|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$115,379.00
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$41,503.30 |
| Max. Negotiated Rate |
$115,379.00 |
| Rate for Payer: Aetna Managed Medicare |
$41,503.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90,843.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69,630.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66,153.74
|
| Rate for Payer: Anthem Medicare Advantage |
$41,503.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41,503.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41,503.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$41,503.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73,436.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$41,503.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84,392.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41,503.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41,503.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$41,503.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$41,503.30
|
| Rate for Payer: NAPHCARE Commercial |
$62,254.95
|
| Rate for Payer: Quartz Medicare Advantage |
$41,503.30
|
| Rate for Payer: The Alliance Commercial |
$115,379.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41,503.30
|
| Rate for Payer: United Healthcare PPO |
$65,700.33
|
| Rate for Payer: Wellcare Medicare |
$41,503.30
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,327.00
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$11,988.09 |
| Max. Negotiated Rate |
$33,327.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,988.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,015.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,940.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,944.72
|
| Rate for Payer: Anthem Medicare Advantage |
$11,988.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,988.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,988.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,988.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,030.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,988.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,209.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,988.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,988.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,988.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,988.09
|
| Rate for Payer: NAPHCARE Commercial |
$17,982.14
|
| Rate for Payer: Quartz Medicare Advantage |
$11,988.09
|
| Rate for Payer: The Alliance Commercial |
$33,327.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,988.09
|
| Rate for Payer: United Healthcare PPO |
$18,847.21
|
| Rate for Payer: Wellcare Medicare |
$11,988.09
|
|
|
Wound Drainage Management
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005549
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
Wound Drainage Management
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005549
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$1,144.00 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$80.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$214.50
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$171.60
|
| Rate for Payer: The Alliance Commercial |
$1,144.00
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
WOUND MATRIX INTEGRA BILAYER 4 IN X 5 IN (10CM X 12.5CM = 125SQ CM) BMW4051
|
Facility
|
IP
|
$231.46
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
6246270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.42 |
| Max. Negotiated Rate |
$212.94 |
| Rate for Payer: Aetna Commercial |
$208.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.67
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cigna Commercial |
$212.94
|
| Rate for Payer: Health EOS Commercial |
$206.00
|
| Rate for Payer: HFN Commercial |
$212.94
|
| Rate for Payer: Multiplan Commercial |
$185.17
|
| Rate for Payer: NAPHCARE Commercial |
$138.88
|
| Rate for Payer: Preferred Network Access Commercial |
$212.94
|
| Rate for Payer: Quartz Beloit One Network |
$113.42
|
| Rate for Payer: Quartz Commercial |
$138.88
|
| Rate for Payer: WEA Trust Commercial |
$127.30
|
| Rate for Payer: WPS Commercial |
$171.44
|
|
|
WOUND MATRIX INTEGRA BILAYER 4 IN X 5 IN (10CM X 12.5CM = 125SQ CM) BMW4051
|
Facility
|
OP
|
$231.46
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
6246270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$925.84 |
| Rate for Payer: Aetna Commercial |
$208.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.06
|
| Rate for Payer: Aetna Managed Medicare |
$64.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.67
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cigna Commercial |
$212.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.66
|
| Rate for Payer: Health EOS Commercial |
$206.00
|
| Rate for Payer: HFN Commercial |
$212.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.60
|
| Rate for Payer: Multiplan Commercial |
$185.17
|
| Rate for Payer: NAPHCARE Commercial |
$138.88
|
| Rate for Payer: Preferred Network Access Commercial |
$212.94
|
| Rate for Payer: Quartz Beloit One Network |
$113.42
|
| Rate for Payer: Quartz Commercial |
$150.45
|
| Rate for Payer: Quartz Medicare Advantage |
$138.88
|
| Rate for Payer: The Alliance Commercial |
$925.84
|
| Rate for Payer: WEA Trust Commercial |
$127.30
|
| Rate for Payer: WPS Commercial |
$122.19
|
|
|
WOUND MATRIX INTEGRA MESHED BILAYER 2 X 2 (5CM X 5CM=25SQ CM) MWM2021
|
Facility
|
OP
|
$622.50
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
6171711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$2,490.00 |
| Rate for Payer: Aetna Commercial |
$560.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$535.35
|
| Rate for Payer: Aetna Managed Medicare |
$174.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$404.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$311.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.92
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.66
|
| Rate for Payer: Health EOS Commercial |
$554.02
|
| Rate for Payer: HFN Commercial |
$572.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.88
|
| Rate for Payer: Multiplan Commercial |
$498.00
|
| Rate for Payer: NAPHCARE Commercial |
$373.50
|
| Rate for Payer: Preferred Network Access Commercial |
$572.70
|
| Rate for Payer: Quartz Beloit One Network |
$305.02
|
| Rate for Payer: Quartz Commercial |
$404.62
|
| Rate for Payer: Quartz Medicare Advantage |
$373.50
|
| Rate for Payer: The Alliance Commercial |
$2,490.00
|
| Rate for Payer: WEA Trust Commercial |
$342.38
|
| Rate for Payer: WPS Commercial |
$122.19
|
|
|
WOUND MATRIX INTEGRA MESHED BILAYER 2 X 2 (5CM X 5CM=25SQ CM) MWM2021
|
Facility
|
IP
|
$622.50
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
6171711
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$305.02 |
| Max. Negotiated Rate |
$572.70 |
| Rate for Payer: Aetna Commercial |
$560.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$535.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.92
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna Commercial |
$572.70
|
| Rate for Payer: Health EOS Commercial |
$554.02
|
| Rate for Payer: HFN Commercial |
$572.70
|
| Rate for Payer: Multiplan Commercial |
$498.00
|
| Rate for Payer: NAPHCARE Commercial |
$373.50
|
| Rate for Payer: Preferred Network Access Commercial |
$572.70
|
| Rate for Payer: Quartz Beloit One Network |
$305.02
|
| Rate for Payer: Quartz Commercial |
$373.50
|
| Rate for Payer: WEA Trust Commercial |
$342.38
|
| Rate for Payer: WPS Commercial |
$461.09
|
|
|
WOUND MATRIX INTEGRA MESHED BILAYER 4 IN X 5 IN (10CM X 12.5CM = 125SQ CM) MWM4051
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
6166229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
WOUND MATRIX INTEGRA MESHED BILAYER 4 IN X 5 IN (10CM X 12.5CM = 125SQ CM) MWM4051
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
6166229
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.66
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$122.19
|
|
|
WOUND REPAIR
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
WOUND REPAIR
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
WRENCH SPANNER 5MM HOFFMANN LIMB 4933-9-205
|
Facility
|
IP
|
$3,846.00
|
|
| Hospital Charge Code |
6167872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,884.54 |
| Max. Negotiated Rate |
$3,538.32 |
| Rate for Payer: Aetna Commercial |
$3,461.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,307.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,038.38
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna Commercial |
$3,538.32
|
| Rate for Payer: Health EOS Commercial |
$3,422.94
|
| Rate for Payer: HFN Commercial |
$3,538.32
|
| Rate for Payer: Multiplan Commercial |
$3,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,307.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,538.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.54
|
| Rate for Payer: Quartz Commercial |
$2,307.60
|
| Rate for Payer: WEA Trust Commercial |
$2,115.30
|
| Rate for Payer: WPS Commercial |
$2,848.73
|
|
|
WRENCH SPANNER 5MM HOFFMANN LIMB 4933-9-205
|
Facility
|
OP
|
$3,846.00
|
|
| Hospital Charge Code |
6167872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,076.88 |
| Max. Negotiated Rate |
$15,384.00 |
| Rate for Payer: Aetna Commercial |
$3,461.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,307.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,076.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,499.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,846.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,038.38
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna Commercial |
$3,538.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,152.22
|
| Rate for Payer: Health EOS Commercial |
$3,422.94
|
| Rate for Payer: HFN Commercial |
$3,538.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,884.50
|
| Rate for Payer: Multiplan Commercial |
$3,076.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,307.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,538.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,884.54
|
| Rate for Payer: Quartz Commercial |
$2,499.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,307.60
|
| Rate for Payer: The Alliance Commercial |
$15,384.00
|
| Rate for Payer: WEA Trust Commercial |
$2,115.30
|
| Rate for Payer: WPS Commercial |
$2,848.73
|
|
|
WRENCH SPANNER 7/10MM HOFFMANN LIMB 4933-9-204
|
Facility
|
OP
|
$1,385.00
|
|
| Hospital Charge Code |
5599711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$5,540.00 |
| Rate for Payer: Aetna Commercial |
$1,246.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.10
|
| Rate for Payer: Aetna Managed Medicare |
$387.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$900.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$692.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$664.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.05
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,274.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$775.05
|
| Rate for Payer: Health EOS Commercial |
$1,232.65
|
| Rate for Payer: HFN Commercial |
$1,274.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,038.75
|
| Rate for Payer: Multiplan Commercial |
$1,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$831.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.20
|
| Rate for Payer: Quartz Beloit One Network |
$678.65
|
| Rate for Payer: Quartz Commercial |
$900.25
|
| Rate for Payer: Quartz Medicare Advantage |
$831.00
|
| Rate for Payer: The Alliance Commercial |
$5,540.00
|
| Rate for Payer: WEA Trust Commercial |
$761.75
|
| Rate for Payer: WPS Commercial |
$1,025.87
|
|
|
WRENCH SPANNER 7/10MM HOFFMANN LIMB 4933-9-204
|
Facility
|
IP
|
$1,385.00
|
|
| Hospital Charge Code |
5599711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.65 |
| Max. Negotiated Rate |
$1,274.20 |
| Rate for Payer: Aetna Commercial |
$1,246.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.05
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,274.20
|
| Rate for Payer: Health EOS Commercial |
$1,232.65
|
| Rate for Payer: HFN Commercial |
$1,274.20
|
| Rate for Payer: Multiplan Commercial |
$1,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$831.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.20
|
| Rate for Payer: Quartz Beloit One Network |
$678.65
|
| Rate for Payer: Quartz Commercial |
$831.00
|
| Rate for Payer: WEA Trust Commercial |
$761.75
|
| Rate for Payer: WPS Commercial |
$1,025.87
|
|
|
WRIST ARTHRODESIS
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2959824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,406.88 |
| Max. Negotiated Rate |
$4,519.04 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$2,947.20
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
WRIST ARTHRODESIS
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2959824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,375.36 |
| Max. Negotiated Rate |
$19,648.00 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,375.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,192.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,357.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,748.76
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,684.00
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$3,192.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,947.20
|
| Rate for Payer: The Alliance Commercial |
$19,648.00
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
Wrist Arthrogram XR Left
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072709
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,520.48 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,425.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.34
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$791.70
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
Wrist Arthrogram XR Left
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072709
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$596.82 |
| Max. Negotiated Rate |
$1,120.56 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.54
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$730.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$730.80
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
Wrist Arthrogram XR Left
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072709
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$465.15 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Aetna Commercial |
$1,157.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,157.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$609.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.80
|
| Rate for Payer: Health EOS Commercial |
$1,108.38
|
| Rate for Payer: HFN Commercial |
$1,157.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$465.15
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.10
|
| Rate for Payer: Quartz Beloit One Network |
$535.92
|
| Rate for Payer: Quartz Commercial |
$694.26
|
| Rate for Payer: The Alliance Commercial |
$609.00
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
Wrist Arthrogram XR Right
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$465.15 |
| Max. Negotiated Rate |
$1,157.10 |
| Rate for Payer: Aetna Commercial |
$1,157.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,157.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$609.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.80
|
| Rate for Payer: Health EOS Commercial |
$1,108.38
|
| Rate for Payer: HFN Commercial |
$1,157.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$465.15
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,157.10
|
| Rate for Payer: Quartz Beloit One Network |
$535.92
|
| Rate for Payer: Quartz Commercial |
$694.26
|
| Rate for Payer: The Alliance Commercial |
$609.00
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
Wrist Arthrogram XR Right
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$596.82 |
| Max. Negotiated Rate |
$1,120.56 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.54
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$730.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$730.80
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
Wrist Arthrogram XR Right
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,520.48 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,047.48
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,425.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.34
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$681.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$791.70
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
|
WRIST ARTHROPLASTY
|
Facility
|
IP
|
$8,012.00
|
|
| Hospital Charge Code |
2960446
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,925.88 |
| Max. Negotiated Rate |
$7,371.04 |
| Rate for Payer: Aetna Commercial |
$7,210.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,890.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,246.36
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,371.04
|
| Rate for Payer: Health EOS Commercial |
$7,130.68
|
| Rate for Payer: HFN Commercial |
$7,371.04
|
| Rate for Payer: Multiplan Commercial |
$6,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,807.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,371.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,925.88
|
| Rate for Payer: Quartz Commercial |
$4,807.20
|
| Rate for Payer: WEA Trust Commercial |
$4,406.60
|
| Rate for Payer: WPS Commercial |
$5,934.49
|
|
