|
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 |
$705.80 |
| 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: 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: Health EOS Commercial |
$1,281.96
|
| Rate for Payer: HFN Commercial |
$1,325.17
|
| Rate for Payer: Multiplan Commercial |
$1,152.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,325.17
|
| Rate for Payer: Quartz Beloit One Network |
$705.80
|
| Rate for Payer: Quartz Commercial |
$864.24
|
| Rate for Payer: WEA Trust Commercial |
$792.22
|
| Rate for Payer: WPS Commercial |
$1,066.87
|
|
|
WRIST ARTHRODESIS
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2959824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,503.16 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,065.09
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
WRIST ARTHRODESIS
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2959824
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,430.37 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,430.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,320.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,554.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,452.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,858.78
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,831.36
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,065.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,320.51
|
| Rate for Payer: Quartz Medicare Advantage |
$3,065.09
|
| Rate for Payer: The Alliance Commercial |
$2,554.24
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
Wrist Arthrogram XR Left
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072709
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.42 |
| Max. Negotiated Rate |
$1,203.38 |
| Rate for Payer: Aetna Commercial |
$1,203.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$132.42
|
| Rate for Payer: Anthem Medicare Advantage |
$132.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.42
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,203.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$633.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.42
|
| Rate for Payer: Health EOS Commercial |
$1,152.72
|
| Rate for Payer: HFN Commercial |
$1,203.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$483.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.42
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$198.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.38
|
| Rate for Payer: Quartz Beloit One Network |
$557.36
|
| Rate for Payer: Quartz Commercial |
$722.03
|
| Rate for Payer: Quartz Medicare Advantage |
$132.42
|
| Rate for Payer: The Alliance Commercial |
$503.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.42
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$662.12
|
|
|
Wrist Arthrogram XR Left
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072709
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,482.47 |
| Rate for Payer: Aetna Commercial |
$1,140.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.68
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,165.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$708.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$1,127.38
|
| Rate for Payer: HFN Commercial |
$1,165.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.38
|
| Rate for Payer: Quartz Beloit One Network |
$620.69
|
| Rate for Payer: Quartz Commercial |
$823.37
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$938.23
|
|
|
Wrist Arthrogram XR Left
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072709
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$620.69 |
| Max. Negotiated Rate |
$1,165.38 |
| Rate for Payer: Aetna Commercial |
$1,140.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.36
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,165.38
|
| Rate for Payer: Health EOS Commercial |
$1,127.38
|
| Rate for Payer: HFN Commercial |
$1,165.38
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.38
|
| Rate for Payer: Quartz Beloit One Network |
$620.69
|
| Rate for Payer: Quartz Commercial |
$760.03
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$938.23
|
|
|
Wrist Arthrogram XR Right
|
Professional
|
Both
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$132.42 |
| Max. Negotiated Rate |
$1,203.38 |
| Rate for Payer: Aetna Commercial |
$1,203.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$132.42
|
| Rate for Payer: Anthem Medicare Advantage |
$132.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.42
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,203.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$633.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.42
|
| Rate for Payer: Health EOS Commercial |
$1,152.72
|
| Rate for Payer: HFN Commercial |
$1,203.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$483.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.42
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$198.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,203.38
|
| Rate for Payer: Quartz Beloit One Network |
$557.36
|
| Rate for Payer: Quartz Commercial |
$722.03
|
| Rate for Payer: Quartz Medicare Advantage |
$132.42
|
| Rate for Payer: The Alliance Commercial |
$503.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.42
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$662.12
|
|
|
Wrist Arthrogram XR Right
|
Facility
|
OP
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,482.47 |
| Rate for Payer: Aetna Commercial |
$1,140.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.68
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,165.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$708.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$1,127.38
|
| Rate for Payer: HFN Commercial |
$1,165.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.38
|
| Rate for Payer: Quartz Beloit One Network |
$620.69
|
| Rate for Payer: Quartz Commercial |
$823.37
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$938.23
|
|
|
Wrist Arthrogram XR Right
|
Facility
|
IP
|
$1,218.00
|
|
|
Service Code
|
CPT 73115
|
| Hospital Charge Code |
3072710
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$620.69 |
| Max. Negotiated Rate |
$1,165.38 |
| Rate for Payer: Aetna Commercial |
$1,140.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.36
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,165.38
|
| Rate for Payer: Health EOS Commercial |
$1,127.38
|
| Rate for Payer: HFN Commercial |
$1,165.38
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.38
|
| Rate for Payer: Quartz Beloit One Network |
$620.69
|
| Rate for Payer: Quartz Commercial |
$760.03
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$938.23
|
|
|
WRIST ARTHROPLASTY
|
Facility
|
IP
|
$8,012.00
|
|
| Hospital Charge Code |
2960446
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,082.92 |
| Max. Negotiated Rate |
$7,665.88 |
| Rate for Payer: Aetna Commercial |
$7,499.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,165.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.21
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,665.88
|
| Rate for Payer: Health EOS Commercial |
$7,415.91
|
| Rate for Payer: HFN Commercial |
$7,665.88
|
| Rate for Payer: Multiplan Commercial |
$6,665.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,665.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,082.92
|
| Rate for Payer: Quartz Commercial |
$4,999.49
|
| Rate for Payer: WEA Trust Commercial |
$4,582.86
|
| Rate for Payer: WPS Commercial |
$6,171.64
|
|
|
WRIST ARTHROPLASTY
|
Facility
|
OP
|
$8,012.00
|
|
| Hospital Charge Code |
2960446
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,333.09 |
| Max. Negotiated Rate |
$7,665.88 |
| Rate for Payer: Aetna Commercial |
$7,499.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,165.93
|
| Rate for Payer: Aetna Managed Medicare |
$2,333.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,416.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,166.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.21
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,665.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,662.98
|
| Rate for Payer: Health EOS Commercial |
$7,415.91
|
| Rate for Payer: HFN Commercial |
$7,665.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,249.36
|
| Rate for Payer: Multiplan Commercial |
$6,665.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,999.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,665.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,082.92
|
| Rate for Payer: Quartz Commercial |
$5,416.11
|
| Rate for Payer: Quartz Medicare Advantage |
$4,999.49
|
| Rate for Payer: The Alliance Commercial |
$4,166.24
|
| Rate for Payer: WEA Trust Commercial |
$4,582.86
|
| Rate for Payer: WPS Commercial |
$6,171.64
|
|
|
WRIST ARTHROSCOPY
|
Facility
|
OP
|
$7,950.00
|
|
| Hospital Charge Code |
2959831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,315.04 |
| Max. Negotiated Rate |
$7,606.56 |
| Rate for Payer: Aetna Commercial |
$7,441.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,110.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,315.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,374.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,134.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,968.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,606.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,626.90
|
| Rate for Payer: Health EOS Commercial |
$7,358.52
|
| Rate for Payer: HFN Commercial |
$7,606.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,201.00
|
| Rate for Payer: Multiplan Commercial |
$6,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,960.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,606.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,051.32
|
| Rate for Payer: Quartz Commercial |
$5,374.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,960.80
|
| Rate for Payer: The Alliance Commercial |
$4,134.00
|
| Rate for Payer: WEA Trust Commercial |
$4,547.40
|
| Rate for Payer: WPS Commercial |
$6,123.89
|
|
|
WRIST ARTHROSCOPY
|
Facility
|
IP
|
$7,950.00
|
|
| Hospital Charge Code |
2959831
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,051.32 |
| Max. Negotiated Rate |
$7,606.56 |
| Rate for Payer: Aetna Commercial |
$7,441.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,110.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,606.56
|
| Rate for Payer: Health EOS Commercial |
$7,358.52
|
| Rate for Payer: HFN Commercial |
$7,606.56
|
| Rate for Payer: Multiplan Commercial |
$6,614.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,606.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,051.32
|
| Rate for Payer: Quartz Commercial |
$4,960.80
|
| Rate for Payer: WEA Trust Commercial |
$4,547.40
|
| Rate for Payer: WPS Commercial |
$6,123.89
|
|
|
WRIST BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959868
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
WRIST BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959868
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
WRIST BRACE AMBIDEXTROUS XL 55984004
|
Facility
|
IP
|
$332.00
|
|
| Hospital Charge Code |
2970944
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$169.19 |
| Max. Negotiated Rate |
$317.66 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.00
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$317.66
|
| Rate for Payer: Health EOS Commercial |
$307.30
|
| Rate for Payer: HFN Commercial |
$317.66
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: Preferred Network Access Commercial |
$317.66
|
| Rate for Payer: Quartz Beloit One Network |
$169.19
|
| Rate for Payer: Quartz Commercial |
$207.17
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: WPS Commercial |
$255.74
|
|
|
WRIST BRACE AMBIDEXTROUS XL 55984004
|
Facility
|
OP
|
$332.00
|
|
| Hospital Charge Code |
2970944
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.68 |
| Max. Negotiated Rate |
$317.66 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Aetna Managed Medicare |
$96.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$224.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.00
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$317.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.22
|
| Rate for Payer: Health EOS Commercial |
$307.30
|
| Rate for Payer: HFN Commercial |
$317.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.96
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: NAPHCARE Commercial |
$207.17
|
| Rate for Payer: Preferred Network Access Commercial |
$317.66
|
| Rate for Payer: Quartz Beloit One Network |
$169.19
|
| Rate for Payer: Quartz Commercial |
$224.43
|
| Rate for Payer: Quartz Medicare Advantage |
$207.17
|
| Rate for Payer: The Alliance Commercial |
$172.64
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: WPS Commercial |
$255.74
|
|
|
WRIST BRACE RIGHT TITAN 450-RT #5547-67-02
|
Facility
|
OP
|
$360.00
|
|
| Hospital Charge Code |
2969685
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$104.83 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Aetna Managed Medicare |
$104.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$243.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$187.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.52
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$280.80
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$243.36
|
| Rate for Payer: Quartz Medicare Advantage |
$224.64
|
| Rate for Payer: The Alliance Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
WRIST BRACE RIGHT TITAN 450-RT #5547-67-02
|
Facility
|
IP
|
$360.00
|
|
| Hospital Charge Code |
2969685
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$183.46 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$224.64
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
WRIST, EXTERNAL FIXATOR
|
Facility
|
IP
|
$5,453.00
|
|
| Hospital Charge Code |
2960041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,778.85 |
| Max. Negotiated Rate |
$5,217.43 |
| Rate for Payer: Aetna Commercial |
$5,104.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,877.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,005.69
|
| Rate for Payer: Cash Price |
$1,635.90
|
| Rate for Payer: Cigna Commercial |
$5,217.43
|
| Rate for Payer: Health EOS Commercial |
$5,047.30
|
| Rate for Payer: HFN Commercial |
$5,217.43
|
| Rate for Payer: Multiplan Commercial |
$4,536.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,217.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,778.85
|
| Rate for Payer: Quartz Commercial |
$3,402.67
|
| Rate for Payer: WEA Trust Commercial |
$3,119.12
|
| Rate for Payer: WPS Commercial |
$4,200.45
|
|
|
WRIST, EXTERNAL FIXATOR
|
Facility
|
OP
|
$5,453.00
|
|
| Hospital Charge Code |
2960041
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,587.91 |
| Max. Negotiated Rate |
$5,217.43 |
| Rate for Payer: Aetna Commercial |
$5,104.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,877.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,587.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,686.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,835.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,722.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,005.69
|
| Rate for Payer: Cash Price |
$1,635.90
|
| Rate for Payer: Cigna Commercial |
$5,217.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,173.65
|
| Rate for Payer: Health EOS Commercial |
$5,047.30
|
| Rate for Payer: HFN Commercial |
$5,217.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,253.34
|
| Rate for Payer: Multiplan Commercial |
$4,536.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,402.67
|
| Rate for Payer: Preferred Network Access Commercial |
$5,217.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,778.85
|
| Rate for Payer: Quartz Commercial |
$3,686.23
|
| Rate for Payer: Quartz Medicare Advantage |
$3,402.67
|
| Rate for Payer: The Alliance Commercial |
$2,835.56
|
| Rate for Payer: WEA Trust Commercial |
$3,119.12
|
| Rate for Payer: WPS Commercial |
$4,200.45
|
|
|
WRIST KIT MONOTUBE TRIAX 5150-9-960
|
Facility
|
OP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,359.01 |
| Max. Negotiated Rate |
$7,751.04 |
| Rate for Payer: Aetna Commercial |
$7,582.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,245.53
|
| Rate for Payer: Aetna Managed Medicare |
$2,359.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,476.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,212.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,044.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,465.27
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,751.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,714.78
|
| Rate for Payer: Health EOS Commercial |
$7,498.29
|
| Rate for Payer: HFN Commercial |
$7,751.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,318.78
|
| Rate for Payer: Multiplan Commercial |
$6,740.03
|
| Rate for Payer: NAPHCARE Commercial |
$5,055.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,751.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,128.27
|
| Rate for Payer: Quartz Commercial |
$5,476.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5,055.02
|
| Rate for Payer: The Alliance Commercial |
$4,212.52
|
| Rate for Payer: WEA Trust Commercial |
$4,633.77
|
| Rate for Payer: WPS Commercial |
$6,240.20
|
|
|
WRIST KIT MONOTUBE TRIAX 5150-9-960
|
Facility
|
IP
|
$8,101.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4519002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,128.27 |
| Max. Negotiated Rate |
$7,751.04 |
| Rate for Payer: Aetna Commercial |
$7,582.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,245.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,465.27
|
| Rate for Payer: Cash Price |
$2,430.30
|
| Rate for Payer: Cigna Commercial |
$7,751.04
|
| Rate for Payer: Health EOS Commercial |
$7,498.29
|
| Rate for Payer: HFN Commercial |
$7,751.04
|
| Rate for Payer: Multiplan Commercial |
$6,740.03
|
| Rate for Payer: Preferred Network Access Commercial |
$7,751.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,128.27
|
| Rate for Payer: Quartz Commercial |
$5,055.02
|
| Rate for Payer: WEA Trust Commercial |
$4,633.77
|
| Rate for Payer: WPS Commercial |
$6,240.20
|
|
|
WRIST SPLINT 8 XS LT **USE DMECON1081
|
Facility
|
IP
|
$253.00
|
|
| Hospital Charge Code |
2974323
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$128.93 |
| Max. Negotiated Rate |
$242.07 |
| Rate for Payer: Aetna Commercial |
$236.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.45
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$242.07
|
| Rate for Payer: Health EOS Commercial |
$234.18
|
| Rate for Payer: HFN Commercial |
$242.07
|
| Rate for Payer: Multiplan Commercial |
$210.50
|
| Rate for Payer: Preferred Network Access Commercial |
$242.07
|
| Rate for Payer: Quartz Beloit One Network |
$128.93
|
| Rate for Payer: Quartz Commercial |
$157.87
|
| Rate for Payer: WEA Trust Commercial |
$144.72
|
| Rate for Payer: WPS Commercial |
$194.89
|
|
|
WRIST SPLINT 8 XS LT **USE DMECON1081
|
Facility
|
OP
|
$253.00
|
|
| Hospital Charge Code |
2974323
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.67 |
| Max. Negotiated Rate |
$242.07 |
| Rate for Payer: Aetna Commercial |
$236.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.28
|
| Rate for Payer: Aetna Managed Medicare |
$73.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$171.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.45
|
| Rate for Payer: Cash Price |
$75.90
|
| Rate for Payer: Cigna Commercial |
$242.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.25
|
| Rate for Payer: Health EOS Commercial |
$234.18
|
| Rate for Payer: HFN Commercial |
$242.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.34
|
| Rate for Payer: Multiplan Commercial |
$210.50
|
| Rate for Payer: NAPHCARE Commercial |
$157.87
|
| Rate for Payer: Preferred Network Access Commercial |
$242.07
|
| Rate for Payer: Quartz Beloit One Network |
$128.93
|
| Rate for Payer: Quartz Commercial |
$171.03
|
| Rate for Payer: Quartz Medicare Advantage |
$157.87
|
| Rate for Payer: The Alliance Commercial |
$131.56
|
| Rate for Payer: WEA Trust Commercial |
$144.72
|
| Rate for Payer: WPS Commercial |
$194.89
|
|
