|
CLOSURE DEVICE MYNX 5F MX5060 **ACCESS CLOSURE
|
Facility
|
IP
|
$2,793.00
|
|
|
Service Code
|
HCPCS C1760
|
| Hospital Charge Code |
3613525
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,423.31 |
| Max. Negotiated Rate |
$2,672.34 |
| Rate for Payer: Aetna Commercial |
$2,614.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,498.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,539.50
|
| Rate for Payer: Cash Price |
$837.90
|
| Rate for Payer: Cigna Commercial |
$2,672.34
|
| Rate for Payer: Health EOS Commercial |
$2,585.20
|
| Rate for Payer: HFN Commercial |
$2,672.34
|
| Rate for Payer: Multiplan Commercial |
$2,323.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,672.34
|
| Rate for Payer: Quartz Beloit One Network |
$1,423.31
|
| Rate for Payer: Quartz Commercial |
$1,742.83
|
| Rate for Payer: WEA Trust Commercial |
$1,597.60
|
| Rate for Payer: WPS Commercial |
$2,151.45
|
|
|
CLOSURE LAP WOUND 1/PK
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2964068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
CLOSURE LAP WOUND 1/PK
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2964068
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
CLOSURE OF EYELID BY SUTURE 67875
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
CPT 67875
|
| Hospital Charge Code |
3015246
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.85 |
| Max. Negotiated Rate |
$439.66 |
| Rate for Payer: Aetna Commercial |
$439.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$80.31
|
| Rate for Payer: Anthem Medicare Advantage |
$80.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.31
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$439.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.31
|
| Rate for Payer: Health EOS Commercial |
$421.15
|
| Rate for Payer: HFN Commercial |
$439.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$333.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$333.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.31
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$120.46
|
| Rate for Payer: Preferred Network Access Commercial |
$439.66
|
| Rate for Payer: Quartz Beloit One Network |
$203.63
|
| Rate for Payer: Quartz Commercial |
$263.80
|
| Rate for Payer: Quartz Medicare Advantage |
$80.31
|
| Rate for Payer: The Alliance Commercial |
$341.31
|
| Rate for Payer: United Healthcare Medicaid |
$62.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.31
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$361.39
|
|
|
CLOSURE OF SPLIT WOUND 12020
|
Professional
|
Both
|
$739.00
|
|
|
Service Code
|
CPT 12020
|
| Hospital Charge Code |
3013590
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.02 |
| Max. Negotiated Rate |
$774.54 |
| Rate for Payer: Aetna Commercial |
$730.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$660.96
|
| Rate for Payer: Aetna Managed Medicare |
$172.12
|
| Rate for Payer: Anthem Medicare Advantage |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$172.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$172.12
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cash Price |
$221.70
|
| Rate for Payer: Cigna Commercial |
$730.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.12
|
| Rate for Payer: Health EOS Commercial |
$699.39
|
| Rate for Payer: HFN Commercial |
$730.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$651.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$651.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$172.12
|
| Rate for Payer: Multiplan Commercial |
$614.85
|
| Rate for Payer: NAPHCARE Commercial |
$258.18
|
| Rate for Payer: Preferred Network Access Commercial |
$730.13
|
| Rate for Payer: Quartz Beloit One Network |
$338.17
|
| Rate for Payer: Quartz Commercial |
$438.08
|
| Rate for Payer: Quartz Medicare Advantage |
$172.12
|
| Rate for Payer: The Alliance Commercial |
$731.51
|
| Rate for Payer: United Healthcare Medicaid |
$33.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.12
|
| Rate for Payer: WEA Trust Commercial |
$422.71
|
| Rate for Payer: WPS Commercial |
$774.54
|
|
|
CLOSURE OF SPLIT WOUND 12021
|
Professional
|
Both
|
$562.00
|
|
|
Service Code
|
CPT 12021
|
| Hospital Charge Code |
3013591
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.44 |
| Max. Negotiated Rate |
$582.05 |
| Rate for Payer: Aetna Commercial |
$555.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$502.65
|
| Rate for Payer: Aetna Managed Medicare |
$129.34
|
| Rate for Payer: Anthem Medicare Advantage |
$129.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.34
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$555.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.34
|
| Rate for Payer: Health EOS Commercial |
$531.88
|
| Rate for Payer: HFN Commercial |
$555.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$483.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$129.34
|
| Rate for Payer: Multiplan Commercial |
$467.58
|
| Rate for Payer: NAPHCARE Commercial |
$194.02
|
| Rate for Payer: Preferred Network Access Commercial |
$555.26
|
| Rate for Payer: Quartz Beloit One Network |
$257.17
|
| Rate for Payer: Quartz Commercial |
$333.15
|
| Rate for Payer: Quartz Medicare Advantage |
$129.34
|
| Rate for Payer: The Alliance Commercial |
$549.72
|
| Rate for Payer: United Healthcare Medicaid |
$41.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.34
|
| Rate for Payer: WEA Trust Commercial |
$321.46
|
| Rate for Payer: WPS Commercial |
$582.05
|
|
|
CLOSURE SYSTEM 10/12MM CARTER-THOMASON CTXL
|
Facility
|
IP
|
$2,562.00
|
|
| Hospital Charge Code |
2964984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,305.60 |
| Max. Negotiated Rate |
$2,451.32 |
| Rate for Payer: Aetna Commercial |
$2,398.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,291.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.17
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$2,451.32
|
| Rate for Payer: Health EOS Commercial |
$2,371.39
|
| Rate for Payer: HFN Commercial |
$2,451.32
|
| Rate for Payer: Multiplan Commercial |
$2,131.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,451.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,305.60
|
| Rate for Payer: Quartz Commercial |
$1,598.69
|
| Rate for Payer: WEA Trust Commercial |
$1,465.46
|
| Rate for Payer: WPS Commercial |
$1,973.51
|
|
|
CLOSURE SYSTEM 10/12MM CARTER-THOMASON CTXL
|
Facility
|
OP
|
$2,562.00
|
|
| Hospital Charge Code |
2964984
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$2,451.32 |
| Rate for Payer: Aetna Commercial |
$2,398.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,291.45
|
| Rate for Payer: Aetna Managed Medicare |
$746.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,731.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,332.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,278.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.17
|
| Rate for Payer: Cash Price |
$768.60
|
| Rate for Payer: Cigna Commercial |
$2,451.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,491.08
|
| Rate for Payer: Health EOS Commercial |
$2,371.39
|
| Rate for Payer: HFN Commercial |
$2,451.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,998.36
|
| Rate for Payer: Multiplan Commercial |
$2,131.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,598.69
|
| Rate for Payer: Preferred Network Access Commercial |
$2,451.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,305.60
|
| Rate for Payer: Quartz Commercial |
$1,731.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,598.69
|
| Rate for Payer: The Alliance Commercial |
$1,332.24
|
| Rate for Payer: WEA Trust Commercial |
$1,465.46
|
| Rate for Payer: WPS Commercial |
$1,973.51
|
|
|
CLOSURE SYSTEM 5MM CARTER-THOMASON CTI-512N
|
Facility
|
IP
|
$1,878.00
|
|
| Hospital Charge Code |
2964983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$957.03 |
| Max. Negotiated Rate |
$1,796.87 |
| Rate for Payer: Aetna Commercial |
$1,757.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.15
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,796.87
|
| Rate for Payer: Health EOS Commercial |
$1,738.28
|
| Rate for Payer: HFN Commercial |
$1,796.87
|
| Rate for Payer: Multiplan Commercial |
$1,562.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.87
|
| Rate for Payer: Quartz Beloit One Network |
$957.03
|
| Rate for Payer: Quartz Commercial |
$1,171.87
|
| Rate for Payer: WEA Trust Commercial |
$1,074.22
|
| Rate for Payer: WPS Commercial |
$1,446.62
|
|
|
CLOSURE SYSTEM 5MM CARTER-THOMASON CTI-512N
|
Facility
|
OP
|
$1,878.00
|
|
| Hospital Charge Code |
2964983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.87 |
| Max. Negotiated Rate |
$1,796.87 |
| Rate for Payer: Aetna Commercial |
$1,757.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.68
|
| Rate for Payer: Aetna Managed Medicare |
$546.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,269.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$976.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$937.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,035.15
|
| Rate for Payer: Cash Price |
$563.40
|
| Rate for Payer: Cigna Commercial |
$1,796.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,093.00
|
| Rate for Payer: Health EOS Commercial |
$1,738.28
|
| Rate for Payer: HFN Commercial |
$1,796.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,464.84
|
| Rate for Payer: Multiplan Commercial |
$1,562.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,171.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.87
|
| Rate for Payer: Quartz Beloit One Network |
$957.03
|
| Rate for Payer: Quartz Commercial |
$1,269.53
|
| Rate for Payer: Quartz Medicare Advantage |
$1,171.87
|
| Rate for Payer: The Alliance Commercial |
$976.56
|
| Rate for Payer: WEA Trust Commercial |
$1,074.22
|
| Rate for Payer: WPS Commercial |
$1,446.62
|
|
|
CLOSURE SYSTEM STERNALOCK 360 MULTI-IMPLANT 74-0004
|
Facility
|
IP
|
$18,808.00
|
|
| Hospital Charge Code |
5415794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$9,584.56 |
| Max. Negotiated Rate |
$17,995.49 |
| Rate for Payer: Aetna Commercial |
$17,604.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,821.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,366.97
|
| Rate for Payer: Cash Price |
$5,642.40
|
| Rate for Payer: Cigna Commercial |
$17,995.49
|
| Rate for Payer: Health EOS Commercial |
$17,408.68
|
| Rate for Payer: HFN Commercial |
$17,995.49
|
| Rate for Payer: Multiplan Commercial |
$15,648.26
|
| Rate for Payer: Preferred Network Access Commercial |
$17,995.49
|
| Rate for Payer: Quartz Beloit One Network |
$9,584.56
|
| Rate for Payer: Quartz Commercial |
$11,736.19
|
| Rate for Payer: WEA Trust Commercial |
$10,758.18
|
| Rate for Payer: WPS Commercial |
$14,487.80
|
|
|
CLOSURE SYSTEM STERNALOCK 360 MULTI-IMPLANT 74-0004
|
Facility
|
OP
|
$18,808.00
|
|
| Hospital Charge Code |
5415794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,476.89 |
| Max. Negotiated Rate |
$17,995.49 |
| Rate for Payer: Aetna Commercial |
$17,604.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,821.88
|
| Rate for Payer: Aetna Managed Medicare |
$5,476.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,714.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,780.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,388.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,366.97
|
| Rate for Payer: Cash Price |
$5,642.40
|
| Rate for Payer: Cigna Commercial |
$17,995.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,946.26
|
| Rate for Payer: Health EOS Commercial |
$17,408.68
|
| Rate for Payer: HFN Commercial |
$17,995.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,670.24
|
| Rate for Payer: Multiplan Commercial |
$15,648.26
|
| Rate for Payer: NAPHCARE Commercial |
$11,736.19
|
| Rate for Payer: Preferred Network Access Commercial |
$17,995.49
|
| Rate for Payer: Quartz Beloit One Network |
$9,584.56
|
| Rate for Payer: Quartz Commercial |
$12,714.21
|
| Rate for Payer: Quartz Medicare Advantage |
$11,736.19
|
| Rate for Payer: The Alliance Commercial |
$9,780.16
|
| Rate for Payer: WEA Trust Commercial |
$10,758.18
|
| Rate for Payer: WPS Commercial |
$14,487.80
|
|
|
CLOTH CHG PATIENT SKIN PREP 9707
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
5298708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$25.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.08
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$53.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$53.66
|
| Rate for Payer: The Alliance Commercial |
$44.72
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
CLOTH CHG PATIENT SKIN PREP 9707
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
5298708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
CLOUD WALKR ORTH LG M 10-11 W 12-13 L3040
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH LG M 10-11 W 12-13 L3040
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$240.61
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH LG M 10-11 W 12-13 L3040
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607692
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$173.46 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$60.15
|
| Rate for Payer: Anthem Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.15
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.15
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$90.23
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$60.15
|
| Rate for Payer: The Alliance Commercial |
$165.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.15
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$105.27
|
|
|
CLOUD WALKR ORTH MED M 8-9 W 10-11 L3040
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$240.61
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH MED M 8-9 W 10-11 L3040
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH MED M 8-9 W 10-11 L3040
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607693
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$173.46 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$60.15
|
| Rate for Payer: Anthem Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.15
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.15
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$90.23
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$60.15
|
| Rate for Payer: The Alliance Commercial |
$165.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.15
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$105.27
|
|
|
CLOUD WALKR ORTH SM M 6-7 W 8-9 L3040
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$240.61
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH SM M 6-7 W 8-9 L3040
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH SM M 6-7 W 8-9 L3040
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607694
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$173.46 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$60.15
|
| Rate for Payer: Anthem Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.15
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.15
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$90.23
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$60.15
|
| Rate for Payer: The Alliance Commercial |
$165.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.15
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$105.27
|
|
|
CLOUD WALKR ORTH XLG M 12-13 W 14-15 L3040
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH XLG M 12-13 W 14-15 L3040
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$240.61
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
