Payer: Aetna Commercial |
$1,707.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.39
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,745.20
|
| Rate for Payer: Health EOS Commercial |
$1,688.29
|
| Rate for Payer: HFN Commercial |
$1,745.20
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.20
|
| Rate for Payer: Quartz Beloit One Network |
$929.51
|
| Rate for Payer: Quartz Commercial |
$1,138.18
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
BCE Renal Biopsy
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
5418644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$531.15 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,707.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Aetna Managed Medicare |
$531.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.39
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,745.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,688.29
|
| Rate for Payer: HFN Commercial |
$1,745.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,422.72
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,138.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.20
|
| Rate for Payer: Quartz Beloit One Network |
$929.51
|
| Rate for Payer: Quartz Commercial |
$1,233.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,138.18
|
| Rate for Payer: The Alliance Commercial |
$948.48
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
BCE Renal Biopsy
|
Professional
|
Both
|
$1,824.00
|
|
|
Service Code
|
CPT 50200 TC
|
| Hospital Charge Code |
5418644
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$144.98 |
| Max. Negotiated Rate |
$1,802.11 |
| Rate for Payer: Aetna Commercial |
$1,802.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,802.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,138.18
|
| Rate for Payer: Health EOS Commercial |
$1,726.23
|
| Rate for Payer: HFN Commercial |
$1,802.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$445.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$445.58
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,802.11
|
| Rate for Payer: Quartz Beloit One Network |
$834.66
|
| Rate for Payer: Quartz Commercial |
$1,081.27
|
| Rate for Payer: The Alliance Commercial |
$948.48
|
| Rate for Payer: United Healthcare Medicaid |
$144.98
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
BCE Sacroiliac Joint Injection
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
5595259
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$157.38 |
| Max. Negotiated Rate |
$631.33 |
| Rate for Payer: Aetna Commercial |
$631.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$631.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$398.74
|
| Rate for Payer: Health EOS Commercial |
$604.75
|
| Rate for Payer: HFN Commercial |
$631.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.64
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: Preferred Network Access Commercial |
$631.33
|
| Rate for Payer: Quartz Beloit One Network |
$292.41
|
| Rate for Payer: Quartz Commercial |
$378.80
|
| Rate for Payer: The Alliance Commercial |
$332.28
|
| Rate for Payer: United Healthcare Medicaid |
$157.38
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
BCE Sacroiliac Joint Injection
|
Facility
|
OP
|
$639.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
5595259
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$186.08 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Aetna Managed Medicare |
$186.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.22
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$611.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$591.46
|
| Rate for Payer: HFN Commercial |
$611.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.42
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: NAPHCARE Commercial |
$398.74
|
| Rate for Payer: Preferred Network Access Commercial |
$611.40
|
| Rate for Payer: Quartz Beloit One Network |
$325.63
|
| Rate for Payer: Quartz Commercial |
$431.96
|
| Rate for Payer: Quartz Medicare Advantage |
$398.74
|
| Rate for Payer: The Alliance Commercial |
$332.28
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
BCE Sacroiliac Joint Injection
|
Facility
|
IP
|
$639.00
|
|
|
Service Code
|
CPT 27096 TC
|
| Hospital Charge Code |
5595259
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$325.63 |
| Max. Negotiated Rate |
$611.40 |
| Rate for Payer: Aetna Commercial |
$598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.22
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$611.40
|
| Rate for Payer: Health EOS Commercial |
$591.46
|
| Rate for Payer: HFN Commercial |
$611.40
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: Preferred Network Access Commercial |
$611.40
|
| Rate for Payer: Quartz Beloit One Network |
$325.63
|
| Rate for Payer: Quartz Commercial |
$398.74
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$492.22
|
|
|
BCE Saliva Confirmation 15-21
|
Facility
|
OP
|
$640.00
|
|
|
Service Code
|
HCPCS G0482
|
| Hospital Charge Code |
5542877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.69 |
| Max. Negotiated Rate |
$826.76 |
| Rate for Payer: Aetna Commercial |
$599.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$572.42
|
| Rate for Payer: Aetna Managed Medicare |
$206.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$432.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$319.49
|
| Rate for Payer: Anthem Medicare Advantage |
$206.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$206.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$206.69
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cash Price |
$192.00
|
| Rate for Payer: Cigna Commercial |
$612.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$206.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$206.69
|
| Rate for Payer: Health EOS Commercial |
$592.38
|
| Rate for Payer: HFN Commercial |
$612.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$768.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$206.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$206.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$206.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$206.69
|
| Rate for Payer: Multiplan Commercial |
$532.48
|
| Rate for Payer: NAPHCARE Commercial |
$310.03
|
| Rate for Payer: Preferred Network Access Commercial |
$612.35
|
| Rate for Payer: Quartz Beloit One Network |
$326.14
|
| Rate for Payer: Quartz Commercial |
$432.64
|
| Rate for Payer: Quartz Medicare Advantage |
$206.69
|
| Rate for Payer: The Alliance Commercial |
$826.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$206.69
|
| Rate for Payer: United Healthcare PPO |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$366.08
|
| Rate for Payer: Wellcare Medicare |
$206.69
|
| Rate for Payer: WPS Commercial |
$492.99
|
|
