|
CT Spine Thoracic w/ + w/o Contrast
|
Facility
OP
|
$5,148.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
630164
|
| Min. Negotiated Rate |
$4.96 |
| Max. Negotiated Rate |
$4,736.16 |
| Rate for Payer: Aetna Commercial |
$4,633.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,427.28
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,346.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,574.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,471.04
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,728.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,736.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$4,581.72
|
| Rate for Payer: HFN Commercial |
$4,736.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$4,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,736.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,522.52
|
| Rate for Payer: Quartz Commercial |
$3,346.20
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$4.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$2,831.40
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$3,813.12
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Facility
IP
|
$5,148.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
630164
|
| Min. Negotiated Rate |
$2,522.52 |
| Max. Negotiated Rate |
$4,736.16 |
| Rate for Payer: Aetna Commercial |
$4,633.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,728.44
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,736.16
|
| Rate for Payer: Health EOS Commercial |
$4,581.72
|
| Rate for Payer: HFN Commercial |
$4,736.16
|
| Rate for Payer: Multiplan Commercial |
$4,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,088.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,736.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,522.52
|
| Rate for Payer: Quartz Commercial |
$3,088.80
|
| Rate for Payer: WEA Trust Commercial |
$2,831.40
|
| Rate for Payer: WPS Commercial |
$3,813.12
|
|
|
CT Spine Thoracic w/ + w/o Contrast
|
Professional
|
$5,148.00
|
|
|
Service Code
|
CPT 72130
|
| Hospital Charge Code |
630164
|
| Min. Negotiated Rate |
$199.81 |
| Max. Negotiated Rate |
$4,890.60 |
| Rate for Payer: Aetna Commercial |
$4,890.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,427.28
|
| Rate for Payer: Aetna Managed Medicare |
$199.81
|
| Rate for Payer: Anthem Medicare Advantage |
$199.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$199.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$199.81
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cash Price |
$1,544.40
|
| Rate for Payer: Cigna Commercial |
$4,890.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,574.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.81
|
| Rate for Payer: Health EOS Commercial |
$4,684.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$735.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$735.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$199.81
|
| Rate for Payer: Multiplan Commercial |
$4,118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,890.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,265.12
|
| Rate for Payer: Quartz Commercial |
$2,934.36
|
| Rate for Payer: Quartz Medicare Advantage |
$199.81
|
| Rate for Payer: The Alliance Commercial |
$759.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$199.81
|
| Rate for Payer: WEA Trust Commercial |
$2,831.40
|
| Rate for Payer: WPS Commercial |
$999.05
|
|
|
CT Stereo Nav for Sinus Surgery
|
Facility
IP
|
$2,378.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
1238811
|
| Min. Negotiated Rate |
$1,165.22 |
| Max. Negotiated Rate |
$2,187.76 |
| Rate for Payer: Aetna Commercial |
$2,140.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.34
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,187.76
|
| Rate for Payer: Health EOS Commercial |
$2,116.42
|
| Rate for Payer: HFN Commercial |
$2,187.76
|
| Rate for Payer: Multiplan Commercial |
$1,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,426.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.22
|
| Rate for Payer: Quartz Commercial |
$1,426.80
|
| Rate for Payer: WEA Trust Commercial |
$1,307.90
|
| Rate for Payer: WPS Commercial |
$1,761.38
|
|
|
CT Stereo Nav for Sinus Surgery
|
Professional
|
$2,610.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241281
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$88.96 |
| Max. Negotiated Rate |
$2,479.50 |
| Rate for Payer: Aetna Commercial |
$2,479.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,244.60
|
| Rate for Payer: Aetna Managed Medicare |
$88.96
|
| Rate for Payer: Anthem Medicare Advantage |
$88.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.96
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,479.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,305.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.96
|
| Rate for Payer: Health EOS Commercial |
$2,375.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$327.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$327.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.96
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,148.40
|
| Rate for Payer: Quartz Commercial |
$1,487.70
|
| Rate for Payer: Quartz Medicare Advantage |
$88.96
|
| Rate for Payer: The Alliance Commercial |
$338.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.96
|
| Rate for Payer: WEA Trust Commercial |
$1,435.50
|
| Rate for Payer: WPS Commercial |
$444.80
|
|
|
CT Stereo Nav for Sinus Surgery
|
Facility
IP
|
$2,610.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241281
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,278.90 |
| Max. Negotiated Rate |
$2,401.20 |
| Rate for Payer: Aetna Commercial |
$2,349.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,383.30
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,401.20
|
| Rate for Payer: Health EOS Commercial |
$2,322.90
|
| Rate for Payer: HFN Commercial |
$2,401.20
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,401.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,278.90
|
| Rate for Payer: Quartz Commercial |
$1,566.00
|
| Rate for Payer: WEA Trust Commercial |
$1,435.50
|
| Rate for Payer: WPS Commercial |
$1,933.23
|
|
|
CT Stereo Nav for Sinus Surgery
|
Facility
OP
|
$2,378.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
1238811
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$2,187.76 |
| Rate for Payer: Aetna Commercial |
$2,140.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.08
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,545.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,189.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,141.44
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,260.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,187.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$2,116.42
|
| Rate for Payer: HFN Commercial |
$2,187.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,902.40
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,165.22
|
| Rate for Payer: Quartz Commercial |
$1,545.70
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$85.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: WEA Trust Commercial |
$1,307.90
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,761.38
|
|
|
CT Stereo Nav for Sinus Surgery
|
Facility
OP
|
$2,610.00
|
|
|
Service Code
|
CPT 70486 TC
|
| Hospital Charge Code |
1241281
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$622.72 |
| Max. Negotiated Rate |
$10,440.00 |
| Rate for Payer: Aetna Commercial |
$2,349.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,244.60
|
| Rate for Payer: Aetna Managed Medicare |
$730.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,383.30
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,401.20
|
| Rate for Payer: Health EOS Commercial |
$2,322.90
|
| Rate for Payer: HFN Commercial |
$2,401.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,957.50
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,401.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,278.90
|
| Rate for Payer: Quartz Commercial |
$1,696.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.00
|
| Rate for Payer: The Alliance Commercial |
$10,440.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,435.50
|
| Rate for Payer: WPS Commercial |
$622.72
|
|
|
CT Stereo Nav for Sinus Surgery
|
Professional
|
$2,378.00
|
|
|
Service Code
|
CPT 70486
|
| Hospital Charge Code |
1238811
|
| Min. Negotiated Rate |
$128.49 |
| Max. Negotiated Rate |
$2,259.10 |
| Rate for Payer: Aetna Commercial |
$2,259.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,045.08
|
| Rate for Payer: Aetna Managed Medicare |
$128.49
|
| Rate for Payer: Anthem Medicare Advantage |
$128.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.49
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cash Price |
$713.40
|
| Rate for Payer: Cigna Commercial |
$2,259.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,189.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.49
|
| Rate for Payer: Health EOS Commercial |
$2,163.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$469.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.49
|
| Rate for Payer: Multiplan Commercial |
$1,902.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,259.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,046.32
|
| Rate for Payer: Quartz Commercial |
$1,355.46
|
| Rate for Payer: Quartz Medicare Advantage |
$128.49
|
| Rate for Payer: The Alliance Commercial |
$488.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.49
|
| Rate for Payer: WEA Trust Commercial |
$1,307.90
|
| Rate for Payer: WPS Commercial |
$642.45
|
|
|
CT Stone Protocol w/o Contrast
|
Facility
OP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5724172
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$720.37 |
| Max. Negotiated Rate |
$23,844.00 |
| Rate for Payer: Aetna Commercial |
$5,364.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,126.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,669.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,159.33
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,484.12
|
| Rate for Payer: Health EOS Commercial |
$5,305.29
|
| Rate for Payer: HFN Commercial |
$5,484.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,470.75
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,484.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,920.89
|
| Rate for Payer: Quartz Commercial |
$3,874.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,576.60
|
| Rate for Payer: The Alliance Commercial |
$23,844.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$720.37
|
|
|
CT Stone Protocol w/o Contrast
|
Professional
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5724172
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$102.91 |
| Max. Negotiated Rate |
$5,662.95 |
| Rate for Payer: Aetna Commercial |
$5,662.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,126.46
|
| Rate for Payer: Aetna Managed Medicare |
$102.91
|
| Rate for Payer: Anthem Medicare Advantage |
$102.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.91
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,662.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,980.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.91
|
| Rate for Payer: Health EOS Commercial |
$5,424.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.91
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,662.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,622.84
|
| Rate for Payer: Quartz Commercial |
$3,397.77
|
| Rate for Payer: Quartz Medicare Advantage |
$102.91
|
| Rate for Payer: The Alliance Commercial |
$391.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.91
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$514.55
|
|
|
CT Stone Protocol w/o Contrast
|
Facility
IP
|
$5,961.00
|
|
|
Service Code
|
CPT 74176 TC
|
| Hospital Charge Code |
5724172
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$2,920.89 |
| Max. Negotiated Rate |
$5,484.12 |
| Rate for Payer: Aetna Commercial |
$5,364.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,159.33
|
| Rate for Payer: Cash Price |
$1,788.30
|
| Rate for Payer: Cigna Commercial |
$5,484.12
|
| Rate for Payer: Health EOS Commercial |
$5,305.29
|
| Rate for Payer: HFN Commercial |
$5,484.12
|
| Rate for Payer: Multiplan Commercial |
$4,768.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,576.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,484.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,920.89
|
| Rate for Payer: Quartz Commercial |
$3,576.60
|
| Rate for Payer: WEA Trust Commercial |
$3,278.55
|
| Rate for Payer: WPS Commercial |
$4,415.31
|
|
|
CT Thoracic Spine Unenhanced
|
Facility
OP
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
3072652
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$588.91 |
| Max. Negotiated Rate |
$15,176.00 |
| Rate for Payer: Aetna Commercial |
$3,414.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,262.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,062.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,010.82
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,490.48
|
| Rate for Payer: Health EOS Commercial |
$3,376.66
|
| Rate for Payer: HFN Commercial |
$3,490.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,845.50
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,276.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,490.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,859.06
|
| Rate for Payer: Quartz Commercial |
$2,466.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,276.40
|
| Rate for Payer: The Alliance Commercial |
$15,176.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,086.70
|
| Rate for Payer: WPS Commercial |
$588.91
|
|
|
CT Thoracic Spine Unenhanced
|
Facility
IP
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
3072652
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,859.06 |
| Max. Negotiated Rate |
$3,490.48 |
| Rate for Payer: Aetna Commercial |
$3,414.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,010.82
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,490.48
|
| Rate for Payer: Health EOS Commercial |
$3,376.66
|
| Rate for Payer: HFN Commercial |
$3,490.48
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,276.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,490.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,859.06
|
| Rate for Payer: Quartz Commercial |
$2,276.40
|
| Rate for Payer: WEA Trust Commercial |
$2,086.70
|
| Rate for Payer: WPS Commercial |
$2,810.22
|
|
|
CT Thoracic Spine Unenhanced
|
Professional
|
$3,794.00
|
|
|
Service Code
|
CPT 72128 TC
|
| Hospital Charge Code |
3072652
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$84.13 |
| Max. Negotiated Rate |
$3,604.30 |
| Rate for Payer: Aetna Commercial |
$3,604.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,262.84
|
| Rate for Payer: Aetna Managed Medicare |
$84.13
|
| Rate for Payer: Anthem Medicare Advantage |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.13
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cash Price |
$1,138.20
|
| Rate for Payer: Cigna Commercial |
$3,604.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,897.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.13
|
| Rate for Payer: Health EOS Commercial |
$3,452.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.13
|
| Rate for Payer: Multiplan Commercial |
$3,035.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,604.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,669.36
|
| Rate for Payer: Quartz Commercial |
$2,162.58
|
| Rate for Payer: Quartz Medicare Advantage |
$84.13
|
| Rate for Payer: The Alliance Commercial |
$319.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.13
|
| Rate for Payer: WEA Trust Commercial |
$2,086.70
|
| Rate for Payer: WPS Commercial |
$420.65
|
|
|
CT Thorax Enhanced
|
Facility
IP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
2948642
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,890.42 |
| Max. Negotiated Rate |
$3,549.36 |
| Rate for Payer: Aetna Commercial |
$3,472.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,044.74
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,549.36
|
| Rate for Payer: Health EOS Commercial |
$3,433.62
|
| Rate for Payer: HFN Commercial |
$3,549.36
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,314.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,549.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.42
|
| Rate for Payer: Quartz Commercial |
$2,314.80
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$2,857.62
|
|
|
CT Thorax Enhanced
|
Professional
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
2948642
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$113.21 |
| Max. Negotiated Rate |
$3,665.10 |
| Rate for Payer: Aetna Commercial |
$3,665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,317.88
|
| Rate for Payer: Aetna Managed Medicare |
$113.21
|
| Rate for Payer: Anthem Medicare Advantage |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.21
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,665.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,929.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.21
|
| Rate for Payer: Health EOS Commercial |
$3,510.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$422.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.21
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,665.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,697.52
|
| Rate for Payer: Quartz Commercial |
$2,199.06
|
| Rate for Payer: Quartz Medicare Advantage |
$113.21
|
| Rate for Payer: The Alliance Commercial |
$430.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.21
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$566.05
|
|
|
CT Thorax Enhanced
|
Facility
OP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
2948642
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$792.47 |
| Max. Negotiated Rate |
$15,432.00 |
| Rate for Payer: Aetna Commercial |
$3,472.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,317.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,080.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,044.74
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,549.36
|
| Rate for Payer: Health EOS Commercial |
$3,433.62
|
| Rate for Payer: HFN Commercial |
$3,549.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.50
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,314.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,549.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.42
|
| Rate for Payer: Quartz Commercial |
$2,507.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,314.80
|
| Rate for Payer: The Alliance Commercial |
$15,432.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$792.47
|
|
|
CT Thorax Unenhanced
|
Professional
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
3072765
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$83.49 |
| Max. Negotiated Rate |
$3,015.30 |
| Rate for Payer: Aetna Commercial |
$3,015.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,729.64
|
| Rate for Payer: Aetna Managed Medicare |
$83.49
|
| Rate for Payer: Anthem Medicare Advantage |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.49
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$3,015.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,587.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.49
|
| Rate for Payer: Health EOS Commercial |
$2,888.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.49
|
| Rate for Payer: Multiplan Commercial |
$2,539.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,015.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,396.56
|
| Rate for Payer: Quartz Commercial |
$1,809.18
|
| Rate for Payer: Quartz Medicare Advantage |
$83.49
|
| Rate for Payer: The Alliance Commercial |
$317.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.49
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$417.45
|
|
|
CT Thorax Unenhanced
|
Facility
IP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
3072765
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,555.26 |
| Max. Negotiated Rate |
$2,920.08 |
| Rate for Payer: Aetna Commercial |
$2,856.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,682.22
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$2,920.08
|
| Rate for Payer: Health EOS Commercial |
$2,824.86
|
| Rate for Payer: HFN Commercial |
$2,920.08
|
| Rate for Payer: Multiplan Commercial |
$2,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,904.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,920.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.26
|
| Rate for Payer: Quartz Commercial |
$1,904.40
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$2,350.98
|
|
|
CT Thorax Unenhanced
|
Facility
OP
|
$3,174.00
|
|
|
Service Code
|
CPT 71250 TC
|
| Hospital Charge Code |
3072765
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$584.43 |
| Max. Negotiated Rate |
$12,696.00 |
| Rate for Payer: Aetna Commercial |
$2,856.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,729.64
|
| Rate for Payer: Aetna Managed Medicare |
$888.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,682.22
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cash Price |
$952.20
|
| Rate for Payer: Cigna Commercial |
$2,920.08
|
| Rate for Payer: Health EOS Commercial |
$2,824.86
|
| Rate for Payer: HFN Commercial |
$2,920.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,380.50
|
| Rate for Payer: Multiplan Commercial |
$2,539.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,904.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,920.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,555.26
|
| Rate for Payer: Quartz Commercial |
$2,063.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,904.40
|
| Rate for Payer: The Alliance Commercial |
$12,696.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$1,745.70
|
| Rate for Payer: WPS Commercial |
$584.43
|
|
|
CT Thorax w/ Contrast
|
Facility
OP
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
1241286
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$792.47 |
| Max. Negotiated Rate |
$15,432.00 |
| Rate for Payer: Aetna Commercial |
$3,472.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,317.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,080.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,454.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,044.74
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,549.36
|
| Rate for Payer: Health EOS Commercial |
$3,433.62
|
| Rate for Payer: HFN Commercial |
$3,549.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.50
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,314.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,549.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,890.42
|
| Rate for Payer: Quartz Commercial |
$2,507.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,314.80
|
| Rate for Payer: The Alliance Commercial |
$15,432.00
|
| Rate for Payer: United Healthcare PPO |
$2,065.00
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$792.47
|
|
|
CT Thorax w/ Contrast
|
Professional
|
$3,858.00
|
|
|
Service Code
|
CPT 71260 TC
|
| Hospital Charge Code |
1241286
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$113.21 |
| Max. Negotiated Rate |
$3,665.10 |
| Rate for Payer: Aetna Commercial |
$3,665.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,317.88
|
| Rate for Payer: Aetna Managed Medicare |
$113.21
|
| Rate for Payer: Anthem Medicare Advantage |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.21
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cash Price |
$1,157.40
|
| Rate for Payer: Cigna Commercial |
$3,665.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,929.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.21
|
| Rate for Payer: Health EOS Commercial |
$3,510.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$422.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.21
|
| Rate for Payer: Multiplan Commercial |
$3,086.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,665.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,697.52
|
| Rate for Payer: Quartz Commercial |
$2,199.06
|
| Rate for Payer: Quartz Medicare Advantage |
$113.21
|
| Rate for Payer: The Alliance Commercial |
$430.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.21
|
| Rate for Payer: WEA Trust Commercial |
$2,121.90
|
| Rate for Payer: WPS Commercial |
$566.05
|
|
|
CT Thorax w/ Contrast
|
Professional
|
$3,353.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
629702
|
| Min. Negotiated Rate |
$167.00 |
| Max. Negotiated Rate |
$3,185.35 |
| Rate for Payer: Aetna Commercial |
$3,185.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,883.58
|
| Rate for Payer: Aetna Managed Medicare |
$167.00
|
| Rate for Payer: Anthem Medicare Advantage |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$167.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$167.00
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cigna Commercial |
$3,185.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,676.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.00
|
| Rate for Payer: Health EOS Commercial |
$3,051.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$617.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$617.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$167.00
|
| Rate for Payer: Multiplan Commercial |
$2,682.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,185.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,475.32
|
| Rate for Payer: Quartz Commercial |
$1,911.21
|
| Rate for Payer: Quartz Medicare Advantage |
$167.00
|
| Rate for Payer: The Alliance Commercial |
$634.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$167.00
|
| Rate for Payer: WEA Trust Commercial |
$1,844.15
|
| Rate for Payer: WPS Commercial |
$835.00
|
|
|
CT Thorax w/ Contrast
|
Facility
IP
|
$3,353.00
|
|
|
Service Code
|
CPT 71260
|
| Hospital Charge Code |
629702
|
| Min. Negotiated Rate |
$1,642.97 |
| Max. Negotiated Rate |
$3,084.76 |
| Rate for Payer: Aetna Commercial |
$3,017.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,777.09
|
| Rate for Payer: Cash Price |
$1,005.90
|
| Rate for Payer: Cigna Commercial |
$3,084.76
|
| Rate for Payer: Health EOS Commercial |
$2,984.17
|
| Rate for Payer: HFN Commercial |
$3,084.76
|
| Rate for Payer: Multiplan Commercial |
$2,682.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,011.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,084.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,642.97
|
| Rate for Payer: Quartz Commercial |
$2,011.80
|
| Rate for Payer: WEA Trust Commercial |
$1,844.15
|
| Rate for Payer: WPS Commercial |
$2,483.57
|
|
