|
Witch Hazel Pads [Med]
|
Facility
|
OP
|
$46.00
|
|
| Hospital Charge Code |
2974999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.77
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.88
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$31.10
|
| Rate for Payer: Quartz Medicare Advantage |
$28.70
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
Witch Hazel Pads [Med]
|
Facility
|
IP
|
$46.00
|
|
| Hospital Charge Code |
2974999
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$28.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
With Biopsy - Bronchoscopy Charge
|
Facility
|
IP
|
$4,460.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
2990185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
With Biopsy - Bronchoscopy Charge
|
Facility
|
OP
|
$4,460.00
|
|
|
Service Code
|
CPT 31625
|
| Hospital Charge Code |
2990185
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.14 |
| Max. Negotiated Rate |
$6,968.10 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| 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 |
$4,267.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$3,184.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
With Brushing - Bronchoscopy Charge
|
Facility
|
OP
|
$4,417.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
2990184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.14 |
| Max. Negotiated Rate |
$6,968.10 |
| Rate for Payer: Aetna Commercial |
$4,134.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| 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 |
$4,226.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Health EOS Commercial |
$4,088.38
|
| Rate for Payer: HFN Commercial |
$4,226.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: Multiplan Commercial |
$3,674.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,250.90
|
| Rate for Payer: Quartz Commercial |
$2,985.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$3,184.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$2,526.52
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
| Rate for Payer: WPS Commercial |
$3,402.42
|
|
|
With Brushing - Bronchoscopy Charge
|
Facility
|
IP
|
$4,417.00
|
|
|
Service Code
|
CPT 31623
|
| Hospital Charge Code |
2990184
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,250.90 |
| Max. Negotiated Rate |
$4,226.19 |
| Rate for Payer: Aetna Commercial |
$4,134.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,950.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,434.65
|
| Rate for Payer: Cash Price |
$1,325.10
|
| Rate for Payer: Cigna Commercial |
$4,226.19
|
| Rate for Payer: Health EOS Commercial |
$4,088.38
|
| Rate for Payer: HFN Commercial |
$4,226.19
|
| Rate for Payer: Multiplan Commercial |
$3,674.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,226.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,250.90
|
| Rate for Payer: Quartz Commercial |
$2,756.21
|
| Rate for Payer: WEA Trust Commercial |
$2,526.52
|
| Rate for Payer: WPS Commercial |
$3,402.42
|
|
|
WITH CATH PLCMT IN BYPASS GRAFT INC INTRA INJ 9345526
|
Professional
|
Both
|
$5,825.00
|
|
|
Service Code
|
CPT 93455 26
|
| Hospital Charge Code |
3015391
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$216.08 |
| Max. Negotiated Rate |
$5,755.10 |
| Rate for Payer: Aetna Commercial |
$5,755.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,209.88
|
| Rate for Payer: Aetna Managed Medicare |
$255.15
|
| Rate for Payer: Anthem Medicare Advantage |
$255.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$255.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$255.15
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cash Price |
$1,747.50
|
| Rate for Payer: Cigna Commercial |
$5,755.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.15
|
| Rate for Payer: Health EOS Commercial |
$5,512.78
|
| Rate for Payer: HFN Commercial |
$5,755.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$937.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$937.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$255.15
|
| Rate for Payer: Multiplan Commercial |
$4,846.40
|
| Rate for Payer: NAPHCARE Commercial |
$382.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,755.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,665.52
|
| Rate for Payer: Quartz Commercial |
$3,453.06
|
| Rate for Payer: Quartz Medicare Advantage |
$255.15
|
| Rate for Payer: The Alliance Commercial |
$969.58
|
| Rate for Payer: United Healthcare Medicaid |
$216.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$255.15
|
| Rate for Payer: WEA Trust Commercial |
$3,331.90
|
| Rate for Payer: WPS Commercial |
$1,020.61
|
|
|
With Transl Stent Placement (S), Inc Angio 3722122
|
Professional
|
Both
|
$17,376.00
|
|
|
Service Code
|
CPT 37221 22
|
| Hospital Charge Code |
5078631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,631.04 |
| Max. Negotiated Rate |
$17,167.49 |
| Rate for Payer: Aetna Commercial |
$17,167.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,541.09
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cash Price |
$5,212.80
|
| Rate for Payer: Cigna Commercial |
$17,167.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,035.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,842.62
|
| Rate for Payer: Health EOS Commercial |
$16,444.65
|
| Rate for Payer: HFN Commercial |
$17,167.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.04
|
| Rate for Payer: Multiplan Commercial |
$14,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$17,167.49
|
| Rate for Payer: Quartz Beloit One Network |
$7,951.26
|
| Rate for Payer: Quartz Commercial |
$10,300.49
|
| Rate for Payer: The Alliance Commercial |
$9,035.52
|
| Rate for Payer: WEA Trust Commercial |
$9,939.07
|
| Rate for Payer: WPS Commercial |
$13,384.73
|
|
|
With Transl Stent Placement(S), Inc Angio 3722150
|
Professional
|
Both
|
$28,960.00
|
|
|
Service Code
|
CPT 37221 50
|
| Hospital Charge Code |
3462168
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,631.04 |
| Max. Negotiated Rate |
$28,612.48 |
| Rate for Payer: Aetna Commercial |
$28,612.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,901.82
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cash Price |
$8,688.00
|
| Rate for Payer: Cigna Commercial |
$28,612.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,059.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,071.04
|
| Rate for Payer: Health EOS Commercial |
$27,407.74
|
| Rate for Payer: HFN Commercial |
$28,612.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.04
|
| Rate for Payer: Multiplan Commercial |
$24,094.72
|
| Rate for Payer: Preferred Network Access Commercial |
$28,612.48
|
| Rate for Payer: Quartz Beloit One Network |
$13,252.10
|
| Rate for Payer: Quartz Commercial |
$17,167.49
|
| Rate for Payer: The Alliance Commercial |
$15,059.20
|
| Rate for Payer: WEA Trust Commercial |
$16,565.12
|
| Rate for Payer: WPS Commercial |
$22,307.89
|
|
|
With Transl Stent Placement (S), Inc Angio, Extnd Svc & Bilateral 372212250
|
Professional
|
Both
|
$34,753.00
|
|
|
Service Code
|
CPT 37221 22,50
|
| Hospital Charge Code |
6173582
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,631.04 |
| Max. Negotiated Rate |
$34,335.96 |
| Rate for Payer: Aetna Commercial |
$34,335.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,083.08
|
| Rate for Payer: Cash Price |
$10,425.90
|
| Rate for Payer: Cash Price |
$10,425.90
|
| Rate for Payer: Cash Price |
$10,425.90
|
| Rate for Payer: Cigna Commercial |
$34,335.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,071.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,685.87
|
| Rate for Payer: Health EOS Commercial |
$32,890.24
|
| Rate for Payer: HFN Commercial |
$34,335.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.04
|
| Rate for Payer: Multiplan Commercial |
$28,914.50
|
| Rate for Payer: Preferred Network Access Commercial |
$34,335.96
|
| Rate for Payer: Quartz Beloit One Network |
$15,902.97
|
| Rate for Payer: Quartz Commercial |
$20,601.58
|
| Rate for Payer: The Alliance Commercial |
$18,071.56
|
| Rate for Payer: WEA Trust Commercial |
$19,878.72
|
| Rate for Payer: WPS Commercial |
$26,770.24
|
|
|
WITH TRANSL STENT PLACEMENT(S), INC ANGIO SAME VES 37221
|
Professional
|
Both
|
$14,479.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
3014551
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,631.04 |
| Max. Negotiated Rate |
$14,305.25 |
| Rate for Payer: Aetna Commercial |
$14,305.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,950.02
|
| Rate for Payer: Cash Price |
$4,343.70
|
| Rate for Payer: Cash Price |
$4,343.70
|
| Rate for Payer: Cash Price |
$4,343.70
|
| Rate for Payer: Cigna Commercial |
$14,305.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,529.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,034.90
|
| Rate for Payer: Health EOS Commercial |
$13,702.93
|
| Rate for Payer: HFN Commercial |
$14,305.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,631.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,631.04
|
| Rate for Payer: Multiplan Commercial |
$12,046.53
|
| Rate for Payer: Preferred Network Access Commercial |
$14,305.25
|
| Rate for Payer: Quartz Beloit One Network |
$6,625.59
|
| Rate for Payer: Quartz Commercial |
$8,583.15
|
| Rate for Payer: The Alliance Commercial |
$7,529.08
|
| Rate for Payer: WEA Trust Commercial |
$8,281.99
|
| Rate for Payer: WPS Commercial |
$11,153.17
|
|
|
WND PREP CH/INF, F/N/HF/G 15004
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
CPT 15004
|
| Hospital Charge Code |
3013632
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$220.48 |
| Max. Negotiated Rate |
$992.16 |
| Rate for Payer: Aetna Commercial |
$689.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.29
|
| Rate for Payer: Aetna Managed Medicare |
$220.48
|
| Rate for Payer: Anthem Medicare Advantage |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$220.48
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$689.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.48
|
| Rate for Payer: Health EOS Commercial |
$660.59
|
| Rate for Payer: HFN Commercial |
$689.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$220.48
|
| Rate for Payer: Multiplan Commercial |
$580.74
|
| Rate for Payer: NAPHCARE Commercial |
$330.72
|
| Rate for Payer: Preferred Network Access Commercial |
$689.62
|
| Rate for Payer: Quartz Beloit One Network |
$319.40
|
| Rate for Payer: Quartz Commercial |
$413.77
|
| Rate for Payer: Quartz Medicare Advantage |
$220.48
|
| Rate for Payer: The Alliance Commercial |
$937.04
|
| Rate for Payer: United Healthcare Medicaid |
$303.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$220.48
|
| Rate for Payer: WEA Trust Commercial |
$399.26
|
| Rate for Payer: WPS Commercial |
$992.16
|
|
|
WND PREP F/N/HF/G ADDL CM 15005
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
CPT 15005
|
| Hospital Charge Code |
5587501
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.47 |
| Max. Negotiated Rate |
$326.10 |
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$72.47
|
| Rate for Payer: Anthem Medicare Advantage |
$72.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.47
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$254.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.47
|
| Rate for Payer: Health EOS Commercial |
$244.17
|
| Rate for Payer: HFN Commercial |
$254.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$307.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.47
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$108.70
|
| Rate for Payer: Preferred Network Access Commercial |
$254.90
|
| Rate for Payer: Quartz Beloit One Network |
$118.06
|
| Rate for Payer: Quartz Commercial |
$152.94
|
| Rate for Payer: Quartz Medicare Advantage |
$72.47
|
| Rate for Payer: The Alliance Commercial |
$307.99
|
| Rate for Payer: United Healthcare Medicaid |
$94.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.47
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$326.10
|
|
|
Work Hardening/Cond add 1 hr Charges
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 97546 GO
|
| Hospital Charge Code |
2564874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$93.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.40
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$200.93
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$217.67
|
| Rate for Payer: Quartz Medicare Advantage |
$200.93
|
| Rate for Payer: The Alliance Commercial |
$167.44
|
| Rate for Payer: United Healthcare PPO |
$251.16
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
Work Hardening/Cond add 1 hr Charges
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 97546 GO
|
| Hospital Charge Code |
2564874
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$164.09 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$200.93
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
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 |
$164.09 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$200.93
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
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 |
$93.77 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$93.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.40
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$200.93
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$217.67
|
| Rate for Payer: Quartz Medicare Advantage |
$200.93
|
| Rate for Payer: The Alliance Commercial |
$167.44
|
| Rate for Payer: United Healthcare PPO |
$251.16
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
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 |
$409.21 |
| Max. Negotiated Rate |
$768.31 |
| Rate for Payer: Aetna Commercial |
$751.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$442.61
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cigna Commercial |
$768.31
|
| Rate for Payer: Health EOS Commercial |
$743.26
|
| Rate for Payer: HFN Commercial |
$768.31
|
| Rate for Payer: Multiplan Commercial |
$668.10
|
| Rate for Payer: Preferred Network Access Commercial |
$768.31
|
| Rate for Payer: Quartz Beloit One Network |
$409.21
|
| Rate for Payer: Quartz Commercial |
$501.07
|
| Rate for Payer: WEA Trust Commercial |
$459.32
|
| Rate for Payer: WPS Commercial |
$618.55
|
|
|
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 |
$210.08 |
| Max. Negotiated Rate |
$768.31 |
| Rate for Payer: Aetna Commercial |
$751.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.20
|
| Rate for Payer: Aetna Managed Medicare |
$233.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$442.61
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cigna Commercial |
$768.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$467.35
|
| Rate for Payer: Health EOS Commercial |
$743.26
|
| Rate for Payer: HFN Commercial |
$768.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$668.10
|
| Rate for Payer: NAPHCARE Commercial |
$501.07
|
| Rate for Payer: Preferred Network Access Commercial |
$768.31
|
| Rate for Payer: Quartz Beloit One Network |
$409.21
|
| Rate for Payer: Quartz Commercial |
$542.83
|
| Rate for Payer: Quartz Medicare Advantage |
$501.07
|
| Rate for Payer: The Alliance Commercial |
$417.56
|
| Rate for Payer: United Healthcare PPO |
$626.34
|
| Rate for Payer: WEA Trust Commercial |
$459.32
|
| Rate for Payer: WPS Commercial |
$618.55
|
|
|
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 |
$210.08 |
| Max. Negotiated Rate |
$768.31 |
| Rate for Payer: Aetna Commercial |
$751.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.20
|
| Rate for Payer: Aetna Managed Medicare |
$233.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$442.61
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cigna Commercial |
$768.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$467.35
|
| Rate for Payer: Health EOS Commercial |
$743.26
|
| Rate for Payer: HFN Commercial |
$768.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$668.10
|
| Rate for Payer: NAPHCARE Commercial |
$501.07
|
| Rate for Payer: Preferred Network Access Commercial |
$768.31
|
| Rate for Payer: Quartz Beloit One Network |
$409.21
|
| Rate for Payer: Quartz Commercial |
$542.83
|
| Rate for Payer: Quartz Medicare Advantage |
$501.07
|
| Rate for Payer: The Alliance Commercial |
$417.56
|
| Rate for Payer: United Healthcare PPO |
$626.34
|
| Rate for Payer: WEA Trust Commercial |
$459.32
|
| Rate for Payer: WPS Commercial |
$618.55
|
|
|
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 |
$409.21 |
| Max. Negotiated Rate |
$768.31 |
| Rate for Payer: Aetna Commercial |
$751.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$718.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$442.61
|
| Rate for Payer: Cash Price |
$240.90
|
| Rate for Payer: Cigna Commercial |
$768.31
|
| Rate for Payer: Health EOS Commercial |
$743.26
|
| Rate for Payer: HFN Commercial |
$768.31
|
| Rate for Payer: Multiplan Commercial |
$668.10
|
| Rate for Payer: Preferred Network Access Commercial |
$768.31
|
| Rate for Payer: Quartz Beloit One Network |
$409.21
|
| Rate for Payer: Quartz Commercial |
$501.07
|
| Rate for Payer: WEA Trust Commercial |
$459.32
|
| Rate for Payer: WPS Commercial |
$618.55
|
|
|
Wound cleanser any type/size A6260
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
HCPCS A6260
|
| Hospital Charge Code |
4520649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$3.95 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.50
|
| Rate for Payer: Health EOS Commercial |
$3.79
|
| Rate for Payer: HFN Commercial |
$3.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.42
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.95
|
| Rate for Payer: Quartz Beloit One Network |
$1.83
|
| Rate for Payer: Quartz Commercial |
$2.37
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
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 |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
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 |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
WOUND CLOSURE SYSTEM 3M STERI-STRIP 5/PK W8516
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
2963302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$36.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.17
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$77.38
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
