|
Wound Culture
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Wound 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
|
|
|
Wound Debridement
|
Facility
OP
|
$277.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
5006606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$132.96 |
| Max. Negotiated Rate |
$736.11 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$180.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.96
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$180.05
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
Wound Debridement
|
Facility
IP
|
$277.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
5006606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$166.20
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
IP
|
$80,116.00
|
|
|
Service Code
|
MS-DRG 464
|
| Min. Negotiated Rate |
$28,818.54 |
| Max. Negotiated Rate |
$80,116.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,818.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62,940.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,243.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45,834.00
|
| Rate for Payer: Anthem Medicare Advantage |
$28,818.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,818.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,818.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,818.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50,879.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,818.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58,527.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,818.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,818.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,818.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,818.54
|
| Rate for Payer: NAPHCARE Commercial |
$43,227.81
|
| Rate for Payer: Quartz Medicare Advantage |
$28,818.54
|
| Rate for Payer: The Alliance Commercial |
$80,116.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,818.54
|
| Rate for Payer: United Healthcare PPO |
$45,564.25
|
| Rate for Payer: Wellcare Medicare |
$28,818.54
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
IP
|
$150,895.00
|
|
|
Service Code
|
MS-DRG 463
|
| Min. Negotiated Rate |
$54,278.88 |
| Max. Negotiated Rate |
$150,895.00 |
| Rate for Payer: Aetna Managed Medicare |
$54,278.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118,746.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91,018.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86,473.48
|
| Rate for Payer: Anthem Medicare Advantage |
$54,278.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54,278.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54,278.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54,278.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95,993.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54,278.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110,442.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54,278.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54,278.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54,278.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54,278.88
|
| Rate for Payer: NAPHCARE Commercial |
$81,418.32
|
| Rate for Payer: Quartz Medicare Advantage |
$54,278.88
|
| Rate for Payer: The Alliance Commercial |
$150,895.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54,278.88
|
| Rate for Payer: United Healthcare PPO |
$85,980.63
|
| Rate for Payer: Wellcare Medicare |
$54,278.88
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$50,057.00
|
|
|
Service Code
|
MS-DRG 465
|
| Min. Negotiated Rate |
$18,006.27 |
| Max. Negotiated Rate |
$50,057.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,006.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,232.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,071.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,569.86
|
| Rate for Payer: Anthem Medicare Advantage |
$18,006.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,006.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,006.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,006.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,715.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,006.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,480.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,006.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,006.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,006.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,006.27
|
| Rate for Payer: NAPHCARE Commercial |
$27,009.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18,006.27
|
| Rate for Payer: The Alliance Commercial |
$50,057.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,006.27
|
| Rate for Payer: United Healthcare PPO |
$28,400.61
|
| Rate for Payer: Wellcare Medicare |
$18,006.27
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
IP
|
$50,427.00
|
|
|
Service Code
|
MS-DRG 902
|
| Min. Negotiated Rate |
$18,139.21 |
| Max. Negotiated Rate |
$50,427.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,139.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,442.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,232.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,722.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18,139.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,139.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,139.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,139.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,884.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,139.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,751.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,139.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,139.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,139.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,139.21
|
| Rate for Payer: NAPHCARE Commercial |
$27,208.82
|
| Rate for Payer: Quartz Medicare Advantage |
$18,139.21
|
| Rate for Payer: The Alliance Commercial |
$50,427.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,139.21
|
| Rate for Payer: United Healthcare PPO |
$28,611.63
|
| Rate for Payer: Wellcare Medicare |
$18,139.21
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
IP
|
$115,379.00
|
|
|
Service Code
|
MS-DRG 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
|
MS-DRG 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: 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 |
$263.12 |
| 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: 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
OP
|
$231.46
|
|
|
Service Code
|
HCPCS Q4104
|
| Hospital Charge Code |
6246270
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$64.66 |
| Max. Negotiated Rate |
$5,217.88 |
| 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 |
$5,217.88
|
| Rate for Payer: WEA Trust Commercial |
$127.30
|
| Rate for Payer: WPS Commercial |
$122.19
|
|
|
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: 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 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: 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 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 |
$5,217.88 |
| 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 |
$5,217.88
|
| Rate for Payer: WEA Trust Commercial |
$342.38
|
| Rate for Payer: WPS Commercial |
$122.19
|
|
|
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 |
$5,217.88 |
| 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 |
$5,217.88
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$122.19
|
|
|
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: 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 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
|
|
|
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: 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
|
|
|
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 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: 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 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: 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
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
|
|
