|
WITH TRANSL STENT PLACEMENT(S), INC ANGIO SAME VES 37221
|
Professional
|
Both
|
$14,479.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
3014551
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$367.57 |
| Max. Negotiated Rate |
$13,755.05 |
| Rate for Payer: Aetna Commercial |
$13,755.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,451.94
|
| Rate for Payer: Cash Price |
$4,343.70
|
| Rate for Payer: Cash Price |
$4,343.70
|
| Rate for Payer: Cash Price |
$4,343.70
|
| Rate for Payer: Cigna Commercial |
$13,755.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$367.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,687.40
|
| Rate for Payer: Health EOS Commercial |
$13,175.89
|
| Rate for Payer: HFN Commercial |
$13,755.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,568.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,568.31
|
| Rate for Payer: Multiplan Commercial |
$11,583.20
|
| Rate for Payer: Preferred Network Access Commercial |
$13,755.05
|
| Rate for Payer: Quartz Beloit One Network |
$6,370.76
|
| Rate for Payer: Quartz Commercial |
$8,253.03
|
| Rate for Payer: The Alliance Commercial |
$7,239.50
|
| Rate for Payer: United Healthcare Medicaid |
$367.57
|
| Rate for Payer: WEA Trust Commercial |
$7,963.45
|
| Rate for Payer: WPS Commercial |
$10,724.60
|
|
|
WND PREP CH/INF, F/N/HF/G 15004
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
3013632
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$292.29 |
| Max. Negotiated Rate |
$870.57 |
| Rate for Payer: Aetna Commercial |
$663.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.28
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$663.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$292.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.80
|
| Rate for Payer: Health EOS Commercial |
$635.18
|
| Rate for Payer: HFN Commercial |
$663.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$870.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$870.57
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Preferred Network Access Commercial |
$663.10
|
| Rate for Payer: Quartz Beloit One Network |
$307.12
|
| Rate for Payer: Quartz Commercial |
$397.86
|
| Rate for Payer: The Alliance Commercial |
$349.00
|
| Rate for Payer: United Healthcare Medicaid |
$292.29
|
| Rate for Payer: WEA Trust Commercial |
$383.90
|
| Rate for Payer: WPS Commercial |
$517.01
|
|
|
WND PREP F/N/HF/G ADDL CM 15005
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
5587501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.58 |
| Max. Negotiated Rate |
$295.78 |
| Rate for Payer: Aetna Commercial |
$245.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$245.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.80
|
| Rate for Payer: Health EOS Commercial |
$234.78
|
| Rate for Payer: HFN Commercial |
$245.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$295.78
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$245.10
|
| Rate for Payer: Quartz Beloit One Network |
$113.52
|
| Rate for Payer: Quartz Commercial |
$147.06
|
| Rate for Payer: The Alliance Commercial |
$129.00
|
| Rate for Payer: United Healthcare Medicaid |
$90.58
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
Work Hardening/Cond add 1 hr Charges
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 97546 GO
|
| Hospital Charge Code |
2564874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Work Hardening/Cond add 1 hr Charges
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 97546 GO
|
| Hospital Charge Code |
2564874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$90.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$193.20
|
| Rate for Payer: The Alliance Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare PPO |
$241.50
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Work Hardening/Cond add 1 hr Charges OT
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 97546 GO
|
| Hospital Charge Code |
5294652
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$90.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$193.20
|
| Rate for Payer: The Alliance Commercial |
$1,288.00
|
| Rate for Payer: United Healthcare PPO |
$241.50
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Work Hardening/Cond add 1 hr Charges OT
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 97546 GO
|
| Hospital Charge Code |
5294652
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Work Hardening/Cond first 2 hrs Charges
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT 97545 GO
|
| Hospital Charge Code |
2564876
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$393.47 |
| Max. Negotiated Rate |
$738.76 |
| Rate for Payer: Aetna Commercial |
$722.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.59
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cigna Commercial |
$738.76
|
| Rate for Payer: Health EOS Commercial |
$714.67
|
| Rate for Payer: HFN Commercial |
$738.76
|
| Rate for Payer: Multiplan Commercial |
$642.40
|
| Rate for Payer: NAPHCARE Commercial |
$481.80
|
| Rate for Payer: Preferred Network Access Commercial |
$738.76
|
| Rate for Payer: Quartz Beloit One Network |
$393.47
|
| Rate for Payer: Quartz Commercial |
$481.80
|
| Rate for Payer: WEA Trust Commercial |
$441.65
|
| Rate for Payer: WPS Commercial |
$594.78
|
|
|
Work Hardening/Cond first 2 hrs Charges
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT 97545 GO
|
| Hospital Charge Code |
2564876
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$3,212.00 |
| Rate for Payer: Aetna Commercial |
$722.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.58
|
| Rate for Payer: Aetna Managed Medicare |
$224.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.59
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cigna Commercial |
$738.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$449.36
|
| Rate for Payer: Health EOS Commercial |
$714.67
|
| Rate for Payer: HFN Commercial |
$738.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$642.40
|
| Rate for Payer: NAPHCARE Commercial |
$481.80
|
| Rate for Payer: Preferred Network Access Commercial |
$738.76
|
| Rate for Payer: Quartz Beloit One Network |
$393.47
|
| Rate for Payer: Quartz Commercial |
$521.95
|
| Rate for Payer: Quartz Medicare Advantage |
$481.80
|
| Rate for Payer: The Alliance Commercial |
$3,212.00
|
| Rate for Payer: United Healthcare PPO |
$602.25
|
| Rate for Payer: WEA Trust Commercial |
$441.65
|
| Rate for Payer: WPS Commercial |
$594.78
|
|
|
Work Hardening/Cond first 2 hrs charges OT
|
Facility
|
OP
|
$803.00
|
|
|
Service Code
|
CPT 97545 GO
|
| Hospital Charge Code |
5294651
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$3,212.00 |
| Rate for Payer: Aetna Commercial |
$722.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.58
|
| Rate for Payer: Aetna Managed Medicare |
$224.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.59
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cigna Commercial |
$738.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$449.36
|
| Rate for Payer: Health EOS Commercial |
$714.67
|
| Rate for Payer: HFN Commercial |
$738.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$642.40
|
| Rate for Payer: NAPHCARE Commercial |
$481.80
|
| Rate for Payer: Preferred Network Access Commercial |
$738.76
|
| Rate for Payer: Quartz Beloit One Network |
$393.47
|
| Rate for Payer: Quartz Commercial |
$521.95
|
| Rate for Payer: Quartz Medicare Advantage |
$481.80
|
| Rate for Payer: The Alliance Commercial |
$3,212.00
|
| Rate for Payer: United Healthcare PPO |
$602.25
|
| Rate for Payer: WEA Trust Commercial |
$441.65
|
| Rate for Payer: WPS Commercial |
$594.78
|
|
|
Work Hardening/Cond first 2 hrs charges OT
|
Facility
|
IP
|
$803.00
|
|
|
Service Code
|
CPT 97545 GO
|
| Hospital Charge Code |
5294651
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$393.47 |
| Max. Negotiated Rate |
$738.76 |
| Rate for Payer: Aetna Commercial |
$722.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$690.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$425.59
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cigna Commercial |
$738.76
|
| Rate for Payer: Health EOS Commercial |
$714.67
|
| Rate for Payer: HFN Commercial |
$738.76
|
| Rate for Payer: Multiplan Commercial |
$642.40
|
| Rate for Payer: NAPHCARE Commercial |
$481.80
|
| Rate for Payer: Preferred Network Access Commercial |
$738.76
|
| Rate for Payer: Quartz Beloit One Network |
$393.47
|
| Rate for Payer: Quartz Commercial |
$481.80
|
| Rate for Payer: WEA Trust Commercial |
$441.65
|
| Rate for Payer: WPS Commercial |
$594.78
|
|
|
Wound cleanser any type/size A6260
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
HCPCS A6260
|
| Hospital Charge Code |
4520649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Wound cleanser any type/size A6260
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
HCPCS A6260
|
| Hospital Charge Code |
4520649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Wound cleanser any type/size A6260
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS A6260
|
| Hospital Charge Code |
4520649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.76 |
| Max. Negotiated Rate |
$3.80 |
| Rate for Payer: Aetna Commercial |
$3.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.40
|
| Rate for Payer: Health EOS Commercial |
$3.64
|
| Rate for Payer: HFN Commercial |
$3.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.33
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3.80
|
| Rate for Payer: Quartz Beloit One Network |
$1.76
|
| Rate for Payer: Quartz Commercial |
$2.28
|
| Rate for Payer: The Alliance Commercial |
$2.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
WOUND CLOSURE SYSTEM 3M STERI-STRIP 5/PK W8516
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
2963302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.39
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$74.40
|
| Rate for Payer: The Alliance Commercial |
$496.00
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
WOUND CLOSURE SYSTEM 3M STERI-STRIP 5/PK W8516
|
Facility
|
IP
|
$124.00
|
|
| Hospital Charge Code |
2963302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
Wound Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$8.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Dean Health Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Managed Health Services Medicaid |
$9.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.93
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.91
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$34.48
|
| Rate for Payer: United Healthcare Medicaid |
$8.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: WMAP Medicaid |
$8.91
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Wound Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.43 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.00
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: HFN Commercial |
$213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.43
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: The Alliance Commercial |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Wound Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Wound Debridement
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
5006606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$166.20
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
Wound Debridement
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
5006606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.96 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$180.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.96
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$180.05
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$80,116.00
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$28,818.54 |
| Max. Negotiated Rate |
$80,116.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,818.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62,940.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,243.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45,834.00
|
| Rate for Payer: Anthem Medicare Advantage |
$28,818.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,818.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,818.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,818.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50,879.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,818.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58,527.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,818.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,818.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,818.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,818.54
|
| Rate for Payer: NAPHCARE Commercial |
$43,227.81
|
| Rate for Payer: Quartz Medicare Advantage |
$28,818.54
|
| Rate for Payer: The Alliance Commercial |
$80,116.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,818.54
|
| Rate for Payer: United Healthcare PPO |
$45,564.25
|
| Rate for Payer: Wellcare Medicare |
$28,818.54
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$150,895.00
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$54,278.88 |
| Max. Negotiated Rate |
$150,895.00 |
| Rate for Payer: Wellcare Medicare |
$54,278.88
|
| Rate for Payer: Aetna Managed Medicare |
$54,278.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118,746.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91,018.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86,473.48
|
| Rate for Payer: Anthem Medicare Advantage |
$54,278.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54,278.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54,278.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54,278.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95,993.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54,278.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110,442.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54,278.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54,278.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54,278.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54,278.88
|
| Rate for Payer: NAPHCARE Commercial |
$81,418.32
|
| Rate for Payer: Quartz Medicare Advantage |
$54,278.88
|
| Rate for Payer: The Alliance Commercial |
$150,895.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54,278.88
|
| Rate for Payer: United Healthcare PPO |
$85,980.63
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$50,057.00
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$18,006.27 |
| Max. Negotiated Rate |
$50,057.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,006.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,232.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,071.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,569.86
|
| Rate for Payer: Anthem Medicare Advantage |
$18,006.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,006.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,006.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,006.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,715.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,006.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,480.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,006.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,006.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,006.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,006.27
|
| Rate for Payer: NAPHCARE Commercial |
$27,009.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18,006.27
|
| Rate for Payer: The Alliance Commercial |
$50,057.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,006.27
|
| Rate for Payer: United Healthcare PPO |
$28,400.61
|
| Rate for Payer: Wellcare Medicare |
$18,006.27
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$50,427.00
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$18,139.21 |
| Max. Negotiated Rate |
$50,427.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,139.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,442.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,232.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,722.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18,139.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,139.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,139.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,139.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,884.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,139.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,751.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,139.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,139.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,139.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,139.21
|
| Rate for Payer: NAPHCARE Commercial |
$27,208.82
|
| Rate for Payer: Quartz Medicare Advantage |
$18,139.21
|
| Rate for Payer: The Alliance Commercial |
$50,427.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,139.21
|
| Rate for Payer: United Healthcare PPO |
$28,611.63
|
| Rate for Payer: Wellcare Medicare |
$18,139.21
|
|
