|
Yes - Wound Care Non-Selective Debride Charge
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
3554169
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.53 |
| Max. Negotiated Rate |
$844.56 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$211.14
|
| 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: Anthem Medicare Advantage |
$211.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| 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 |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.14
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| 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 |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$316.71
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| 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: United Healthcare PPO |
$83.46
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: Wellcare Medicare |
$211.14
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Yes - Wound Care Non-Selective Debride Charge
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
3554169
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$105.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.77
|
| Rate for Payer: Health EOS Commercial |
$101.26
|
| Rate for Payer: HFN Commercial |
$105.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.64
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$105.72
|
| Rate for Payer: Quartz Beloit One Network |
$48.96
|
| Rate for Payer: Quartz Commercial |
$63.43
|
| Rate for Payer: The Alliance Commercial |
$55.64
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
|
Yes - Wound Vac 50 sq cm Charges
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 97605 GP
|
| Hospital Charge Code |
2989816
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$29.98 |
| Max. Negotiated Rate |
$313.20 |
| Rate for Payer: Aetna Commercial |
$313.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$313.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.81
|
| Rate for Payer: Health EOS Commercial |
$300.01
|
| Rate for Payer: HFN Commercial |
$313.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$90.53
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: Preferred Network Access Commercial |
$313.20
|
| Rate for Payer: Quartz Beloit One Network |
$145.06
|
| Rate for Payer: Quartz Commercial |
$187.92
|
| Rate for Payer: The Alliance Commercial |
$164.84
|
| Rate for Payer: United Healthcare Medicaid |
$29.98
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
Yes - Wound Vac 50 sq cm Charges
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 97605 GP
|
| Hospital Charge Code |
2989816
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Aetna Managed Medicare |
$92.31
|
| 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 |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.49
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: NAPHCARE Commercial |
$197.81
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$214.29
|
| Rate for Payer: Quartz Medicare Advantage |
$197.81
|
| Rate for Payer: The Alliance Commercial |
$164.84
|
| Rate for Payer: United Healthcare PPO |
$247.26
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
Yes - Wound Vac 50 sq cm Charges
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 97605 GP
|
| Hospital Charge Code |
2989816
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$161.54 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$197.81
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
Yes - Wound Vac Addit. 50 sq cm Charges
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 97606 GP
|
| Hospital Charge Code |
2989817
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$96.10 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$308.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.15
|
| Rate for Payer: Aetna Managed Medicare |
$96.10
|
| 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 |
$181.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$315.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.06
|
| Rate for Payer: Health EOS Commercial |
$305.45
|
| Rate for Payer: HFN Commercial |
$315.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$274.56
|
| Rate for Payer: NAPHCARE Commercial |
$205.92
|
| Rate for Payer: Preferred Network Access Commercial |
$315.74
|
| Rate for Payer: Quartz Beloit One Network |
$168.17
|
| Rate for Payer: Quartz Commercial |
$223.08
|
| Rate for Payer: Quartz Medicare Advantage |
$205.92
|
| Rate for Payer: The Alliance Commercial |
$171.60
|
| Rate for Payer: United Healthcare PPO |
$257.40
|
| Rate for Payer: WEA Trust Commercial |
$188.76
|
| Rate for Payer: WPS Commercial |
$254.20
|
|
|
Yes - Wound Vac Addit. 50 sq cm Charges
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 97606 GP
|
| Hospital Charge Code |
2989817
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$168.17 |
| Max. Negotiated Rate |
$315.74 |
| Rate for Payer: Aetna Commercial |
$308.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$315.74
|
| Rate for Payer: Health EOS Commercial |
$305.45
|
| Rate for Payer: HFN Commercial |
$315.74
|
| Rate for Payer: Multiplan Commercial |
$274.56
|
| Rate for Payer: Preferred Network Access Commercial |
$315.74
|
| Rate for Payer: Quartz Beloit One Network |
$168.17
|
| Rate for Payer: Quartz Commercial |
$205.92
|
| Rate for Payer: WEA Trust Commercial |
$188.76
|
| Rate for Payer: WPS Commercial |
$254.20
|
|
|
Yes - Wound Vac Addit. 50 sq cm Charges
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
CPT 97606 GP
|
| Hospital Charge Code |
2989817
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$326.04 |
| Rate for Payer: Aetna Commercial |
$326.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.15
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$326.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.92
|
| Rate for Payer: Health EOS Commercial |
$312.31
|
| Rate for Payer: HFN Commercial |
$326.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.34
|
| Rate for Payer: Multiplan Commercial |
$274.56
|
| Rate for Payer: Preferred Network Access Commercial |
$326.04
|
| Rate for Payer: Quartz Beloit One Network |
$151.01
|
| Rate for Payer: Quartz Commercial |
$195.62
|
| Rate for Payer: The Alliance Commercial |
$171.60
|
| Rate for Payer: United Healthcare Medicaid |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$188.76
|
| Rate for Payer: WPS Commercial |
$254.20
|
|
|
Yes - Wound Vac Disposable Charges >50 sq cm
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 97608 GP
|
| Hospital Charge Code |
5364681
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Aetna Managed Medicare |
$133.08
|
| 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 |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.97
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: NAPHCARE Commercial |
$285.17
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$308.93
|
| Rate for Payer: Quartz Medicare Advantage |
$285.17
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare PPO |
$356.46
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
Yes - Wound Vac Disposable Charges >50 sq cm
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 97608 GP
|
| Hospital Charge Code |
5364681
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$232.89 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$285.17
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
Yes - Wound Vac Disposable Charges 50 sq cm
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
CPT 97607 GP
|
| Hospital Charge Code |
5364671
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$1,211.93 |
| Rate for Payer: Aetna Commercial |
$451.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$451.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.17
|
| Rate for Payer: Health EOS Commercial |
$432.50
|
| Rate for Payer: HFN Commercial |
$451.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,211.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,211.93
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: Preferred Network Access Commercial |
$451.52
|
| Rate for Payer: Quartz Beloit One Network |
$209.12
|
| Rate for Payer: Quartz Commercial |
$270.91
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare Medicaid |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
Yes - Wound Vac Disposable Charges 50 sq cm
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 97607 GP
|
| Hospital Charge Code |
5364671
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Aetna Managed Medicare |
$133.08
|
| 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 |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.97
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: NAPHCARE Commercial |
$285.17
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$308.93
|
| Rate for Payer: Quartz Medicare Advantage |
$285.17
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: United Healthcare PPO |
$356.46
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
Yes - Wound Vac Disposable Charges 50 sq cm
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 97607 GP
|
| Hospital Charge Code |
5364671
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$232.89 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$285.17
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
YID
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$47.22
|
|
|
YID
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
YID
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.82
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$10.73
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Y-PLATE 1.3MM 3H HEAD/8H SHAFT 221.335
|
Facility
|
IP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.23 |
| Max. Negotiated Rate |
$3,062.72 |
| Rate for Payer: Aetna Commercial |
$2,996.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,862.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,764.39
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$3,062.72
|
| Rate for Payer: Health EOS Commercial |
$2,962.85
|
| Rate for Payer: HFN Commercial |
$3,062.72
|
| Rate for Payer: Multiplan Commercial |
$2,663.23
|
| Rate for Payer: Preferred Network Access Commercial |
$3,062.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,631.23
|
| Rate for Payer: Quartz Commercial |
$1,997.42
|
| Rate for Payer: WEA Trust Commercial |
$1,830.97
|
| Rate for Payer: WPS Commercial |
$2,465.73
|
|
|
Y-PLATE 1.3MM 3H HEAD/8H SHAFT 221.335
|
Facility
|
OP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.13 |
| Max. Negotiated Rate |
$3,062.72 |
| Rate for Payer: Aetna Commercial |
$2,996.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,862.97
|
| Rate for Payer: Aetna Managed Medicare |
$932.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,163.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,664.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,597.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,764.39
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$3,062.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,862.98
|
| Rate for Payer: Health EOS Commercial |
$2,962.85
|
| Rate for Payer: HFN Commercial |
$3,062.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,496.78
|
| Rate for Payer: Multiplan Commercial |
$2,663.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,997.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,062.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,631.23
|
| Rate for Payer: Quartz Commercial |
$2,163.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,997.42
|
| Rate for Payer: The Alliance Commercial |
$1,664.52
|
| Rate for Payer: WEA Trust Commercial |
$1,830.97
|
| Rate for Payer: WPS Commercial |
$2,465.73
|
|
|
Y-PLATE 1.5MM 3H HEAD 8H SHAFT 246.612
|
Facility
|
OP
|
$3,819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,112.09 |
| Max. Negotiated Rate |
$3,654.02 |
| Rate for Payer: Aetna Commercial |
$3,574.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,415.71
|
| Rate for Payer: Aetna Managed Medicare |
$1,112.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,581.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,985.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,906.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.03
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cigna Commercial |
$3,654.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,222.66
|
| Rate for Payer: Health EOS Commercial |
$3,534.87
|
| Rate for Payer: HFN Commercial |
$3,654.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,978.82
|
| Rate for Payer: Multiplan Commercial |
$3,177.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,383.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,654.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.16
|
| Rate for Payer: Quartz Commercial |
$2,581.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,383.06
|
| Rate for Payer: The Alliance Commercial |
$1,985.88
|
| Rate for Payer: WEA Trust Commercial |
$2,184.47
|
| Rate for Payer: WPS Commercial |
$2,941.78
|
|
|
Y-PLATE 1.5MM 3H HEAD 8H SHAFT 246.612
|
Facility
|
IP
|
$3,819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,946.16 |
| Max. Negotiated Rate |
$3,654.02 |
| Rate for Payer: Aetna Commercial |
$3,574.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,415.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,105.03
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cigna Commercial |
$3,654.02
|
| Rate for Payer: Health EOS Commercial |
$3,534.87
|
| Rate for Payer: HFN Commercial |
$3,654.02
|
| Rate for Payer: Multiplan Commercial |
$3,177.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,654.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,946.16
|
| Rate for Payer: Quartz Commercial |
$2,383.06
|
| Rate for Payer: WEA Trust Commercial |
$2,184.47
|
| Rate for Payer: WPS Commercial |
$2,941.78
|
|
|
Y-PLATE 1.5MM LCP 3H HEAD/8H SHAFT 02.114.513
|
Facility
|
IP
|
$5,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,894.53 |
| Max. Negotiated Rate |
$5,434.62 |
| Rate for Payer: Aetna Commercial |
$5,316.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,080.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,130.82
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$5,434.62
|
| Rate for Payer: Health EOS Commercial |
$5,257.41
|
| Rate for Payer: HFN Commercial |
$5,434.62
|
| Rate for Payer: Multiplan Commercial |
$4,725.76
|
| Rate for Payer: Preferred Network Access Commercial |
$5,434.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,894.53
|
| Rate for Payer: Quartz Commercial |
$3,544.32
|
| Rate for Payer: WEA Trust Commercial |
$3,248.96
|
| Rate for Payer: WPS Commercial |
$4,375.30
|
|
|
Y-PLATE 1.5MM LCP 3H HEAD/8H SHAFT 02.114.513
|
Facility
|
OP
|
$5,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,654.02 |
| Max. Negotiated Rate |
$5,434.62 |
| Rate for Payer: Aetna Commercial |
$5,316.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,080.19
|
| Rate for Payer: Aetna Managed Medicare |
$1,654.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,839.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,953.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,130.82
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$5,434.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,305.76
|
| Rate for Payer: Health EOS Commercial |
$5,257.41
|
| Rate for Payer: HFN Commercial |
$5,434.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,430.40
|
| Rate for Payer: Multiplan Commercial |
$4,725.76
|
| Rate for Payer: NAPHCARE Commercial |
$3,544.32
|
| Rate for Payer: Preferred Network Access Commercial |
$5,434.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,894.53
|
| Rate for Payer: Quartz Commercial |
$3,839.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,544.32
|
| Rate for Payer: The Alliance Commercial |
$2,953.60
|
| Rate for Payer: WEA Trust Commercial |
$3,248.96
|
| Rate for Payer: WPS Commercial |
$4,375.30
|
|
|
Y-PLATE 2.0 3HEAD 7HL 247.350
|
Facility
|
IP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,009.86 |
| Max. Negotiated Rate |
$3,773.62 |
| Rate for Payer: Aetna Commercial |
$3,691.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,173.93
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,773.62
|
| Rate for Payer: Health EOS Commercial |
$3,650.57
|
| Rate for Payer: HFN Commercial |
$3,773.62
|
| Rate for Payer: Multiplan Commercial |
$3,281.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.86
|
| Rate for Payer: Quartz Commercial |
$2,461.06
|
| Rate for Payer: WEA Trust Commercial |
$2,255.97
|
| Rate for Payer: WPS Commercial |
$3,038.06
|
|
|
Y-PLATE 2.0 3HEAD 7HL 247.350
|
Facility
|
OP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.49 |
| Max. Negotiated Rate |
$3,773.62 |
| Rate for Payer: Aetna Commercial |
$3,691.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,666.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,050.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,968.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,173.93
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,773.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,295.41
|
| Rate for Payer: Health EOS Commercial |
$3,650.57
|
| Rate for Payer: HFN Commercial |
$3,773.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,076.32
|
| Rate for Payer: Multiplan Commercial |
$3,281.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.86
|
| Rate for Payer: Quartz Commercial |
$2,666.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.06
|
| Rate for Payer: The Alliance Commercial |
$2,050.88
|
| Rate for Payer: WEA Trust Commercial |
$2,255.97
|
| Rate for Payer: WPS Commercial |
$3,038.06
|
|
|
Y-PLATE 2.0MM 3H HEAD/ 8H SHAFT 247.612
|
Facility
|
IP
|
$4,330.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508690
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,206.57 |
| Max. Negotiated Rate |
$4,142.94 |
| Rate for Payer: Aetna Commercial |
$4,052.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,872.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,386.70
|
| Rate for Payer: Cash Price |
$1,299.00
|
| Rate for Payer: Cigna Commercial |
$4,142.94
|
| Rate for Payer: Health EOS Commercial |
$4,007.85
|
| Rate for Payer: HFN Commercial |
$4,142.94
|
| Rate for Payer: Multiplan Commercial |
$3,602.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,142.94
|
| Rate for Payer: Quartz Beloit One Network |
$2,206.57
|
| Rate for Payer: Quartz Commercial |
$2,701.92
|
| Rate for Payer: WEA Trust Commercial |
$2,476.76
|
| Rate for Payer: WPS Commercial |
$3,335.40
|
|
