|
Finger splint, aluminum applied - Treatments Done
|
Facility
|
OP
|
$19.00
|
|
| Hospital Charge Code |
3002550
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Aetna Managed Medicare |
$5.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.47
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.06
|
| Rate for Payer: Health EOS Commercial |
$17.59
|
| Rate for Payer: HFN Commercial |
$18.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.82
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: NAPHCARE Commercial |
$11.86
|
| Rate for Payer: Preferred Network Access Commercial |
$18.18
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$12.84
|
| Rate for Payer: Quartz Medicare Advantage |
$11.86
|
| Rate for Payer: The Alliance Commercial |
$9.88
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
Finger splint, aluminum applied - Treatments Done
|
Facility
|
IP
|
$19.00
|
|
| Hospital Charge Code |
3002550
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.47
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.18
|
| Rate for Payer: Health EOS Commercial |
$17.59
|
| Rate for Payer: HFN Commercial |
$18.18
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Preferred Network Access Commercial |
$18.18
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$11.86
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
FINGER SPLINT GUTTER 9113-02
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
3072374
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.12
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$33.70
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$33.70
|
| Rate for Payer: The Alliance Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
FINGER SPLINT GUTTER 9113-02
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
3072374
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
FINGER SPLINT GUTTER 9113-03
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
3072376
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.12
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$33.70
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$33.70
|
| Rate for Payer: The Alliance Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
FINGER SPLINT GUTTER 9113-03
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
3072376
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
FINGER SPLINT GUTTER 9113-04
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
3072377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.12
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$33.70
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$33.70
|
| Rate for Payer: The Alliance Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
FINGER SPLINT GUTTER 9113-04
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
3072377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Finger Splint L3927
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
HCPCS L3927
|
| Hospital Charge Code |
3983506
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$162.86 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.97
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.98
|
| Rate for Payer: The Alliance Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
Finger Splint L3927
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
HCPCS L3927
|
| Hospital Charge Code |
3983506
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
Finger Splint L3927
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
HCPCS L3927
|
| Hospital Charge Code |
3983506
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$117.41 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$40.72
|
| Rate for Payer: Anthem Medicare Advantage |
$40.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$23.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.72
|
| Rate for Payer: Health EOS Commercial |
$22.71
|
| Rate for Payer: HFN Commercial |
$23.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.72
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$61.07
|
| Rate for Payer: Preferred Network Access Commercial |
$23.71
|
| Rate for Payer: Quartz Beloit One Network |
$10.98
|
| Rate for Payer: Quartz Commercial |
$14.23
|
| Rate for Payer: Quartz Medicare Advantage |
$40.72
|
| Rate for Payer: The Alliance Commercial |
$111.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.72
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$71.25
|
|
|
Finger Splint, Static Q4049
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Hospital Charge Code |
4524747
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Finger Splint, Static Q4049
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Hospital Charge Code |
4524747
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$11.15 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.49
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$11.15
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Finger Splint, Static Q4049
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS Q4049
|
| Hospital Charge Code |
4524747
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$1.60 |
| Max. Negotiated Rate |
$8.11 |
| Rate for Payer: Aetna Commercial |
$5.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$2.79
|
| Rate for Payer: Anthem Medicare Advantage |
$2.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.79
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.79
|
| Rate for Payer: Health EOS Commercial |
$5.68
|
| Rate for Payer: HFN Commercial |
$5.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.79
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$4.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5.93
|
| Rate for Payer: Quartz Beloit One Network |
$2.75
|
| Rate for Payer: Quartz Commercial |
$3.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2.79
|
| Rate for Payer: The Alliance Commercial |
$7.66
|
| Rate for Payer: United Healthcare Medicaid |
$1.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.79
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.88
|
|
|
FINGER, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960419
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
FINGER, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960419
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
FINGER TRAP ALLEN MEDIUM STERILE 30522-4-A1
|
Facility
|
IP
|
$562.00
|
|
| Hospital Charge Code |
4067891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$537.72 |
| Rate for Payer: Aetna Commercial |
$526.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$502.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.77
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$537.72
|
| Rate for Payer: Health EOS Commercial |
$520.19
|
| Rate for Payer: HFN Commercial |
$537.72
|
| Rate for Payer: Multiplan Commercial |
$467.58
|
| Rate for Payer: Preferred Network Access Commercial |
$537.72
|
| Rate for Payer: Quartz Beloit One Network |
$286.40
|
| Rate for Payer: Quartz Commercial |
$350.69
|
| Rate for Payer: WEA Trust Commercial |
$321.46
|
| Rate for Payer: WPS Commercial |
$432.91
|
|
|
FINGER TRAP ALLEN MEDIUM STERILE 30522-4-A1
|
Facility
|
OP
|
$562.00
|
|
| Hospital Charge Code |
4067891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.65 |
| Max. Negotiated Rate |
$537.72 |
| Rate for Payer: Aetna Commercial |
$526.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$502.65
|
| Rate for Payer: Aetna Managed Medicare |
$163.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$379.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$292.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.77
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$537.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.08
|
| Rate for Payer: Health EOS Commercial |
$520.19
|
| Rate for Payer: HFN Commercial |
$537.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$438.36
|
| Rate for Payer: Multiplan Commercial |
$467.58
|
| Rate for Payer: NAPHCARE Commercial |
$350.69
|
| Rate for Payer: Preferred Network Access Commercial |
$537.72
|
| Rate for Payer: Quartz Beloit One Network |
$286.40
|
| Rate for Payer: Quartz Commercial |
$379.91
|
| Rate for Payer: Quartz Medicare Advantage |
$350.69
|
| Rate for Payer: The Alliance Commercial |
$292.24
|
| Rate for Payer: WEA Trust Commercial |
$321.46
|
| Rate for Payer: WPS Commercial |
$432.91
|
|
|
FINGER TRIGGER SOLUTIONS MED
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
2970747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$127.40
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
FINGER TRIGGER SOLUTIONS MED
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
2970747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
First Vaccine 90471 - Admin Hep B Charge
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3013439
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$50.92 |
| Max. Negotiated Rate |
$303.10 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.92
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.77
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.77
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$75.77
|
| Rate for Payer: The Alliance Commercial |
$303.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.77
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
First Vaccine 90471 - Admin Hep B Charge
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3013439
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$100.78 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$21.99
|
| Rate for Payer: Anthem Medicare Advantage |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.99
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.99
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$32.98
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$21.99
|
| Rate for Payer: The Alliance Commercial |
$54.96
|
| Rate for Payer: United Healthcare Medicaid |
$15.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.99
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$87.94
|
|
|
First Vaccine 90471 - Admin Hep B Charge
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3013439
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
First Vaccine 90471 - Admin Immunization Charge
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
2473258
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
First Vaccine 90471 - Admin Immunization Charge
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
2473258
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$100.78 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$21.99
|
| Rate for Payer: Anthem Medicare Advantage |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.99
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.99
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.99
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$32.98
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$21.99
|
| Rate for Payer: The Alliance Commercial |
$54.96
|
| Rate for Payer: United Healthcare Medicaid |
$15.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.99
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$87.94
|
|
