|
WIRE ZIP .035 180cm STIFF STRA 46-309B
|
Facility
IP
|
$1,012.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973302
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$495.88 |
| Max. Negotiated Rate |
$931.04 |
| Rate for Payer: Aetna Commercial |
$910.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.36
|
| Rate for Payer: Cash Price |
$303.60
|
| Rate for Payer: Cigna Commercial |
$931.04
|
| Rate for Payer: Health EOS Commercial |
$900.68
|
| Rate for Payer: HFN Commercial |
$931.04
|
| Rate for Payer: Multiplan Commercial |
$809.60
|
| Rate for Payer: NAPHCARE Commercial |
$607.20
|
| Rate for Payer: Preferred Network Access Commercial |
$931.04
|
| Rate for Payer: Quartz Beloit One Network |
$495.88
|
| Rate for Payer: Quartz Commercial |
$607.20
|
| Rate for Payer: WEA Trust Commercial |
$556.60
|
| Rate for Payer: WPS Commercial |
$749.59
|
|
|
Witch Hazel Pads [Med]
|
Facility
IP
|
$46.00
|
|
| Hospital Charge Code |
2974999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$22.54 |
| Max. Negotiated Rate |
$42.32 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.38
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$42.32
|
| Rate for Payer: Health EOS Commercial |
$40.94
|
| Rate for Payer: HFN Commercial |
$42.32
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$42.32
|
| Rate for Payer: Quartz Beloit One Network |
$22.54
|
| Rate for Payer: Quartz Commercial |
$27.60
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
Witch Hazel Pads [Med]
|
Facility
OP
|
$46.00
|
|
| Hospital Charge Code |
2974999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$184.00 |
| Rate for Payer: Aetna Commercial |
$41.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.38
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$42.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.74
|
| Rate for Payer: Health EOS Commercial |
$40.94
|
| Rate for Payer: HFN Commercial |
$42.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$36.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$42.32
|
| Rate for Payer: Quartz Beloit One Network |
$22.54
|
| Rate for Payer: Quartz Commercial |
$29.90
|
| Rate for Payer: Quartz Medicare Advantage |
$27.60
|
| Rate for Payer: The Alliance Commercial |
$184.00
|
| Rate for Payer: WEA Trust Commercial |
$25.30
|
| Rate for Payer: WPS Commercial |
$34.07
|
|
|
With Biopsy - Bronchoscopy Charge
|
Facility
OP
|
$4,460.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
2990185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.59 |
| Max. Negotiated Rate |
$11,587.76 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$11,587.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
With Biopsy - Bronchoscopy Charge
|
Facility
IP
|
$4,460.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
2990185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
With Brushing - Bronchoscopy Charge
|
Facility
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
2990184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.59 |
| Max. Negotiated Rate |
$6,240.63 |
| Rate for Payer: Aetna Commercial |
$3,975.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,798.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,341.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cigna Commercial |
$4,063.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Health EOS Commercial |
$3,931.13
|
| Rate for Payer: HFN Commercial |
$4,063.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: Multiplan Commercial |
$3,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,063.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,164.33
|
| Rate for Payer: Quartz Commercial |
$2,871.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$5,242.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$2,429.35
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
| Rate for Payer: WPS Commercial |
$3,271.67
|
|
|
With Brushing - Bronchoscopy Charge
|
Facility
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
2990184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,164.33 |
| Max. Negotiated Rate |
$4,063.64 |
| Rate for Payer: Aetna Commercial |
$3,975.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,341.01
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cigna Commercial |
$4,063.64
|
| Rate for Payer: Health EOS Commercial |
$3,931.13
|
| Rate for Payer: HFN Commercial |
$4,063.64
|
| Rate for Payer: Multiplan Commercial |
$3,533.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,650.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,063.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,164.33
|
| Rate for Payer: Quartz Commercial |
$2,650.20
|
| Rate for Payer: WEA Trust Commercial |
$2,429.35
|
| Rate for Payer: WPS Commercial |
$3,271.67
|
|
|
WITH CATH PLCMT IN BYPASS GRAFT INC INTRA INJ 9345526
|
Professional
|
$5,825.00
|
|
|
Service Code
|
CPT 93455 26
|
| Hospital Charge Code |
3015391
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$248.18 |
| Max. Negotiated Rate |
$5,533.75 |
| Rate for Payer: Aetna Commercial |
$5,533.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,009.50
|
| Rate for Payer: Aetna Managed Medicare |
$248.18
|
| Rate for Payer: Anthem Medicare Advantage |
$248.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$248.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$248.18
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cigna Commercial |
$5,533.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,912.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$248.18
|
| Rate for Payer: Health EOS Commercial |
$5,300.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$901.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$901.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$248.18
|
| Rate for Payer: Multiplan Commercial |
$4,660.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,533.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,563.00
|
| Rate for Payer: Quartz Commercial |
$3,320.25
|
| Rate for Payer: Quartz Medicare Advantage |
$248.18
|
| Rate for Payer: The Alliance Commercial |
$943.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$248.18
|
| Rate for Payer: WEA Trust Commercial |
$3,203.75
|
| Rate for Payer: WPS Commercial |
$992.72
|
|
|
With Transl Stent Placement (S), Inc Angio 3722122
|
Professional
|
$17,376.00
|
|
|
Service Code
|
CPT 37221 22
|
| Hospital Charge Code |
5078631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7,645.44 |
| Max. Negotiated Rate |
$16,507.20 |
| Rate for Payer: Aetna Commercial |
$16,507.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,943.36
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cigna Commercial |
$16,507.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,688.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,425.60
|
| Rate for Payer: Health EOS Commercial |
$15,812.16
|
| Rate for Payer: Multiplan Commercial |
$13,900.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,507.20
|
| Rate for Payer: Quartz Beloit One Network |
$7,645.44
|
| Rate for Payer: Quartz Commercial |
$9,904.32
|
| Rate for Payer: The Alliance Commercial |
$8,688.00
|
| Rate for Payer: WEA Trust Commercial |
$9,556.80
|
| Rate for Payer: WPS Commercial |
$12,870.40
|
|
|
With Transl Stent Placement(S), Inc Angio 3722150
|
Professional
|
$28,960.00
|
|
|
Service Code
|
CPT 37221 50
|
| Hospital Charge Code |
3462168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$367.57 |
| Max. Negotiated Rate |
$27,512.00 |
| Rate for Payer: Aetna Commercial |
$27,512.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,905.60
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cigna Commercial |
$27,512.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,480.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,376.00
|
| Rate for Payer: Health EOS Commercial |
$26,353.60
|
| Rate for Payer: Multiplan Commercial |
$23,168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27,512.00
|
| Rate for Payer: Quartz Beloit One Network |
$12,742.40
|
| Rate for Payer: Quartz Commercial |
$16,507.20
|
| Rate for Payer: The Alliance Commercial |
$14,480.00
|
| Rate for Payer: United Healthcare Medicaid |
$367.57
|
| Rate for Payer: WEA Trust Commercial |
$15,928.00
|
| Rate for Payer: WPS Commercial |
$21,450.67
|
|
|
WITH TRANSL STENT PLACEMENT(S), INC ANGIO SAME VES 37221
|
Professional
|
$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: Aetna Managed Medicare |
$431.51
|
| Rate for Payer: Anthem Medicare Advantage |
$431.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$431.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$431.51
|
| 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 |
$7,239.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$431.51
|
| Rate for Payer: Health EOS Commercial |
$13,175.89
|
| 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: Independent Care Health Plan Medicare |
$431.51
|
| 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: Quartz Medicare Advantage |
$431.51
|
| Rate for Payer: The Alliance Commercial |
$1,833.92
|
| Rate for Payer: United Healthcare Medicaid |
$367.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$431.51
|
| Rate for Payer: WEA Trust Commercial |
$7,963.45
|
| Rate for Payer: WPS Commercial |
$1,941.80
|
|
|
WND PREP CH/INF, F/N/HF/G 15004
|
Professional
|
$698.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
3013632
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$242.17 |
| Max. Negotiated Rate |
$1,089.76 |
| Rate for Payer: Aetna Commercial |
$663.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.28
|
| Rate for Payer: Aetna Managed Medicare |
$242.17
|
| Rate for Payer: Anthem Medicare Advantage |
$242.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.17
|
| 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 |
$349.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.17
|
| Rate for Payer: Health EOS Commercial |
$635.18
|
| 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: Independent Care Health Plan Medicare |
$242.17
|
| 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: Quartz Medicare Advantage |
$242.17
|
| Rate for Payer: The Alliance Commercial |
$1,029.22
|
| Rate for Payer: United Healthcare Medicaid |
$292.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.17
|
| Rate for Payer: WEA Trust Commercial |
$383.90
|
| Rate for Payer: WPS Commercial |
$1,089.76
|
|
|
WND PREP F/N/HF/G ADDL CM 15005
|
Professional
|
$258.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
5587501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$366.03 |
| Rate for Payer: Aetna Commercial |
$245.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$81.34
|
| Rate for Payer: Anthem Medicare Advantage |
$81.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.34
|
| 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 |
$129.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.34
|
| Rate for Payer: Health EOS Commercial |
$234.78
|
| 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: Independent Care Health Plan Medicare |
$81.34
|
| 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: Quartz Medicare Advantage |
$81.34
|
| Rate for Payer: The Alliance Commercial |
$345.70
|
| Rate for Payer: United Healthcare Medicaid |
$90.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.34
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$366.03
|
|
|
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: 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 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 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: 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
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: 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 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
|
|
|
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 |
$3.68 |
| 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: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
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: 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
|
Professional
|
$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: 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
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: 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 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 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 |
$900.00 |
| 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 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 |
$900.00
|
| 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
|
|
