|
Angio Abdominal S&I
|
Facility
|
OP
|
$5,487.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
3052537
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$5,135.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,907.57
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,287.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,829.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,338.17
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,024.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cigna Commercial |
$5,249.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,193.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$5,078.77
|
| Rate for Payer: HFN Commercial |
$5,249.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$4,565.18
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,249.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,796.18
|
| Rate for Payer: Quartz Commercial |
$3,709.21
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$3,138.56
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$4,226.64
|
|
|
Angio Abd/Pelvis/LE S&I
|
Facility
|
IP
|
$11,358.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
3052538
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,788.04 |
| Max. Negotiated Rate |
$10,867.33 |
| Rate for Payer: Aetna Commercial |
$10,631.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,158.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,260.53
|
| Rate for Payer: Cash Price |
$3,407.40
|
| Rate for Payer: Cigna Commercial |
$10,867.33
|
| Rate for Payer: Health EOS Commercial |
$10,512.96
|
| Rate for Payer: HFN Commercial |
$10,867.33
|
| Rate for Payer: Multiplan Commercial |
$9,449.86
|
| Rate for Payer: Preferred Network Access Commercial |
$10,867.33
|
| Rate for Payer: Quartz Beloit One Network |
$5,788.04
|
| Rate for Payer: Quartz Commercial |
$7,087.39
|
| Rate for Payer: WEA Trust Commercial |
$6,496.78
|
| Rate for Payer: WPS Commercial |
$8,749.07
|
|
|
Angio Abd/Pelvis/LE S&I
|
Facility
|
OP
|
$11,358.00
|
|
|
Service Code
|
CPT 75630
|
| Hospital Charge Code |
3052538
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$10,631.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,158.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,678.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,906.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,669.91
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,260.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$3,407.40
|
| Rate for Payer: Cash Price |
$3,407.40
|
| Rate for Payer: Cigna Commercial |
$10,867.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,610.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$10,512.96
|
| Rate for Payer: HFN Commercial |
$10,867.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$9,449.86
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$10,867.33
|
| Rate for Payer: Quartz Beloit One Network |
$5,788.04
|
| Rate for Payer: Quartz Commercial |
$7,678.01
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: WEA Trust Commercial |
$6,496.78
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$8,749.07
|
|
|
Angio Arch
|
Facility
|
OP
|
$3,170.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
3052418
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,615.43 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$2,967.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,835.25
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cigna Commercial |
$3,033.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$2,934.15
|
| Rate for Payer: HFN Commercial |
$3,033.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$2,637.44
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,033.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.43
|
| Rate for Payer: Quartz Commercial |
$2,142.92
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$1,813.24
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$2,441.85
|
|
|
Angio Arch
|
Facility
|
IP
|
$3,170.00
|
|
|
Service Code
|
CPT 36221
|
| Hospital Charge Code |
3052418
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,615.43 |
| Max. Negotiated Rate |
$3,033.06 |
| Rate for Payer: Aetna Commercial |
$2,967.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,835.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,747.30
|
| Rate for Payer: Cash Price |
$951.00
|
| Rate for Payer: Cigna Commercial |
$3,033.06
|
| Rate for Payer: Health EOS Commercial |
$2,934.15
|
| Rate for Payer: HFN Commercial |
$3,033.06
|
| Rate for Payer: Multiplan Commercial |
$2,637.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,033.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,615.43
|
| Rate for Payer: Quartz Commercial |
$1,978.08
|
| Rate for Payer: WEA Trust Commercial |
$1,813.24
|
| Rate for Payer: WPS Commercial |
$2,441.85
|
|
|
Angio Carotid Bil w/wo Arch
|
Facility
|
IP
|
$19,467.00
|
|
|
Service Code
|
CPT 36222 50
|
| Hospital Charge Code |
5577888
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,920.38 |
| Max. Negotiated Rate |
$18,626.03 |
| Rate for Payer: Aetna Commercial |
$18,221.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,411.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,730.21
|
| Rate for Payer: Cash Price |
$5,840.10
|
| Rate for Payer: Cigna Commercial |
$18,626.03
|
| Rate for Payer: Health EOS Commercial |
$18,018.66
|
| Rate for Payer: HFN Commercial |
$18,626.03
|
| Rate for Payer: Multiplan Commercial |
$16,196.54
|
| Rate for Payer: Preferred Network Access Commercial |
$18,626.03
|
| Rate for Payer: Quartz Beloit One Network |
$9,920.38
|
| Rate for Payer: Quartz Commercial |
$12,147.41
|
| Rate for Payer: WEA Trust Commercial |
$11,135.12
|
| Rate for Payer: WPS Commercial |
$14,995.43
|
|
|
Angio Carotid Bil w/wo Arch
|
Facility
|
OP
|
$19,467.00
|
|
|
Service Code
|
CPT 36222 50
|
| Hospital Charge Code |
5577888
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,267.12 |
| Max. Negotiated Rate |
$18,626.03 |
| Rate for Payer: Aetna Commercial |
$18,221.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,411.28
|
| Rate for Payer: Aetna Managed Medicare |
$5,668.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,730.21
|
| Rate for Payer: Cash Price |
$5,840.10
|
| Rate for Payer: Cash Price |
$5,840.10
|
| Rate for Payer: Cash Price |
$5,840.10
|
| Rate for Payer: Cigna Commercial |
$18,626.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$18,018.66
|
| Rate for Payer: HFN Commercial |
$18,626.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,184.26
|
| Rate for Payer: Multiplan Commercial |
$16,196.54
|
| Rate for Payer: NAPHCARE Commercial |
$12,147.41
|
| Rate for Payer: Preferred Network Access Commercial |
$18,626.03
|
| Rate for Payer: Quartz Beloit One Network |
$9,920.38
|
| Rate for Payer: Quartz Commercial |
$13,159.69
|
| Rate for Payer: Quartz Medicare Advantage |
$12,147.41
|
| Rate for Payer: The Alliance Commercial |
$10,122.84
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$11,135.12
|
| Rate for Payer: WPS Commercial |
$14,995.43
|
|
|
Angio Carotid Selective Internal w/wo Arch
|
Facility
|
OP
|
$4,513.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
4163434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,299.82 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$4,224.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,036.43
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,487.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cash Price |
$1,353.90
|
| Rate for Payer: Cash Price |
$1,353.90
|
| Rate for Payer: Cash Price |
$1,353.90
|
| Rate for Payer: Cigna Commercial |
$4,318.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$4,177.23
|
| Rate for Payer: HFN Commercial |
$4,318.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$3,754.82
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,318.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,299.82
|
| Rate for Payer: Quartz Commercial |
$3,050.79
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: WEA Trust Commercial |
$2,581.44
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$3,476.36
|
|
|
Angio Carotid Selective Internal w/wo Arch
|
Facility
|
IP
|
$4,513.00
|
|
|
Service Code
|
CPT 36224
|
| Hospital Charge Code |
4163434
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,299.82 |
| Max. Negotiated Rate |
$4,318.04 |
| Rate for Payer: Aetna Commercial |
$4,224.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,036.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,487.57
|
| Rate for Payer: Cash Price |
$1,353.90
|
| Rate for Payer: Cigna Commercial |
$4,318.04
|
| Rate for Payer: Health EOS Commercial |
$4,177.23
|
| Rate for Payer: HFN Commercial |
$4,318.04
|
| Rate for Payer: Multiplan Commercial |
$3,754.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,318.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,299.82
|
| Rate for Payer: Quartz Commercial |
$2,816.11
|
| Rate for Payer: WEA Trust Commercial |
$2,581.44
|
| Rate for Payer: WPS Commercial |
$3,476.36
|
|
|
Angio Carotid Uni w/wo Arch
|
Facility
|
OP
|
$10,108.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
3052419
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$9,461.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,040.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,571.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: Cigna Commercial |
$9,671.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$9,355.96
|
| Rate for Payer: HFN Commercial |
$9,671.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$8,409.86
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$9,671.33
|
| Rate for Payer: Quartz Beloit One Network |
$5,151.04
|
| Rate for Payer: Quartz Commercial |
$6,833.01
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$5,781.78
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$7,786.19
|
|
|
Angio Carotid Uni w/wo Arch
|
Facility
|
IP
|
$10,108.00
|
|
|
Service Code
|
CPT 36222
|
| Hospital Charge Code |
3052419
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,151.04 |
| Max. Negotiated Rate |
$9,671.33 |
| Rate for Payer: Aetna Commercial |
$9,461.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,040.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,571.53
|
| Rate for Payer: Cash Price |
$3,032.40
|
| Rate for Payer: Cigna Commercial |
$9,671.33
|
| Rate for Payer: Health EOS Commercial |
$9,355.96
|
| Rate for Payer: HFN Commercial |
$9,671.33
|
| Rate for Payer: Multiplan Commercial |
$8,409.86
|
| Rate for Payer: Preferred Network Access Commercial |
$9,671.33
|
| Rate for Payer: Quartz Beloit One Network |
$5,151.04
|
| Rate for Payer: Quartz Commercial |
$6,307.39
|
| Rate for Payer: WEA Trust Commercial |
$5,781.78
|
| Rate for Payer: WPS Commercial |
$7,786.19
|
|
|
ANGIOCATH 14gGX 5.25 382269
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2965510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.05 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$324.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.36
|
| Rate for Payer: Aetna Managed Medicare |
$101.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$234.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.27
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$332.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.95
|
| Rate for Payer: Health EOS Commercial |
$321.18
|
| Rate for Payer: HFN Commercial |
$332.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.66
|
| Rate for Payer: Multiplan Commercial |
$288.70
|
| Rate for Payer: NAPHCARE Commercial |
$216.53
|
| Rate for Payer: Preferred Network Access Commercial |
$332.01
|
| Rate for Payer: Quartz Beloit One Network |
$176.83
|
| Rate for Payer: Quartz Commercial |
$234.57
|
| Rate for Payer: Quartz Medicare Advantage |
$216.53
|
| Rate for Payer: The Alliance Commercial |
$180.44
|
| Rate for Payer: WEA Trust Commercial |
$198.48
|
| Rate for Payer: WPS Commercial |
$267.29
|
|
|
ANGIOCATH 14gGX 5.25 382269
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2965510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$176.83 |
| Max. Negotiated Rate |
$332.01 |
| Rate for Payer: Aetna Commercial |
$324.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.27
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$332.01
|
| Rate for Payer: Health EOS Commercial |
$321.18
|
| Rate for Payer: HFN Commercial |
$332.01
|
| Rate for Payer: Multiplan Commercial |
$288.70
|
| Rate for Payer: Preferred Network Access Commercial |
$332.01
|
| Rate for Payer: Quartz Beloit One Network |
$176.83
|
| Rate for Payer: Quartz Commercial |
$216.53
|
| Rate for Payer: WEA Trust Commercial |
$198.48
|
| Rate for Payer: WPS Commercial |
$267.29
|
|
|
Angiocath #16
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Angiocath #16
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040299
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Angiocath #18
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040300
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Angiocath #18
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040300
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
ANGIOCATH 18Gx1.88IN
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2965922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.42
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$55.54
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$55.54
|
| Rate for Payer: The Alliance Commercial |
$46.28
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
ANGIOCATH 18Gx1.88IN
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
2965922
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Angio Cerebral Uni w/wo Arch
|
Facility
|
IP
|
$10,036.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
3052420
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,114.35 |
| Max. Negotiated Rate |
$9,602.44 |
| Rate for Payer: Aetna Commercial |
$9,393.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,976.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,531.84
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,602.44
|
| Rate for Payer: Health EOS Commercial |
$9,289.32
|
| Rate for Payer: HFN Commercial |
$9,602.44
|
| Rate for Payer: Multiplan Commercial |
$8,349.95
|
| Rate for Payer: Preferred Network Access Commercial |
$9,602.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,114.35
|
| Rate for Payer: Quartz Commercial |
$6,262.46
|
| Rate for Payer: WEA Trust Commercial |
$5,740.59
|
| Rate for Payer: WPS Commercial |
$7,730.73
|
|
|
Angio Cerebral Uni w/wo Arch
|
Facility
|
OP
|
$10,036.00
|
|
|
Service Code
|
CPT 36223
|
| Hospital Charge Code |
3052420
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,386.95 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$9,393.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,976.20
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,531.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cash Price |
$3,010.80
|
| Rate for Payer: Cigna Commercial |
$9,602.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$9,289.32
|
| Rate for Payer: HFN Commercial |
$9,602.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$8,349.95
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$9,602.44
|
| Rate for Payer: Quartz Beloit One Network |
$5,114.35
|
| Rate for Payer: Quartz Commercial |
$6,784.34
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: WEA Trust Commercial |
$5,740.59
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$7,730.73
|
|
|
Angio Ea Add Selective S&I +
|
Facility
|
IP
|
$7,756.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
3052544
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,952.46 |
| Max. Negotiated Rate |
$7,420.94 |
| Rate for Payer: Aetna Commercial |
$7,259.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,936.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,275.11
|
| Rate for Payer: Cash Price |
$2,326.80
|
| Rate for Payer: Cigna Commercial |
$7,420.94
|
| Rate for Payer: Health EOS Commercial |
$7,178.95
|
| Rate for Payer: HFN Commercial |
$7,420.94
|
| Rate for Payer: Multiplan Commercial |
$6,452.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,420.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,952.46
|
| Rate for Payer: Quartz Commercial |
$4,839.74
|
| Rate for Payer: WEA Trust Commercial |
$4,436.43
|
| Rate for Payer: WPS Commercial |
$5,974.45
|
|
|
Angio Ea Add Selective S&I +
|
Facility
|
OP
|
$7,756.00
|
|
|
Service Code
|
CPT 75774
|
| Hospital Charge Code |
3052544
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$377.85 |
| Max. Negotiated Rate |
$7,420.94 |
| Rate for Payer: Aetna Commercial |
$7,259.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,936.97
|
| Rate for Payer: Aetna Managed Medicare |
$2,258.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,243.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,033.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,871.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,275.11
|
| Rate for Payer: Cash Price |
$2,326.80
|
| Rate for Payer: Cash Price |
$2,326.80
|
| Rate for Payer: Cigna Commercial |
$7,420.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,513.99
|
| Rate for Payer: Health EOS Commercial |
$7,178.95
|
| Rate for Payer: HFN Commercial |
$7,420.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,049.68
|
| Rate for Payer: Multiplan Commercial |
$6,452.99
|
| Rate for Payer: NAPHCARE Commercial |
$4,839.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,420.94
|
| Rate for Payer: Quartz Beloit One Network |
$3,952.46
|
| Rate for Payer: Quartz Commercial |
$5,243.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4,839.74
|
| Rate for Payer: The Alliance Commercial |
$377.85
|
| Rate for Payer: WEA Trust Commercial |
$4,436.43
|
| Rate for Payer: WPS Commercial |
$5,974.45
|
|
|
ANGIOGRAM, DIALYSIS
|
Facility
|
IP
|
$1,664.00
|
|
| Hospital Charge Code |
6209795
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$847.97 |
| Max. Negotiated Rate |
$1,592.12 |
| Rate for Payer: Aetna Commercial |
$1,557.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,592.12
|
| Rate for Payer: Health EOS Commercial |
$1,540.20
|
| Rate for Payer: HFN Commercial |
$1,592.12
|
| Rate for Payer: Multiplan Commercial |
$1,384.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.12
|
| Rate for Payer: Quartz Beloit One Network |
$847.97
|
| Rate for Payer: Quartz Commercial |
$1,038.34
|
| Rate for Payer: WEA Trust Commercial |
$951.81
|
| Rate for Payer: WPS Commercial |
$1,281.78
|
|
|
ANGIOGRAM, DIALYSIS
|
Facility
|
OP
|
$1,664.00
|
|
| Hospital Charge Code |
6209795
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$484.56 |
| Max. Negotiated Rate |
$1,592.12 |
| Rate for Payer: Aetna Commercial |
$1,557.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,488.28
|
| Rate for Payer: Aetna Managed Medicare |
$484.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,124.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$865.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$830.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$917.20
|
| Rate for Payer: Cash Price |
$499.20
|
| Rate for Payer: Cigna Commercial |
$1,592.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$968.45
|
| Rate for Payer: Health EOS Commercial |
$1,540.20
|
| Rate for Payer: HFN Commercial |
$1,592.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,297.92
|
| Rate for Payer: Multiplan Commercial |
$1,384.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,038.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,592.12
|
| Rate for Payer: Quartz Beloit One Network |
$847.97
|
| Rate for Payer: Quartz Commercial |
$1,124.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,038.34
|
| Rate for Payer: The Alliance Commercial |
$865.28
|
| Rate for Payer: WEA Trust Commercial |
$951.81
|
| Rate for Payer: WPS Commercial |
$1,281.78
|
|
