|
WRIST ARTHROPLASTY
|
Facility
|
OP
|
$8,012.00
|
|
| Hospital Charge Code |
2960446
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,243.36 |
| Max. Negotiated Rate |
$32,048.00 |
| Rate for Payer: Aetna Commercial |
$7,210.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,890.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,243.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,207.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,006.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,845.76
|
| 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: Dean Health DHI/DHP/ASO |
$4,483.52
|
| Rate for Payer: Health EOS Commercial |
$7,130.68
|
| Rate for Payer: HFN Commercial |
$7,371.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,009.00
|
| 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 |
$5,207.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,807.20
|
| Rate for Payer: The Alliance Commercial |
$32,048.00
|
| Rate for Payer: WEA Trust Commercial |
$4,406.60
|
| Rate for Payer: WPS Commercial |
$5,934.49
|
|
|
WRIST ARTHROSCOPY
|
Facility
|
OP
|
$7,950.00
|
|
| Hospital Charge Code |
2959831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,226.00 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$7,155.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,837.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,226.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,167.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,816.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,213.50
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,314.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,448.82
|
| Rate for Payer: Health EOS Commercial |
$7,075.50
|
| Rate for Payer: HFN Commercial |
$7,314.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,962.50
|
| Rate for Payer: Multiplan Commercial |
$6,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,770.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,314.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,895.50
|
| Rate for Payer: Quartz Commercial |
$5,167.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,770.00
|
| Rate for Payer: The Alliance Commercial |
$31,800.00
|
| Rate for Payer: WEA Trust Commercial |
$4,372.50
|
| Rate for Payer: WPS Commercial |
$5,888.56
|
|
|
WRIST ARTHROSCOPY
|
Facility
|
IP
|
$7,950.00
|
|
| Hospital Charge Code |
2959831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,895.50 |
| Max. Negotiated Rate |
$7,314.00 |
| Rate for Payer: Aetna Commercial |
$7,155.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,837.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,213.50
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,314.00
|
| Rate for Payer: Health EOS Commercial |
$7,075.50
|
| Rate for Payer: HFN Commercial |
$7,314.00
|
| Rate for Payer: Multiplan Commercial |
$6,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,770.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,314.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,895.50
|
| Rate for Payer: Quartz Commercial |
$4,770.00
|
| Rate for Payer: WEA Trust Commercial |
$4,372.50
|
| Rate for Payer: WPS Commercial |
$5,888.56
|
|
|
WRIST BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959868
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
WRIST BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959868
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
WRIST BRACE AMBIDEXTROUS XL 55984004
|
Facility
|
IP
|
$332.00
|
|
| Hospital Charge Code |
2970944
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$162.68 |
| Max. Negotiated Rate |
$305.44 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$199.20
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
WRIST BRACE AMBIDEXTROUS XL 55984004
|
Facility
|
OP
|
$332.00
|
|
| Hospital Charge Code |
2970944
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$92.96 |
| Max. Negotiated Rate |
$1,328.00 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Aetna Managed Medicare |
$92.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$215.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.79
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.00
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$215.80
|
| Rate for Payer: Quartz Medicare Advantage |
$199.20
|
| Rate for Payer: The Alliance Commercial |
$1,328.00
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
WRIST BRACE RIGHT TITAN 450-RT #5547-67-02
|
Facility
|
OP
|
$360.00
|
|
| Hospital Charge Code |
2969685
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.80 |
| Max. Negotiated Rate |
$1,440.00 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Aetna Managed Medicare |
$100.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$234.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.46
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$270.00
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: Quartz Medicare Advantage |
$216.00
|
| Rate for Payer: The Alliance Commercial |
$1,440.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
WRIST BRACE RIGHT TITAN 450-RT #5547-67-02
|
Facility
|
IP
|
$360.00
|
|
| Hospital Charge Code |
2969685
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$176.40 |
| Max. Negotiated Rate |
$331.20 |
| Rate for Payer: Aetna Commercial |
$324.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.80
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$331.20
|
| Rate for Payer: Health EOS Commercial |
$320.40
|
| Rate for Payer: HFN Commercial |
$331.20
|
| Rate for Payer: Multiplan Commercial |
$288.00
|
| Rate for Payer: NAPHCARE Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$331.20
|
| Rate for Payer: Quartz Beloit One Network |
$176.40
|
| Rate for Payer: Quartz Commercial |
$216.00
|
| Rate for Payer: WEA Trust Commercial |
$198.00
|
| Rate for Payer: WPS Commercial |
$266.65
|
|
|
WRIST, EXTERNAL FIXATOR
|
Facility
|
OP
|
$5,453.00
|
|
| Hospital Charge Code |
2960041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,526.84 |
| Max. Negotiated Rate |
$21,812.00 |
| Rate for Payer: Aetna Commercial |
$4,907.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,689.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,526.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,544.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,726.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,617.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,890.09
|
| Rate for Payer: Cash Price |
$1,635.90
|
| Rate for Payer: Cigna Commercial |
$5,016.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,051.50
|
| Rate for Payer: Health EOS Commercial |
$4,853.17
|
| Rate for Payer: HFN Commercial |
$5,016.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,089.75
|
| Rate for Payer: Multiplan Commercial |
$4,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,016.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,671.97
|
| Rate for Payer: Quartz Commercial |
$3,544.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,271.80
|
| Rate for Payer: The Alliance Commercial |
$21,812.00
|
| Rate for Payer: WEA Trust Commercial |
$2,999.15
|
| Rate for Payer: WPS Commercial |
$4,039.04
|
|
|
WRIST, EXTERNAL FIXATOR
|
Facility
|
IP
|
$5,453.00
|
|
| Hospital Charge Code |
2960041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,671.97 |
| Max. Negotiated Rate |
$5,016.76 |
| Rate for Payer: Aetna Commercial |
$4,907.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,689.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,890.09
|
| Rate for Payer: Cash Price |
$1,635.90
|
| Rate for Payer: Cigna Commercial |
$5,016.76
|
| Rate for Payer: Health EOS Commercial |
$4,853.17
|
| Rate for Payer: HFN Commercial |
$5,016.76
|
| Rate for Payer: Multiplan Commercial |
$4,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,016.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,671.97
|
| Rate for Payer: Quartz Commercial |
$3,271.80
|
| Rate for Payer: WEA Trust Commercial |
$2,999.15
|
| Rate for Payer: WPS Commercial |
$4,039.04
|
|
|
WRIST KIT MONOTUBE TRIAX 5150-9-960
|
Facility
|
IP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,969.49 |
| Max. Negotiated Rate |
$7,452.92 |
| Rate for Payer: Aetna Commercial |
$7,290.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,966.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,293.53
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,452.92
|
| Rate for Payer: Health EOS Commercial |
$7,209.89
|
| Rate for Payer: HFN Commercial |
$7,452.92
|
| Rate for Payer: Multiplan Commercial |
$6,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,860.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,452.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,969.49
|
| Rate for Payer: Quartz Commercial |
$4,860.60
|
| Rate for Payer: WEA Trust Commercial |
$4,455.55
|
| Rate for Payer: WPS Commercial |
$6,000.41
|
|
|
WRIST KIT MONOTUBE TRIAX 5150-9-960
|
Facility
|
OP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,268.28 |
| Max. Negotiated Rate |
$32,404.00 |
| Rate for Payer: Aetna Commercial |
$7,290.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,966.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,268.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,265.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,050.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,888.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,293.53
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,452.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,533.32
|
| Rate for Payer: Health EOS Commercial |
$7,209.89
|
| Rate for Payer: HFN Commercial |
$7,452.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,075.75
|
| Rate for Payer: Multiplan Commercial |
$6,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,860.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,452.92
|
| Rate for Payer: Quartz Beloit One Network |
$3,969.49
|
| Rate for Payer: Quartz Commercial |
$5,265.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,860.60
|
| Rate for Payer: The Alliance Commercial |
$32,404.00
|
| Rate for Payer: WEA Trust Commercial |
$4,455.55
|
| Rate for Payer: WPS Commercial |
$6,000.41
|
|
|
WRIST SPLINT 8 XS LT **USE DMECON1081
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
2974323
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$70.84 |
| Max. Negotiated Rate |
$1,012.00 |
| Rate for Payer: Aetna Commercial |
$227.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.58
|
| Rate for Payer: Aetna Managed Medicare |
$70.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$126.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.09
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$232.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.58
|
| Rate for Payer: Health EOS Commercial |
$225.17
|
| Rate for Payer: HFN Commercial |
$232.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.75
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: NAPHCARE Commercial |
$151.80
|
| Rate for Payer: Preferred Network Access Commercial |
$232.76
|
| Rate for Payer: Quartz Beloit One Network |
$123.97
|
| Rate for Payer: Quartz Commercial |
$164.45
|
| Rate for Payer: Quartz Medicare Advantage |
$151.80
|
| Rate for Payer: The Alliance Commercial |
$1,012.00
|
| Rate for Payer: WEA Trust Commercial |
$139.15
|
| Rate for Payer: WPS Commercial |
$187.40
|
|
|
WRIST SPLINT 8 XS LT **USE DMECON1081
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
2974323
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$123.97 |
| Max. Negotiated Rate |
$232.76 |
| Rate for Payer: Aetna Commercial |
$227.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.09
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$232.76
|
| Rate for Payer: Health EOS Commercial |
$225.17
|
| Rate for Payer: HFN Commercial |
$232.76
|
| Rate for Payer: Multiplan Commercial |
$202.40
|
| Rate for Payer: NAPHCARE Commercial |
$151.80
|
| Rate for Payer: Preferred Network Access Commercial |
$232.76
|
| Rate for Payer: Quartz Beloit One Network |
$123.97
|
| Rate for Payer: Quartz Commercial |
$151.80
|
| Rate for Payer: WEA Trust Commercial |
$139.15
|
| Rate for Payer: WPS Commercial |
$187.40
|
|
|
WRIST SUPPORT ADULT ARTERIAL 29980
|
Facility
|
OP
|
$194.00
|
|
| Hospital Charge Code |
2965834
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$54.32 |
| Max. Negotiated Rate |
$776.00 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Aetna Managed Medicare |
$54.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$126.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$93.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.50
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$116.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$126.10
|
| Rate for Payer: Quartz Medicare Advantage |
$116.40
|
| Rate for Payer: The Alliance Commercial |
$776.00
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
WRIST SUPPORT ADULT ARTERIAL 29980
|
Facility
|
IP
|
$194.00
|
|
| Hospital Charge Code |
2965834
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$95.06 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$116.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$116.40
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
WRIST, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$4,492.00
|
|
| Hospital Charge Code |
2960426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,257.76 |
| Max. Negotiated Rate |
$17,968.00 |
| Rate for Payer: Aetna Commercial |
$4,042.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,257.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,919.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,246.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,156.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,380.76
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,132.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,513.72
|
| Rate for Payer: Health EOS Commercial |
$3,997.88
|
| Rate for Payer: HFN Commercial |
$4,132.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,369.00
|
| Rate for Payer: Multiplan Commercial |
$3,593.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,132.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.08
|
| Rate for Payer: Quartz Commercial |
$2,919.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,695.20
|
| Rate for Payer: The Alliance Commercial |
$17,968.00
|
| Rate for Payer: WEA Trust Commercial |
$2,470.60
|
| Rate for Payer: WPS Commercial |
$3,327.22
|
|
|
WRIST, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,492.00
|
|
| Hospital Charge Code |
2960426
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,201.08 |
| Max. Negotiated Rate |
$4,132.64 |
| Rate for Payer: Aetna Commercial |
$4,042.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,380.76
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,132.64
|
| Rate for Payer: Health EOS Commercial |
$3,997.88
|
| Rate for Payer: HFN Commercial |
$4,132.64
|
| Rate for Payer: Multiplan Commercial |
$3,593.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,132.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.08
|
| Rate for Payer: Quartz Commercial |
$2,695.20
|
| Rate for Payer: WEA Trust Commercial |
$2,470.60
|
| Rate for Payer: WPS Commercial |
$3,327.22
|
|
|
WRIST WRAP UNIVERSAL NEOPRENE #7807-01
|
Facility
|
IP
|
$144.00
|
|
| Hospital Charge Code |
2969684
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$86.40
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
WRIST WRAP UNIVERSAL NEOPRENE #7807-01
|
Facility
|
OP
|
$144.00
|
|
| Hospital Charge Code |
2969684
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$576.00 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Aetna Managed Medicare |
$40.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.58
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: Quartz Medicare Advantage |
$86.40
|
| Rate for Payer: The Alliance Commercial |
$576.00
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
Xe-133 gas
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
1486830
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$367.41 |
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$144.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.20
|
| Rate for Payer: Health EOS Commercial |
$138.32
|
| Rate for Payer: HFN Commercial |
$144.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$367.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.41
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Preferred Network Access Commercial |
$144.40
|
| Rate for Payer: Quartz Beloit One Network |
$66.88
|
| Rate for Payer: Quartz Commercial |
$86.64
|
| Rate for Payer: The Alliance Commercial |
$76.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Xe-133 gas
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
1486830
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$42.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$91.20
|
| Rate for Payer: The Alliance Commercial |
$608.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Xe-133 gas
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
HCPCS A9558
|
| Hospital Charge Code |
1486830
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Xiaflex 0.9mg vial J0775
|
Facility
|
OP
|
$10,805.00
|
|
|
Service Code
|
HCPCS J0775
|
| Hospital Charge Code |
4356598
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.27 |
| Max. Negotiated Rate |
$9,940.60 |
| Rate for Payer: Aetna Commercial |
$9,724.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,292.30
|
| Rate for Payer: Aetna Managed Medicare |
$66.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,023.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,402.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,186.40
|
| Rate for Payer: Anthem Medicare Advantage |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,726.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.27
|
| Rate for Payer: Cash Price |
$3,241.50
|
| Rate for Payer: Cash Price |
$3,241.50
|
| Rate for Payer: Cigna Commercial |
$9,940.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$66.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$66.27
|
| Rate for Payer: Health EOS Commercial |
$9,616.45
|
| Rate for Payer: HFN Commercial |
$9,940.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$66.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$66.27
|
| Rate for Payer: Multiplan Commercial |
$8,644.00
|
| Rate for Payer: NAPHCARE Commercial |
$99.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,940.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,294.45
|
| Rate for Payer: Quartz Commercial |
$7,023.25
|
| Rate for Payer: Quartz Medicare Advantage |
$66.27
|
| Rate for Payer: The Alliance Commercial |
$265.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.27
|
| Rate for Payer: WEA Trust Commercial |
$5,942.75
|
| Rate for Payer: Wellcare Medicare |
$66.27
|
| Rate for Payer: WPS Commercial |
$172.42
|
|
