|
Cortisol Morning
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
977911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
Cortisol Saliva
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
1038907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$17.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.38
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.38
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.38
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$26.07
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$264.32
|
| Rate for Payer: Quartz Medicare Advantage |
$17.38
|
| Rate for Payer: The Alliance Commercial |
$69.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.38
|
| Rate for Payer: United Healthcare PPO |
$304.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: Wellcare Medicare |
$17.38
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
Cortisol Saliva
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
1038907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$243.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
Cortisol Saliva
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
1038907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$17.38
|
| Rate for Payer: Anthem Medicare Advantage |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.38
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$386.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.38
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.38
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$26.07
|
| Rate for Payer: Preferred Network Access Commercial |
$386.31
|
| Rate for Payer: Quartz Beloit One Network |
$178.92
|
| Rate for Payer: Quartz Commercial |
$231.78
|
| Rate for Payer: Quartz Medicare Advantage |
$17.38
|
| Rate for Payer: The Alliance Commercial |
$68.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.38
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$76.46
|
|
|
Cortisol Saliva 3sp
|
Professional
|
Both
|
$148.20
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
6180723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$146.42 |
| Rate for Payer: Aetna Commercial |
$146.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.55
|
| Rate for Payer: Aetna Managed Medicare |
$17.38
|
| Rate for Payer: Anthem Medicare Advantage |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.38
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna Commercial |
$146.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.38
|
| Rate for Payer: Health EOS Commercial |
$140.26
|
| Rate for Payer: HFN Commercial |
$146.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.38
|
| Rate for Payer: Multiplan Commercial |
$123.30
|
| Rate for Payer: NAPHCARE Commercial |
$26.07
|
| Rate for Payer: Preferred Network Access Commercial |
$146.42
|
| Rate for Payer: Quartz Beloit One Network |
$67.82
|
| Rate for Payer: Quartz Commercial |
$87.85
|
| Rate for Payer: Quartz Medicare Advantage |
$17.38
|
| Rate for Payer: The Alliance Commercial |
$68.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.38
|
| Rate for Payer: WEA Trust Commercial |
$84.77
|
| Rate for Payer: WPS Commercial |
$76.46
|
|
|
Cortisol Saliva 3sp
|
Facility
|
OP
|
$148.20
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
6180723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.38 |
| Max. Negotiated Rate |
$141.80 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.55
|
| Rate for Payer: Aetna Managed Medicare |
$17.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.38
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna Commercial |
$141.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.38
|
| Rate for Payer: Health EOS Commercial |
$137.17
|
| Rate for Payer: HFN Commercial |
$141.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.38
|
| Rate for Payer: Multiplan Commercial |
$123.30
|
| Rate for Payer: NAPHCARE Commercial |
$26.07
|
| Rate for Payer: Preferred Network Access Commercial |
$141.80
|
| Rate for Payer: Quartz Beloit One Network |
$75.52
|
| Rate for Payer: Quartz Commercial |
$100.18
|
| Rate for Payer: Quartz Medicare Advantage |
$17.38
|
| Rate for Payer: The Alliance Commercial |
$69.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.38
|
| Rate for Payer: United Healthcare PPO |
$115.60
|
| Rate for Payer: WEA Trust Commercial |
$84.77
|
| Rate for Payer: Wellcare Medicare |
$17.38
|
| Rate for Payer: WPS Commercial |
$114.16
|
|
|
Cortisol Saliva 3sp
|
Facility
|
IP
|
$148.20
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
6180723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.52 |
| Max. Negotiated Rate |
$141.80 |
| Rate for Payer: Aetna Commercial |
$138.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.69
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna Commercial |
$141.80
|
| Rate for Payer: Health EOS Commercial |
$137.17
|
| Rate for Payer: HFN Commercial |
$141.80
|
| Rate for Payer: Multiplan Commercial |
$123.30
|
| Rate for Payer: Preferred Network Access Commercial |
$141.80
|
| Rate for Payer: Quartz Beloit One Network |
$75.52
|
| Rate for Payer: Quartz Commercial |
$92.48
|
| Rate for Payer: WEA Trust Commercial |
$84.77
|
| Rate for Payer: WPS Commercial |
$114.16
|
|
|
Cortisol Total
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2942880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Cortisol Total
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2942880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$113.62 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$16.95
|
| Rate for Payer: Anthem Medicare Advantage |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.95
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$25.43
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: Quartz Medicare Advantage |
$16.95
|
| Rate for Payer: The Alliance Commercial |
$66.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.95
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$74.59
|
|
|
Cortisol Total
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2942880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$16.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.14
|
| Rate for Payer: Anthem Medicare Advantage |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.95
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$25.43
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$16.95
|
| Rate for Payer: The Alliance Commercial |
$67.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.95
|
| Rate for Payer: United Healthcare PPO |
$89.70
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: Wellcare Medicare |
$16.95
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Cortisone 24 Hour Urine
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
1038926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$272.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$25.07
|
| Rate for Payer: Anthem Medicare Advantage |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.07
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.07
|
| Rate for Payer: Health EOS Commercial |
$261.21
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.07
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$37.61
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$126.30
|
| Rate for Payer: Quartz Commercial |
$163.61
|
| Rate for Payer: Quartz Medicare Advantage |
$25.07
|
| Rate for Payer: The Alliance Commercial |
$99.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.07
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$110.33
|
|
|
Cortisone 24 Hour Urine
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
1038926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
Cortisone 24 Hour Urine
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
1038926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.07 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$25.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.62
|
| Rate for Payer: Anthem Medicare Advantage |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.07
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.07
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.07
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$37.61
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$25.07
|
| Rate for Payer: The Alliance Commercial |
$100.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.07
|
| Rate for Payer: United Healthcare PPO |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: Wellcare Medicare |
$25.07
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
Cortisporin Otic Suspension 10ml [Med]
|
Facility
|
IP
|
$340.00
|
|
| Hospital Charge Code |
2974926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$173.26 |
| Max. Negotiated Rate |
$325.31 |
| Rate for Payer: Aetna Commercial |
$318.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.41
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$325.31
|
| Rate for Payer: Health EOS Commercial |
$314.70
|
| Rate for Payer: HFN Commercial |
$325.31
|
| Rate for Payer: Multiplan Commercial |
$282.88
|
| Rate for Payer: Preferred Network Access Commercial |
$325.31
|
| Rate for Payer: Quartz Beloit One Network |
$173.26
|
| Rate for Payer: Quartz Commercial |
$212.16
|
| Rate for Payer: WEA Trust Commercial |
$194.48
|
| Rate for Payer: WPS Commercial |
$261.90
|
|
|
Cortisporin Otic Suspension 10ml [Med]
|
Facility
|
OP
|
$340.00
|
|
| Hospital Charge Code |
2974926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$99.01 |
| Max. Negotiated Rate |
$325.31 |
| Rate for Payer: Aetna Commercial |
$318.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.10
|
| Rate for Payer: Aetna Managed Medicare |
$99.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.41
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$325.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$314.70
|
| Rate for Payer: HFN Commercial |
$325.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$282.88
|
| Rate for Payer: NAPHCARE Commercial |
$212.16
|
| Rate for Payer: Preferred Network Access Commercial |
$325.31
|
| Rate for Payer: Quartz Beloit One Network |
$173.26
|
| Rate for Payer: Quartz Commercial |
$229.84
|
| Rate for Payer: Quartz Medicare Advantage |
$212.16
|
| Rate for Payer: The Alliance Commercial |
$176.80
|
| Rate for Payer: WEA Trust Commercial |
$194.48
|
| Rate for Payer: WPS Commercial |
$261.90
|
|
|
Cortrosyn 0.25 mg Charge
|
Facility
|
OP
|
$848.00
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
2958863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$39.34 |
| Max. Negotiated Rate |
$811.37 |
| Rate for Payer: Aetna Commercial |
$793.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$758.45
|
| Rate for Payer: Aetna Managed Medicare |
$246.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$573.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$440.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$423.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.42
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$811.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.34
|
| Rate for Payer: Health EOS Commercial |
$784.91
|
| Rate for Payer: HFN Commercial |
$811.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$661.44
|
| Rate for Payer: Multiplan Commercial |
$705.54
|
| Rate for Payer: NAPHCARE Commercial |
$529.15
|
| Rate for Payer: Preferred Network Access Commercial |
$811.37
|
| Rate for Payer: Quartz Beloit One Network |
$432.14
|
| Rate for Payer: Quartz Commercial |
$573.25
|
| Rate for Payer: Quartz Medicare Advantage |
$529.15
|
| Rate for Payer: The Alliance Commercial |
$85.90
|
| Rate for Payer: WEA Trust Commercial |
$485.06
|
| Rate for Payer: WPS Commercial |
$74.34
|
|
|
Cortrosyn 0.25 mg Charge
|
Facility
|
IP
|
$848.00
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
2958863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$811.37 |
| Rate for Payer: Aetna Commercial |
$793.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$758.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.42
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$811.37
|
| Rate for Payer: Health EOS Commercial |
$784.91
|
| Rate for Payer: HFN Commercial |
$811.37
|
| Rate for Payer: Multiplan Commercial |
$705.54
|
| Rate for Payer: Preferred Network Access Commercial |
$811.37
|
| Rate for Payer: Quartz Beloit One Network |
$432.14
|
| Rate for Payer: Quartz Commercial |
$529.15
|
| Rate for Payer: WEA Trust Commercial |
$485.06
|
| Rate for Payer: WPS Commercial |
$653.21
|
|
|
Cortrosyn 0.25 mg Charge
|
Professional
|
Both
|
$848.00
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
2958863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.48 |
| Max. Negotiated Rate |
$837.82 |
| Rate for Payer: Aetna Commercial |
$837.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$758.45
|
| Rate for Payer: Aetna Managed Medicare |
$21.48
|
| Rate for Payer: Anthem Medicare Advantage |
$21.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.48
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$837.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.74
|
| Rate for Payer: Health EOS Commercial |
$802.55
|
| Rate for Payer: HFN Commercial |
$837.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.48
|
| Rate for Payer: Multiplan Commercial |
$705.54
|
| Rate for Payer: NAPHCARE Commercial |
$32.21
|
| Rate for Payer: Preferred Network Access Commercial |
$837.82
|
| Rate for Payer: Quartz Beloit One Network |
$388.04
|
| Rate for Payer: Quartz Commercial |
$502.69
|
| Rate for Payer: Quartz Medicare Advantage |
$21.48
|
| Rate for Payer: The Alliance Commercial |
$59.06
|
| Rate for Payer: United Healthcare Medicaid |
$21.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.48
|
| Rate for Payer: WEA Trust Commercial |
$485.06
|
| Rate for Payer: WPS Commercial |
$74.34
|
|
|
COTTON TIP APPLICATOR PLASTIC 6 IN STERILE 10PK 30-351
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
2969967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
COTTON TIP APPLICATOR PLASTIC 6 IN STERILE 10PK 30-351
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
2969967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Coude* - Urinary catheter type:
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877762
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$344.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$264.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.09
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$344.08
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
Coude* - Urinary catheter type:
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877762
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$259.39 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$317.62
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
Coude - Urinary Catheter Type
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
2999941
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$259.39 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$317.62
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
Coude - Urinary Catheter Type
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
2999941
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$344.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$264.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.09
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$344.08
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
Coude* - Urinary Catheter Type:
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510856
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$259.39 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$317.62
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
