|
Application of multi-layer venous wound compression system, below knee 2958150
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
CPT 29581 50
|
| Hospital Charge Code |
5494772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.94 |
| Max. Negotiated Rate |
$412.98 |
| Rate for Payer: Aetna Commercial |
$412.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.86
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$412.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.83
|
| Rate for Payer: Health EOS Commercial |
$395.60
|
| Rate for Payer: HFN Commercial |
$412.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.34
|
| Rate for Payer: Multiplan Commercial |
$347.78
|
| Rate for Payer: Preferred Network Access Commercial |
$412.98
|
| Rate for Payer: Quartz Beloit One Network |
$191.28
|
| Rate for Payer: Quartz Commercial |
$247.79
|
| Rate for Payer: The Alliance Commercial |
$217.36
|
| Rate for Payer: United Healthcare Medicaid |
$74.94
|
| Rate for Payer: WEA Trust Commercial |
$239.10
|
| Rate for Payer: WPS Commercial |
$321.99
|
|
|
Application of Paste Boot 29580
|
Professional
|
Both
|
$209.00
|
|
|
Service Code
|
CPT 29580
|
| Hospital Charge Code |
3595525
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$206.49 |
| Rate for Payer: Aetna Commercial |
$206.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$22.51
|
| Rate for Payer: Anthem Medicare Advantage |
$22.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.51
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$206.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.51
|
| Rate for Payer: Health EOS Commercial |
$197.80
|
| Rate for Payer: HFN Commercial |
$206.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.51
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$33.76
|
| Rate for Payer: Preferred Network Access Commercial |
$206.49
|
| Rate for Payer: Quartz Beloit One Network |
$95.64
|
| Rate for Payer: Quartz Commercial |
$123.90
|
| Rate for Payer: Quartz Medicare Advantage |
$22.51
|
| Rate for Payer: The Alliance Commercial |
$95.65
|
| Rate for Payer: United Healthcare Medicaid |
$21.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.51
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$101.28
|
|
|
Application of Paste Boot 2958050
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 29580 50
|
| Hospital Charge Code |
3165544
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$357.66 |
| Rate for Payer: Aetna Commercial |
$357.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.77
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$357.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.89
|
| Rate for Payer: Health EOS Commercial |
$342.60
|
| Rate for Payer: HFN Commercial |
$357.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92.04
|
| Rate for Payer: Multiplan Commercial |
$301.18
|
| Rate for Payer: Preferred Network Access Commercial |
$357.66
|
| Rate for Payer: Quartz Beloit One Network |
$165.65
|
| Rate for Payer: Quartz Commercial |
$214.59
|
| Rate for Payer: The Alliance Commercial |
$188.24
|
| Rate for Payer: United Healthcare Medicaid |
$21.02
|
| Rate for Payer: WEA Trust Commercial |
$207.06
|
| Rate for Payer: WPS Commercial |
$278.85
|
|
|
Application of Rigid Total Contact Leg Cast
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
CPT 29445
|
| Hospital Charge Code |
2572818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$693.58 |
| Rate for Payer: Aetna Commercial |
$693.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.87
|
| Rate for Payer: Aetna Managed Medicare |
$88.20
|
| Rate for Payer: Anthem Medicare Advantage |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.20
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$693.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.20
|
| Rate for Payer: Health EOS Commercial |
$664.37
|
| Rate for Payer: HFN Commercial |
$693.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$349.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.20
|
| Rate for Payer: Multiplan Commercial |
$584.06
|
| Rate for Payer: NAPHCARE Commercial |
$132.30
|
| Rate for Payer: Preferred Network Access Commercial |
$693.58
|
| Rate for Payer: Quartz Beloit One Network |
$321.24
|
| Rate for Payer: Quartz Commercial |
$416.15
|
| Rate for Payer: Quartz Medicare Advantage |
$88.20
|
| Rate for Payer: The Alliance Commercial |
$374.86
|
| Rate for Payer: United Healthcare Medicaid |
$157.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$401.54
|
| Rate for Payer: WPS Commercial |
$396.91
|
|
|
Application of Short Leg Cast 29405
|
Professional
|
Both
|
$422.00
|
|
|
Service Code
|
CPT 29405
|
| Hospital Charge Code |
2572816
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.78 |
| Max. Negotiated Rate |
$416.94 |
| Rate for Payer: Aetna Commercial |
$416.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.44
|
| Rate for Payer: Aetna Managed Medicare |
$53.78
|
| Rate for Payer: Anthem Medicare Advantage |
$53.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.78
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cash Price |
$126.60
|
| Rate for Payer: Cigna Commercial |
$416.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.78
|
| Rate for Payer: Health EOS Commercial |
$399.38
|
| Rate for Payer: HFN Commercial |
$416.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$201.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.78
|
| Rate for Payer: Multiplan Commercial |
$351.10
|
| Rate for Payer: NAPHCARE Commercial |
$80.67
|
| Rate for Payer: Preferred Network Access Commercial |
$416.94
|
| Rate for Payer: Quartz Beloit One Network |
$193.11
|
| Rate for Payer: Quartz Commercial |
$250.16
|
| Rate for Payer: Quartz Medicare Advantage |
$53.78
|
| Rate for Payer: The Alliance Commercial |
$228.56
|
| Rate for Payer: United Healthcare Medicaid |
$75.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.78
|
| Rate for Payer: WEA Trust Commercial |
$241.38
|
| Rate for Payer: WPS Commercial |
$242.00
|
|
|
Application of Short Leg Splint 29515
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
CPT 29515
|
| Hospital Charge Code |
3014304
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.64 |
| Max. Negotiated Rate |
$215.61 |
| Rate for Payer: Aetna Commercial |
$196.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Aetna Managed Medicare |
$47.91
|
| Rate for Payer: Anthem Medicare Advantage |
$47.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.91
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$196.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.91
|
| Rate for Payer: Health EOS Commercial |
$188.33
|
| Rate for Payer: HFN Commercial |
$196.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.91
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: NAPHCARE Commercial |
$71.87
|
| Rate for Payer: Preferred Network Access Commercial |
$196.61
|
| Rate for Payer: Quartz Beloit One Network |
$91.06
|
| Rate for Payer: Quartz Commercial |
$117.97
|
| Rate for Payer: Quartz Medicare Advantage |
$47.91
|
| Rate for Payer: The Alliance Commercial |
$203.63
|
| Rate for Payer: United Healthcare Medicaid |
$31.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.91
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: WPS Commercial |
$215.61
|
|
|
APPLICATION OF SHOULDER CAST 29058
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
CPT 29058
|
| Hospital Charge Code |
3014288
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$383.34 |
| Rate for Payer: Aetna Commercial |
$383.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Aetna Managed Medicare |
$83.19
|
| Rate for Payer: Anthem Medicare Advantage |
$83.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.19
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$383.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.19
|
| Rate for Payer: Health EOS Commercial |
$367.20
|
| Rate for Payer: HFN Commercial |
$383.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.19
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: NAPHCARE Commercial |
$124.78
|
| Rate for Payer: Preferred Network Access Commercial |
$383.34
|
| Rate for Payer: Quartz Beloit One Network |
$177.55
|
| Rate for Payer: Quartz Commercial |
$230.01
|
| Rate for Payer: Quartz Medicare Advantage |
$83.19
|
| Rate for Payer: The Alliance Commercial |
$353.56
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.19
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$374.35
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; FIRST 100 SQ CM WOUND SURFACE AREA, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
|
Facility
|
OP
|
$8,685.50
|
|
|
Service Code
|
CPT 15277
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,171.37 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; EACH ADDITIONAL 25 SQ CM WOUND SURFACE AREA, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 15276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: The Alliance Commercial |
$84.41
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 15275
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$777.80 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
|
|
APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LESS WOUND SURFACE AREA
|
Facility
|
OP
|
$4,947.89
|
|
|
Service Code
|
CPT 15271
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$777.80 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Managed Medicare |
$777.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$777.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$777.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$777.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$777.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,893.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$777.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$777.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$777.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$777.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,166.69
|
| Rate for Payer: Quartz Medicare Advantage |
$777.80
|
| Rate for Payer: The Alliance Commercial |
$3,111.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$777.80
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$777.80
|
|
|
Application of Thigh to Ankle Cylinder Cast 29365
|
Professional
|
Both
|
$379.00
|
|
|
Service Code
|
CPT 29365
|
| Hospital Charge Code |
3014300
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.35 |
| Max. Negotiated Rate |
$374.45 |
| Rate for Payer: Aetna Commercial |
$374.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Aetna Managed Medicare |
$78.35
|
| Rate for Payer: Anthem Medicare Advantage |
$78.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.35
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$374.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.35
|
| Rate for Payer: Health EOS Commercial |
$358.69
|
| Rate for Payer: HFN Commercial |
$374.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$295.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.35
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: NAPHCARE Commercial |
$117.53
|
| Rate for Payer: Preferred Network Access Commercial |
$374.45
|
| Rate for Payer: Quartz Beloit One Network |
$173.43
|
| Rate for Payer: Quartz Commercial |
$224.67
|
| Rate for Payer: Quartz Medicare Advantage |
$78.35
|
| Rate for Payer: The Alliance Commercial |
$333.00
|
| Rate for Payer: United Healthcare Medicaid |
$140.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.35
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: WPS Commercial |
$352.59
|
|
|
Application of Walking Cast
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
CPT 29425
|
| Hospital Charge Code |
2572817
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.02 |
| Max. Negotiated Rate |
$470.29 |
| Rate for Payer: Aetna Commercial |
$470.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$425.73
|
| Rate for Payer: Aetna Managed Medicare |
$50.02
|
| Rate for Payer: Anthem Medicare Advantage |
$50.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.02
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$470.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.02
|
| Rate for Payer: Health EOS Commercial |
$450.49
|
| Rate for Payer: HFN Commercial |
$470.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$189.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.02
|
| Rate for Payer: Multiplan Commercial |
$396.03
|
| Rate for Payer: NAPHCARE Commercial |
$75.04
|
| Rate for Payer: Preferred Network Access Commercial |
$470.29
|
| Rate for Payer: Quartz Beloit One Network |
$217.82
|
| Rate for Payer: Quartz Commercial |
$282.17
|
| Rate for Payer: Quartz Medicare Advantage |
$50.02
|
| Rate for Payer: The Alliance Commercial |
$212.60
|
| Rate for Payer: United Healthcare Medicaid |
$77.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.02
|
| Rate for Payer: WEA Trust Commercial |
$272.27
|
| Rate for Payer: WPS Commercial |
$225.11
|
|
|
Application Skin Substitute 100 sq cm 15277
|
Professional
|
Both
|
$3,438.00
|
|
|
Service Code
|
CPT 15277
|
| Hospital Charge Code |
5218606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$186.34 |
| Max. Negotiated Rate |
$3,396.74 |
| Rate for Payer: Aetna Commercial |
$3,396.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,074.95
|
| Rate for Payer: Aetna Managed Medicare |
$186.34
|
| Rate for Payer: Anthem Medicare Advantage |
$186.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$186.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$186.34
|
| Rate for Payer: Cash Price |
$1,031.40
|
| Rate for Payer: Cash Price |
$1,031.40
|
| Rate for Payer: Cash Price |
$1,031.40
|
| Rate for Payer: Cigna Commercial |
$3,396.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$233.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.34
|
| Rate for Payer: Health EOS Commercial |
$3,253.72
|
| Rate for Payer: HFN Commercial |
$3,396.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$767.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$767.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$186.34
|
| Rate for Payer: Multiplan Commercial |
$2,860.42
|
| Rate for Payer: NAPHCARE Commercial |
$279.51
|
| Rate for Payer: Preferred Network Access Commercial |
$3,396.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,573.23
|
| Rate for Payer: Quartz Commercial |
$2,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$186.34
|
| Rate for Payer: The Alliance Commercial |
$791.93
|
| Rate for Payer: United Healthcare Medicaid |
$233.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.34
|
| Rate for Payer: WEA Trust Commercial |
$1,966.54
|
| Rate for Payer: WPS Commercial |
$838.52
|
|
|
Application Skin Substitute Graft 15275
|
Professional
|
Both
|
$1,055.00
|
|
|
Service Code
|
CPT 15275
|
| Hospital Charge Code |
2572824
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.94 |
| Max. Negotiated Rate |
$1,042.34 |
| Rate for Payer: Aetna Commercial |
$1,042.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$943.59
|
| Rate for Payer: Aetna Managed Medicare |
$81.94
|
| Rate for Payer: Anthem Medicare Advantage |
$81.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.94
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cash Price |
$316.50
|
| Rate for Payer: Cigna Commercial |
$1,042.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.94
|
| Rate for Payer: Health EOS Commercial |
$998.45
|
| Rate for Payer: HFN Commercial |
$1,042.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$328.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$328.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.94
|
| Rate for Payer: Multiplan Commercial |
$877.76
|
| Rate for Payer: NAPHCARE Commercial |
$122.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,042.34
|
| Rate for Payer: Quartz Beloit One Network |
$482.77
|
| Rate for Payer: Quartz Commercial |
$625.40
|
| Rate for Payer: Quartz Medicare Advantage |
$81.94
|
| Rate for Payer: The Alliance Commercial |
$348.25
|
| Rate for Payer: United Healthcare Medicaid |
$121.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.94
|
| Rate for Payer: WEA Trust Commercial |
$603.46
|
| Rate for Payer: WPS Commercial |
$368.74
|
|
|
Application Skin Substitute Graft, ea add'l 25sq cm 15276
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 15276
|
| Hospital Charge Code |
2572825
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.10 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$21.10
|
| Rate for Payer: Anthem Medicare Advantage |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.10
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.10
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.10
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$31.65
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$21.10
|
| Rate for Payer: The Alliance Commercial |
$89.68
|
| Rate for Payer: United Healthcare Medicaid |
$26.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.10
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$94.96
|
|
|
Application Skin Substitute Trunk 15271
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
CPT 15271
|
| Hospital Charge Code |
3451586
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.26 |
| Max. Negotiated Rate |
$365.56 |
| Rate for Payer: Aetna Commercial |
$365.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Aetna Managed Medicare |
$72.26
|
| Rate for Payer: Anthem Medicare Advantage |
$72.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.26
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$365.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.26
|
| Rate for Payer: Health EOS Commercial |
$350.17
|
| Rate for Payer: HFN Commercial |
$365.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$288.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$288.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.26
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: NAPHCARE Commercial |
$108.39
|
| Rate for Payer: Preferred Network Access Commercial |
$365.56
|
| Rate for Payer: Quartz Beloit One Network |
$169.31
|
| Rate for Payer: Quartz Commercial |
$219.34
|
| Rate for Payer: Quartz Medicare Advantage |
$72.26
|
| Rate for Payer: The Alliance Commercial |
$307.10
|
| Rate for Payer: United Healthcare Medicaid |
$113.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.26
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
APPLICATOR ASSEMBLY 10CC 1:1 RATIO SA-3310
|
Facility
|
IP
|
$820.00
|
|
| Hospital Charge Code |
6234192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$417.87 |
| Max. Negotiated Rate |
$784.58 |
| Rate for Payer: Aetna Commercial |
$767.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.98
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$784.58
|
| Rate for Payer: Health EOS Commercial |
$758.99
|
| Rate for Payer: HFN Commercial |
$784.58
|
| Rate for Payer: Multiplan Commercial |
$682.24
|
| Rate for Payer: Preferred Network Access Commercial |
$784.58
|
| Rate for Payer: Quartz Beloit One Network |
$417.87
|
| Rate for Payer: Quartz Commercial |
$511.68
|
| Rate for Payer: WEA Trust Commercial |
$469.04
|
| Rate for Payer: WPS Commercial |
$631.65
|
|
|
APPLICATOR ASSEMBLY 10CC 1:1 RATIO SA-3310
|
Facility
|
OP
|
$820.00
|
|
| Hospital Charge Code |
6234192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$238.78 |
| Max. Negotiated Rate |
$784.58 |
| Rate for Payer: Aetna Commercial |
$767.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$733.41
|
| Rate for Payer: Aetna Managed Medicare |
$238.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$554.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$426.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$409.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.98
|
| Rate for Payer: Cash Price |
$246.00
|
| Rate for Payer: Cigna Commercial |
$784.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.24
|
| Rate for Payer: Health EOS Commercial |
$758.99
|
| Rate for Payer: HFN Commercial |
$784.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$639.60
|
| Rate for Payer: Multiplan Commercial |
$682.24
|
| Rate for Payer: NAPHCARE Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$784.58
|
| Rate for Payer: Quartz Beloit One Network |
$417.87
|
| Rate for Payer: Quartz Commercial |
$554.32
|
| Rate for Payer: Quartz Medicare Advantage |
$511.68
|
| Rate for Payer: The Alliance Commercial |
$426.40
|
| Rate for Payer: WEA Trust Commercial |
$469.04
|
| Rate for Payer: WPS Commercial |
$631.65
|
|
|
APPLICATOR FLEXITIP SHORT ARISTA AH AM0004
|
Facility
|
OP
|
$556.00
|
|
| Hospital Charge Code |
4595217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.91 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$161.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.68
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$346.94
|
| Rate for Payer: The Alliance Commercial |
$289.12
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
APPLICATOR FLEXITIP SHORT ARISTA AH AM0004
|
Facility
|
IP
|
$556.00
|
|
| Hospital Charge Code |
4595217
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
APPLICATOR FLEXITIP XL ARISTA AH AM0005
|
Facility
|
IP
|
$368.00
|
|
| Hospital Charge Code |
4594722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
APPLICATOR FLEXITIP XL ARISTA AH AM0005
|
Facility
|
OP
|
$368.00
|
|
| Hospital Charge Code |
4594722
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$107.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$229.63
|
| Rate for Payer: The Alliance Commercial |
$191.36
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
APPLICATOR FLEXITIP XL-R 38CM (15 IN) ARISTA AH AM0010
|
Facility
|
OP
|
$1,330.00
|
|
| Hospital Charge Code |
5563555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.30 |
| Max. Negotiated Rate |
$1,272.54 |
| Rate for Payer: Aetna Commercial |
$1,244.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.55
|
| Rate for Payer: Aetna Managed Medicare |
$387.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$899.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$691.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$663.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$733.10
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,272.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$774.06
|
| Rate for Payer: Health EOS Commercial |
$1,231.05
|
| Rate for Payer: HFN Commercial |
$1,272.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,037.40
|
| Rate for Payer: Multiplan Commercial |
$1,106.56
|
| Rate for Payer: NAPHCARE Commercial |
$829.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.54
|
| Rate for Payer: Quartz Beloit One Network |
$677.77
|
| Rate for Payer: Quartz Commercial |
$899.08
|
| Rate for Payer: Quartz Medicare Advantage |
$829.92
|
| Rate for Payer: The Alliance Commercial |
$691.60
|
| Rate for Payer: WEA Trust Commercial |
$760.76
|
| Rate for Payer: WPS Commercial |
$1,024.50
|
|
|
APPLICATOR FLEXITIP XL-R 38CM (15 IN) ARISTA AH AM0010
|
Facility
|
IP
|
$1,330.00
|
|
| Hospital Charge Code |
5563555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.77 |
| Max. Negotiated Rate |
$1,272.54 |
| Rate for Payer: Aetna Commercial |
$1,244.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,189.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$733.10
|
| Rate for Payer: Cash Price |
$399.00
|
| Rate for Payer: Cigna Commercial |
$1,272.54
|
| Rate for Payer: Health EOS Commercial |
$1,231.05
|
| Rate for Payer: HFN Commercial |
$1,272.54
|
| Rate for Payer: Multiplan Commercial |
$1,106.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,272.54
|
| Rate for Payer: Quartz Beloit One Network |
$677.77
|
| Rate for Payer: Quartz Commercial |
$829.92
|
| Rate for Payer: WEA Trust Commercial |
$760.76
|
| Rate for Payer: WPS Commercial |
$1,024.50
|
|
