|
Caffeine, Urine
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 80155
|
| Hospital Charge Code |
3313617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$136.15 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$103.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.40
|
| Rate for Payer: Health EOS Commercial |
$99.19
|
| Rate for Payer: HFN Commercial |
$103.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.15
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.55
|
| Rate for Payer: Quartz Beloit One Network |
$47.96
|
| Rate for Payer: Quartz Commercial |
$62.13
|
| Rate for Payer: The Alliance Commercial |
$54.50
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Calcitonin Level
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
633686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna Commercial |
$349.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$349.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$334.88
|
| Rate for Payer: HFN Commercial |
$349.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.57
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$349.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.92
|
| Rate for Payer: Quartz Commercial |
$209.76
|
| Rate for Payer: The Alliance Commercial |
$184.00
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Calcitonin Level
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
633686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$338.56 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Aetna Managed Medicare |
$26.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.47
|
| Rate for Payer: Anthem Medicaid |
$27.68
|
| Rate for Payer: Anthem Medicare Advantage |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.79
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.93
|
| Rate for Payer: Dean Health Medicaid |
$27.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.79
|
| Rate for Payer: Managed Health Services Medicaid |
$28.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$40.18
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27.68
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$239.20
|
| Rate for Payer: Quartz Medicare Advantage |
$26.79
|
| Rate for Payer: The Alliance Commercial |
$107.16
|
| Rate for Payer: United Healthcare Medicaid |
$27.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.79
|
| Rate for Payer: United Healthcare PPO |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: Wellcare Medicare |
$26.79
|
| Rate for Payer: WMAP Medicaid |
$27.68
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Calcitonin Level
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 82308
|
| Hospital Charge Code |
633686
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$338.56 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$220.80
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Calcitriol 1,25 Dihyroxy Level
|
Professional
|
Both
|
$606.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
978114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.91 |
| Max. Negotiated Rate |
$575.70 |
| Rate for Payer: Aetna Commercial |
$575.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$575.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.60
|
| Rate for Payer: Health EOS Commercial |
$551.46
|
| Rate for Payer: HFN Commercial |
$575.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.91
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$575.70
|
| Rate for Payer: Quartz Beloit One Network |
$266.64
|
| Rate for Payer: Quartz Commercial |
$345.42
|
| Rate for Payer: The Alliance Commercial |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
Calcitriol 1,25 Dihyroxy Level
|
Facility
|
IP
|
$606.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
978114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$296.94 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.60
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$363.60
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
Calcitriol 1,25 Dihyroxy Level
|
Facility
|
OP
|
$606.00
|
|
|
Service Code
|
CPT 82652
|
| Hospital Charge Code |
978114
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.50 |
| Max. Negotiated Rate |
$557.52 |
| Rate for Payer: Aetna Commercial |
$545.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.16
|
| Rate for Payer: Aetna Managed Medicare |
$38.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.91
|
| Rate for Payer: Anthem Medicaid |
$39.78
|
| Rate for Payer: Anthem Medicare Advantage |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.50
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cash Price |
$181.80
|
| Rate for Payer: Cigna Commercial |
$557.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.12
|
| Rate for Payer: Dean Health Medicaid |
$39.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38.50
|
| Rate for Payer: Health EOS Commercial |
$539.34
|
| Rate for Payer: HFN Commercial |
$557.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$39.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.50
|
| Rate for Payer: Managed Health Services Medicaid |
$41.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38.50
|
| Rate for Payer: Multiplan Commercial |
$484.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.75
|
| Rate for Payer: Preferred Network Access Commercial |
$557.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39.78
|
| Rate for Payer: Quartz Beloit One Network |
$296.94
|
| Rate for Payer: Quartz Commercial |
$393.90
|
| Rate for Payer: Quartz Medicare Advantage |
$38.50
|
| Rate for Payer: The Alliance Commercial |
$154.00
|
| Rate for Payer: United Healthcare Medicaid |
$39.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.50
|
| Rate for Payer: United Healthcare PPO |
$454.50
|
| Rate for Payer: WEA Trust Commercial |
$333.30
|
| Rate for Payer: Wellcare Medicare |
$38.50
|
| Rate for Payer: WMAP Medicaid |
$39.78
|
| Rate for Payer: WPS Commercial |
$448.86
|
|
|
Calcitriol Medication 0.25mcg
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
3005564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Calcitriol Medication 0.25mcg
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
3005564
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$3.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.72
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Calcitriol Medication 0.5 mcg
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
3005563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$6.60
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Calcitriol Medication 0.5 mcg
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
3005563
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Aetna Managed Medicare |
$3.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.16
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$7.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.60
|
| Rate for Payer: The Alliance Commercial |
$44.00
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Calcium
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2942966
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Aetna Commercial |
$121.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.80
|
| Rate for Payer: Health EOS Commercial |
$116.48
|
| Rate for Payer: HFN Commercial |
$121.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.21
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$121.60
|
| Rate for Payer: Quartz Beloit One Network |
$56.32
|
| Rate for Payer: Quartz Commercial |
$72.96
|
| Rate for Payer: The Alliance Commercial |
$64.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Calcium
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2942966
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Calcium
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
2942966
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$5.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.57
|
| Rate for Payer: Anthem Medicaid |
$5.33
|
| Rate for Payer: Anthem Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.16
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.63
|
| Rate for Payer: Dean Health Medicaid |
$5.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.16
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.16
|
| Rate for Payer: Managed Health Services Medicaid |
$5.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.74
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.33
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5.16
|
| Rate for Payer: The Alliance Commercial |
$20.64
|
| Rate for Payer: United Healthcare Medicaid |
$5.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.16
|
| Rate for Payer: United Healthcare PPO |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: Wellcare Medicare |
$5.16
|
| Rate for Payer: WMAP Medicaid |
$5.33
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
.Calcium, 24-hour Urine w/creatinine
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
4506619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$21.29 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.20
|
| Rate for Payer: Health EOS Commercial |
$20.02
|
| Rate for Payer: HFN Commercial |
$20.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.29
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Preferred Network Access Commercial |
$20.90
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$12.54
|
| Rate for Payer: The Alliance Commercial |
$11.00
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
.Calcium, 24-hour Urine w/creatinine
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
4506619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$13.20
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
.Calcium, 24-hour Urine w/creatinine
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
4506619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$24.12 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Anthem Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.03
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.31
|
| Rate for Payer: Dean Health Medicaid |
$6.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.03
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.03
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$9.04
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.23
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$14.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6.03
|
| Rate for Payer: The Alliance Commercial |
$24.12
|
| Rate for Payer: United Healthcare Medicaid |
$6.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: United Healthcare PPO |
$16.50
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: Wellcare Medicare |
$6.03
|
| Rate for Payer: WMAP Medicaid |
$6.23
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
Calcium Gluconate 10 ml Charge
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
2958898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Calcium Gluconate 10 ml Charge
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
2958898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Calcium Gluconate 10 ml Charge
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
2958898
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.24 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$23.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$49.80
|
| Rate for Payer: The Alliance Commercial |
$332.00
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Calcium gluconate inj 10 ml charge J0610
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
3451631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.24 |
| Max. Negotiated Rate |
$332.00 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$23.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.25
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$49.80
|
| Rate for Payer: The Alliance Commercial |
$332.00
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Calcium gluconate inj 10 ml charge J0610
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
3451631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Calcium gluconate inj 10 ml charge J0610
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
HCPCS J0610
|
| Hospital Charge Code |
3451631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Calcium, Ionized to Quest
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
3091491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Aetna Managed Medicare |
$13.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.71
|
| Rate for Payer: Anthem Medicaid |
$14.14
|
| Rate for Payer: Anthem Medicare Advantage |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.68
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.21
|
| Rate for Payer: Dean Health Medicaid |
$14.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.68
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.68
|
| Rate for Payer: Managed Health Services Medicaid |
$14.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.68
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$20.52
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.14
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$176.80
|
| Rate for Payer: Quartz Medicare Advantage |
$13.68
|
| Rate for Payer: The Alliance Commercial |
$54.72
|
| Rate for Payer: United Healthcare Medicaid |
$14.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: United Healthcare PPO |
$204.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: Wellcare Medicare |
$13.68
|
| Rate for Payer: WMAP Medicaid |
$14.14
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Calcium, Ionized to Quest
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
3091491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$163.20
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
