|
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
|
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 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 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 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
|
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 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 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 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
|
|
|
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 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 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
|
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 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
|
|
