|
Fine Needle Aspiration - Quest
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
3114201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.04 |
| Max. Negotiated Rate |
$771.63 |
| Rate for Payer: Aetna Commercial |
$771.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Aetna Managed Medicare |
$166.91
|
| Rate for Payer: Anthem Commercial |
$24.04
|
| Rate for Payer: Anthem Medicare Advantage |
$166.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$166.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$166.91
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$771.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$406.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.91
|
| Rate for Payer: Health EOS Commercial |
$739.14
|
| Rate for Payer: HFN Commercial |
$771.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$547.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$166.91
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: NAPHCARE Commercial |
$250.36
|
| Rate for Payer: Preferred Network Access Commercial |
$771.63
|
| Rate for Payer: Quartz Beloit One Network |
$357.39
|
| Rate for Payer: Quartz Commercial |
$462.98
|
| Rate for Payer: Quartz Medicare Advantage |
$166.91
|
| Rate for Payer: The Alliance Commercial |
$659.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.91
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$734.40
|
|
|
Fine Needle Aspiration - Quest
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
3114201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$487.34
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
|
Fine Needle Aspiration Without Imaging 10021
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
CPT 10021
|
| Hospital Charge Code |
2572833
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.22 |
| Max. Negotiated Rate |
$578.97 |
| Rate for Payer: Aetna Commercial |
$578.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.12
|
| Rate for Payer: Aetna Managed Medicare |
$44.22
|
| Rate for Payer: Anthem Medicare Advantage |
$44.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.22
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$578.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.22
|
| Rate for Payer: Health EOS Commercial |
$554.59
|
| Rate for Payer: HFN Commercial |
$578.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$190.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.22
|
| Rate for Payer: Multiplan Commercial |
$487.55
|
| Rate for Payer: NAPHCARE Commercial |
$66.33
|
| Rate for Payer: Preferred Network Access Commercial |
$578.97
|
| Rate for Payer: Quartz Beloit One Network |
$268.15
|
| Rate for Payer: Quartz Commercial |
$347.38
|
| Rate for Payer: Quartz Medicare Advantage |
$44.22
|
| Rate for Payer: The Alliance Commercial |
$187.94
|
| Rate for Payer: United Healthcare Medicaid |
$78.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.22
|
| Rate for Payer: WEA Trust Commercial |
$335.19
|
| Rate for Payer: WPS Commercial |
$198.99
|
|
|
FINGER ARTHRODESIS
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2959818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,430.37 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,430.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,320.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,554.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,452.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,858.78
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,831.36
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,065.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,320.51
|
| Rate for Payer: Quartz Medicare Advantage |
$3,065.09
|
| Rate for Payer: The Alliance Commercial |
$2,554.24
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
FINGER ARTHRODESIS
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2959818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,503.16 |
| Max. Negotiated Rate |
$4,699.80 |
| Rate for Payer: Aetna Commercial |
$4,597.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,393.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,707.49
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,699.80
|
| Rate for Payer: Health EOS Commercial |
$4,546.55
|
| Rate for Payer: HFN Commercial |
$4,699.80
|
| Rate for Payer: Multiplan Commercial |
$4,086.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,699.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,503.16
|
| Rate for Payer: Quartz Commercial |
$3,065.09
|
| Rate for Payer: WEA Trust Commercial |
$2,809.66
|
| Rate for Payer: WPS Commercial |
$3,783.71
|
|
|
FINGER ARTHROPLASTY
|
Facility
|
IP
|
$8,629.00
|
|
| Hospital Charge Code |
2960442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,397.34 |
| Max. Negotiated Rate |
$8,256.23 |
| Rate for Payer: Aetna Commercial |
$8,076.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,717.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,756.30
|
| Rate for Payer: Cash Price |
$2,588.70
|
| Rate for Payer: Cigna Commercial |
$8,256.23
|
| Rate for Payer: Health EOS Commercial |
$7,987.00
|
| Rate for Payer: HFN Commercial |
$8,256.23
|
| Rate for Payer: Multiplan Commercial |
$7,179.33
|
| Rate for Payer: Preferred Network Access Commercial |
$8,256.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,397.34
|
| Rate for Payer: Quartz Commercial |
$5,384.50
|
| Rate for Payer: WEA Trust Commercial |
$4,935.79
|
| Rate for Payer: WPS Commercial |
$6,646.92
|
|
|
FINGER ARTHROPLASTY
|
Facility
|
OP
|
$8,629.00
|
|
| Hospital Charge Code |
2960442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,512.76 |
| Max. Negotiated Rate |
$8,256.23 |
| Rate for Payer: Aetna Commercial |
$8,076.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,717.78
|
| Rate for Payer: Aetna Managed Medicare |
$2,512.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,833.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,487.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,307.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,756.30
|
| Rate for Payer: Cash Price |
$2,588.70
|
| Rate for Payer: Cigna Commercial |
$8,256.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,022.08
|
| Rate for Payer: Health EOS Commercial |
$7,987.00
|
| Rate for Payer: HFN Commercial |
$8,256.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,730.62
|
| Rate for Payer: Multiplan Commercial |
$7,179.33
|
| Rate for Payer: NAPHCARE Commercial |
$5,384.50
|
| Rate for Payer: Preferred Network Access Commercial |
$8,256.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,397.34
|
| Rate for Payer: Quartz Commercial |
$5,833.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,384.50
|
| Rate for Payer: The Alliance Commercial |
$4,487.08
|
| Rate for Payer: WEA Trust Commercial |
$4,935.79
|
| Rate for Payer: WPS Commercial |
$6,646.92
|
|
|
FINGER BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
FINGER BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
FINGER BUDDY STRAP #A3171
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2969890
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
FINGER BUDDY STRAP #A3171
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2969890
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
FINGER GREAT TOE 4/PK 108
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
2970621
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$23.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$51.17
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$51.17
|
| Rate for Payer: The Alliance Commercial |
$42.64
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
FINGER GREAT TOE 4/PK 108
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
2970621
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Finger guard applied - Treatments Done
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3002551
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Finger guard applied - Treatments Done
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3002551
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.74 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$8.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.72
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$18.72
|
| Rate for Payer: The Alliance Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
FINGER GUARD PLASTIC 4 PRONG
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
2974243
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$9.36
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
FINGER GUARD PLASTIC 4 PRONG
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
2974243
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Finger Orthotic Custom
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
2989896
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$992.74 |
| Rate for Payer: Aetna Commercial |
$209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Aetna Managed Medicare |
$65.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.47
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$214.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.37
|
| Rate for Payer: Health EOS Commercial |
$207.33
|
| Rate for Payer: HFN Commercial |
$214.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.72
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: NAPHCARE Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$214.32
|
| Rate for Payer: Quartz Beloit One Network |
$114.15
|
| Rate for Payer: Quartz Commercial |
$151.42
|
| Rate for Payer: Quartz Medicare Advantage |
$139.78
|
| Rate for Payer: The Alliance Commercial |
$992.74
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$172.55
|
|
|
Finger Orthotic Custom
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
HCPCS L3933
|
| Hospital Charge Code |
2989896
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$114.15 |
| Max. Negotiated Rate |
$214.32 |
| Rate for Payer: Aetna Commercial |
$209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.47
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$214.32
|
| Rate for Payer: Health EOS Commercial |
$207.33
|
| Rate for Payer: HFN Commercial |
$214.32
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: Preferred Network Access Commercial |
$214.32
|
| Rate for Payer: Quartz Beloit One Network |
$114.15
|
| Rate for Payer: Quartz Commercial |
$139.78
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$172.55
|
|
|
Finger Orthotic Prefab
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
2989895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Finger Orthotic Prefab
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
HCPCS L3925
|
| Hospital Charge Code |
2989895
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$305.64 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$22.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.84
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$48.67
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$48.67
|
| Rate for Payer: The Alliance Commercial |
$305.64
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
FINGER SLEEVE DIGI LARGE
|
Facility
|
IP
|
$571.00
|
|
| Hospital Charge Code |
2971425
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$290.98 |
| Max. Negotiated Rate |
$546.33 |
| Rate for Payer: Aetna Commercial |
$534.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.74
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$546.33
|
| Rate for Payer: Health EOS Commercial |
$528.52
|
| Rate for Payer: HFN Commercial |
$546.33
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: Preferred Network Access Commercial |
$546.33
|
| Rate for Payer: Quartz Beloit One Network |
$290.98
|
| Rate for Payer: Quartz Commercial |
$356.30
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: WPS Commercial |
$439.84
|
|
|
FINGER SLEEVE DIGI LARGE
|
Facility
|
OP
|
$571.00
|
|
| Hospital Charge Code |
2971425
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$166.28 |
| Max. Negotiated Rate |
$546.33 |
| Rate for Payer: Aetna Commercial |
$534.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Aetna Managed Medicare |
$166.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$386.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$296.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$285.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.74
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$546.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.32
|
| Rate for Payer: Health EOS Commercial |
$528.52
|
| Rate for Payer: HFN Commercial |
$546.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$445.38
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: NAPHCARE Commercial |
$356.30
|
| Rate for Payer: Preferred Network Access Commercial |
$546.33
|
| Rate for Payer: Quartz Beloit One Network |
$290.98
|
| Rate for Payer: Quartz Commercial |
$386.00
|
| Rate for Payer: Quartz Medicare Advantage |
$356.30
|
| Rate for Payer: The Alliance Commercial |
$296.92
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: WPS Commercial |
$439.84
|
|
|
FINGER SLINGS 3 (7.6cm) #A444-14"
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
2971582
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$15.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$32.45
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$32.45
|
| Rate for Payer: The Alliance Commercial |
$27.04
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
FINGER SLINGS 3 (7.6cm) #A444-14"
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
2971582
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
