|
WOUND CLOSURE SYSTEM 3M STERI-STRIP 5/PK W8516
|
Facility
|
IP
|
$124.00
|
|
| Hospital Charge Code |
2963302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| 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: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$77.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
Wound Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.88
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$8.96
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Wound Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Wound Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$39.45
|
|
|
Wound Debridement
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
5006606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$172.85
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
Wound Debridement
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
5006606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.28 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.28
|
| Rate for Payer: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.14
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.14
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$187.25
|
| Rate for Payer: Quartz Medicare Advantage |
$211.14
|
| Rate for Payer: The Alliance Commercial |
$844.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.14
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$83,320.64
|
|
|
Service Code
|
MSDRG 464
|
| Min. Negotiated Rate |
$24,359.76 |
| Max. Negotiated Rate |
$83,320.64 |
| Rate for Payer: Aetna Managed Medicare |
$24,359.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67,960.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52,090.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49,489.84
|
| Rate for Payer: Anthem Medicare Advantage |
$24,359.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,359.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,359.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,359.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54,938.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,359.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60,868.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,359.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,359.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,359.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,359.76
|
| Rate for Payer: NAPHCARE Commercial |
$36,539.65
|
| Rate for Payer: Quartz Medicare Advantage |
$24,359.76
|
| Rate for Payer: The Alliance Commercial |
$83,320.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,359.76
|
| Rate for Payer: United Healthcare PPO |
$47,386.82
|
| Rate for Payer: Wellcare Medicare |
$24,359.76
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$156,930.80
|
|
|
Service Code
|
MSDRG 463
|
| Min. Negotiated Rate |
$44,154.67 |
| Max. Negotiated Rate |
$156,930.80 |
| Rate for Payer: Aetna Managed Medicare |
$44,154.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124,358.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95,319.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90,560.04
|
| Rate for Payer: Anthem Medicare Advantage |
$44,154.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44,154.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44,154.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44,154.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100,529.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44,154.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114,859.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44,154.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44,154.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44,154.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44,154.67
|
| Rate for Payer: NAPHCARE Commercial |
$66,232.00
|
| Rate for Payer: Quartz Medicare Advantage |
$44,154.67
|
| Rate for Payer: The Alliance Commercial |
$156,930.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44,154.67
|
| Rate for Payer: United Healthcare PPO |
$89,419.86
|
| Rate for Payer: Wellcare Medicare |
$44,154.67
|
|
|
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$52,059.28
|
|
|
Service Code
|
MSDRG 465
|
| Min. Negotiated Rate |
$14,473.05 |
| Max. Negotiated Rate |
$52,059.28 |
| Rate for Payer: Aetna Managed Medicare |
$14,473.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,791.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,500.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,976.99
|
| Rate for Payer: Anthem Medicare Advantage |
$14,473.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,473.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,473.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,473.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,167.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,473.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,939.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,473.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,473.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,473.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,473.05
|
| Rate for Payer: NAPHCARE Commercial |
$21,709.57
|
| Rate for Payer: Quartz Medicare Advantage |
$14,473.05
|
| Rate for Payer: The Alliance Commercial |
$52,059.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,473.05
|
| Rate for Payer: United Healthcare PPO |
$29,536.63
|
| Rate for Payer: Wellcare Medicare |
$14,473.05
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH CC
|
Facility
|
IP
|
$52,444.08
|
|
|
Service Code
|
MSDRG 902
|
| Min. Negotiated Rate |
$15,168.40 |
| Max. Negotiated Rate |
$52,444.08 |
| Rate for Payer: Aetna Managed Medicare |
$15,168.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,772.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,018.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,419.72
|
| Rate for Payer: Anthem Medicare Advantage |
$15,168.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,168.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,168.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,168.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,768.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,168.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,221.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,168.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,168.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,168.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,168.40
|
| Rate for Payer: NAPHCARE Commercial |
$22,752.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15,168.40
|
| Rate for Payer: The Alliance Commercial |
$52,444.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,168.40
|
| Rate for Payer: United Healthcare PPO |
$29,756.10
|
| Rate for Payer: Wellcare Medicare |
$15,168.40
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC
|
Facility
|
IP
|
$119,994.16
|
|
|
Service Code
|
MSDRG 901
|
| Min. Negotiated Rate |
$32,645.17 |
| Max. Negotiated Rate |
$119,994.16 |
| Rate for Payer: Aetna Managed Medicare |
$32,645.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91,566.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70,184.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66,680.28
|
| Rate for Payer: Anthem Medicare Advantage |
$32,645.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,645.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,645.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,645.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74,021.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,645.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87,767.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,645.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,645.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,645.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,645.17
|
| Rate for Payer: NAPHCARE Commercial |
$48,967.76
|
| Rate for Payer: Quartz Medicare Advantage |
$32,645.17
|
| Rate for Payer: The Alliance Commercial |
$119,994.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,645.17
|
| Rate for Payer: United Healthcare PPO |
$68,328.34
|
| Rate for Payer: Wellcare Medicare |
$32,645.17
|
|
|
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,660.08
|
|
|
Service Code
|
MSDRG 903
|
| Min. Negotiated Rate |
$9,463.81 |
| Max. Negotiated Rate |
$34,660.08 |
| Rate for Payer: Aetna Managed Medicare |
$9,463.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,519.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,560.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,583.91
|
| Rate for Payer: Anthem Medicare Advantage |
$9,463.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,463.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,463.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,463.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,629.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,463.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,177.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,463.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,463.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,463.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,463.81
|
| Rate for Payer: NAPHCARE Commercial |
$14,195.72
|
| Rate for Payer: Quartz Medicare Advantage |
$9,463.81
|
| Rate for Payer: The Alliance Commercial |
$34,660.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,463.81
|
| Rate for Payer: United Healthcare PPO |
$19,601.10
|
| Rate for Payer: Wellcare Medicare |
$9,463.81
|
|
|
Wound Drainage Management
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005549
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$178.46
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
Wound Drainage Management
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005549
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Aetna Managed Medicare |
$83.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$193.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.45
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.08
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: NAPHCARE Commercial |
$178.46
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$193.34
|
| Rate for Payer: Quartz Medicare Advantage |
$178.46
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
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 |
$117.95 |
| Max. Negotiated Rate |
$221.46 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.58
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cigna Commercial |
$221.46
|
| Rate for Payer: Health EOS Commercial |
$214.24
|
| Rate for Payer: HFN Commercial |
$221.46
|
| Rate for Payer: Multiplan Commercial |
$192.57
|
| Rate for Payer: Preferred Network Access Commercial |
$221.46
|
| Rate for Payer: Quartz Beloit One Network |
$117.95
|
| Rate for Payer: Quartz Commercial |
$144.43
|
| Rate for Payer: WEA Trust Commercial |
$132.40
|
| Rate for Payer: WPS Commercial |
$178.29
|
|
|
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 |
$67.25 |
| Max. Negotiated Rate |
$523.87 |
| Rate for Payer: Aetna Commercial |
$216.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.02
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.54
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cash Price |
$69.44
|
| Rate for Payer: Cigna Commercial |
$221.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$214.24
|
| Rate for Payer: HFN Commercial |
$221.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$192.57
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$221.46
|
| Rate for Payer: Quartz Beloit One Network |
$117.95
|
| Rate for Payer: Quartz Commercial |
$156.47
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$132.40
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$127.08
|
|
|
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 |
$67.25 |
| Max. Negotiated Rate |
$595.61 |
| Rate for Payer: Aetna Commercial |
$582.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$420.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.75
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna Commercial |
$595.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$576.19
|
| Rate for Payer: HFN Commercial |
$595.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$517.92
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$595.61
|
| Rate for Payer: Quartz Beloit One Network |
$317.23
|
| Rate for Payer: Quartz Commercial |
$420.81
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$356.07
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$127.08
|
|
|
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 |
$317.23 |
| Max. Negotiated Rate |
$595.61 |
| Rate for Payer: Aetna Commercial |
$582.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$556.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.12
|
| Rate for Payer: Cash Price |
$186.75
|
| Rate for Payer: Cigna Commercial |
$595.61
|
| Rate for Payer: Health EOS Commercial |
$576.19
|
| Rate for Payer: HFN Commercial |
$595.61
|
| Rate for Payer: Multiplan Commercial |
$517.92
|
| Rate for Payer: Preferred Network Access Commercial |
$595.61
|
| Rate for Payer: Quartz Beloit One Network |
$317.23
|
| Rate for Payer: Quartz Commercial |
$388.44
|
| Rate for Payer: WEA Trust Commercial |
$356.07
|
| Rate for Payer: WPS Commercial |
$479.51
|
|
|
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 |
$67.25 |
| Max. Negotiated Rate |
$523.87 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$127.08
|
|
|
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 |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
WOUND REPAIR
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
WOUND REPAIR
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960512
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
WRENCH SPANNER 5MM HOFFMANN LIMB 4933-9-205
|
Facility
|
IP
|
$3,846.00
|
|
| Hospital Charge Code |
6167872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,959.92 |
| Max. Negotiated Rate |
$3,679.85 |
| Rate for Payer: Aetna Commercial |
$3,599.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,439.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.92
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna Commercial |
$3,679.85
|
| Rate for Payer: Health EOS Commercial |
$3,559.86
|
| Rate for Payer: HFN Commercial |
$3,679.85
|
| Rate for Payer: Multiplan Commercial |
$3,199.87
|
| Rate for Payer: Preferred Network Access Commercial |
$3,679.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.92
|
| Rate for Payer: Quartz Commercial |
$2,399.90
|
| Rate for Payer: WEA Trust Commercial |
$2,199.91
|
| Rate for Payer: WPS Commercial |
$2,962.57
|
|
|
WRENCH SPANNER 5MM HOFFMANN LIMB 4933-9-205
|
Facility
|
OP
|
$3,846.00
|
|
| Hospital Charge Code |
6167872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,119.96 |
| Max. Negotiated Rate |
$3,679.85 |
| Rate for Payer: Aetna Commercial |
$3,599.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,439.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,119.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,599.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,999.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,919.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,119.92
|
| Rate for Payer: Cash Price |
$1,153.80
|
| Rate for Payer: Cigna Commercial |
$3,679.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,238.37
|
| Rate for Payer: Health EOS Commercial |
$3,559.86
|
| Rate for Payer: HFN Commercial |
$3,679.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,999.88
|
| Rate for Payer: Multiplan Commercial |
$3,199.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,399.90
|
| Rate for Payer: Preferred Network Access Commercial |
$3,679.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,959.92
|
| Rate for Payer: Quartz Commercial |
$2,599.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,399.90
|
| Rate for Payer: The Alliance Commercial |
$1,999.92
|
| Rate for Payer: WEA Trust Commercial |
$2,199.91
|
| Rate for Payer: WPS Commercial |
$2,962.57
|
|
|
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 |
$403.31 |
| Max. Negotiated Rate |
$1,325.17 |
| Rate for Payer: Aetna Commercial |
$1,296.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,238.74
|
| Rate for Payer: Aetna Managed Medicare |
$403.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$936.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$720.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$691.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.41
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,325.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$806.07
|
| Rate for Payer: Health EOS Commercial |
$1,281.96
|
| Rate for Payer: HFN Commercial |
$1,325.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,080.30
|
| Rate for Payer: Multiplan Commercial |
$1,152.32
|
| Rate for Payer: NAPHCARE Commercial |
$864.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,325.17
|
| Rate for Payer: Quartz Beloit One Network |
$705.80
|
| Rate for Payer: Quartz Commercial |
$936.26
|
| Rate for Payer: Quartz Medicare Advantage |
$864.24
|
| Rate for Payer: The Alliance Commercial |
$720.20
|
| Rate for Payer: WEA Trust Commercial |
$792.22
|
| Rate for Payer: WPS Commercial |
$1,066.87
|
|
