|
FILTER SMOKE EVACUATION ULPA
|
Facility
|
IP
|
$1,684.00
|
|
| Hospital Charge Code |
2967382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$825.16 |
| Max. Negotiated Rate |
$1,549.28 |
| Rate for Payer: Aetna Commercial |
$1,515.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.52
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: Health EOS Commercial |
$1,498.76
|
| Rate for Payer: HFN Commercial |
$1,549.28
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.28
|
| Rate for Payer: Quartz Beloit One Network |
$825.16
|
| Rate for Payer: Quartz Commercial |
$1,010.40
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
FILTER SMOKE EVACUATION ULPA
|
Facility
|
OP
|
$1,684.00
|
|
| Hospital Charge Code |
2967382
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$471.52 |
| Max. Negotiated Rate |
$6,736.00 |
| Rate for Payer: Aetna Commercial |
$1,515.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.24
|
| Rate for Payer: Aetna Managed Medicare |
$471.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,094.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$842.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$808.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.52
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,549.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.37
|
| Rate for Payer: Health EOS Commercial |
$1,498.76
|
| Rate for Payer: HFN Commercial |
$1,549.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.00
|
| Rate for Payer: Multiplan Commercial |
$1,347.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.28
|
| Rate for Payer: Quartz Beloit One Network |
$825.16
|
| Rate for Payer: Quartz Commercial |
$1,094.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,010.40
|
| Rate for Payer: The Alliance Commercial |
$6,736.00
|
| Rate for Payer: WEA Trust Commercial |
$926.20
|
| Rate for Payer: WPS Commercial |
$1,247.34
|
|
|
FILTER VAPOR-CLEAN #101
|
Facility
|
IP
|
$1,162.00
|
|
| Hospital Charge Code |
2973603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.38 |
| Max. Negotiated Rate |
$1,069.04 |
| Rate for Payer: Aetna Commercial |
$1,045.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.86
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,069.04
|
| Rate for Payer: Health EOS Commercial |
$1,034.18
|
| Rate for Payer: HFN Commercial |
$1,069.04
|
| Rate for Payer: Multiplan Commercial |
$929.60
|
| Rate for Payer: NAPHCARE Commercial |
$697.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.04
|
| Rate for Payer: Quartz Beloit One Network |
$569.38
|
| Rate for Payer: Quartz Commercial |
$697.20
|
| Rate for Payer: WEA Trust Commercial |
$639.10
|
| Rate for Payer: WPS Commercial |
$860.69
|
|
|
FILTER VAPOR-CLEAN #101
|
Facility
|
OP
|
$1,162.00
|
|
| Hospital Charge Code |
2973603
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.36 |
| Max. Negotiated Rate |
$4,648.00 |
| Rate for Payer: Aetna Commercial |
$1,045.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.32
|
| Rate for Payer: Aetna Managed Medicare |
$325.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$755.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$581.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$557.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.86
|
| Rate for Payer: Cash Price |
$348.60
|
| Rate for Payer: Cigna Commercial |
$1,069.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$650.26
|
| Rate for Payer: Health EOS Commercial |
$1,034.18
|
| Rate for Payer: HFN Commercial |
$1,069.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$871.50
|
| Rate for Payer: Multiplan Commercial |
$929.60
|
| Rate for Payer: NAPHCARE Commercial |
$697.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.04
|
| Rate for Payer: Quartz Beloit One Network |
$569.38
|
| Rate for Payer: Quartz Commercial |
$755.30
|
| Rate for Payer: Quartz Medicare Advantage |
$697.20
|
| Rate for Payer: The Alliance Commercial |
$4,648.00
|
| Rate for Payer: WEA Trust Commercial |
$639.10
|
| Rate for Payer: WPS Commercial |
$860.69
|
|
|
FINE NEEDLE ASPIRATION BX W/O IMG GDN EA ADDL 10004
|
Professional
|
Both
|
$456.00
|
|
|
Service Code
|
CPT 10004
|
| Hospital Charge Code |
6209341
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$433.20 |
| Rate for Payer: Aetna Commercial |
$433.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$392.16
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cash Price |
$136.80
|
| Rate for Payer: Cigna Commercial |
$433.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.60
|
| Rate for Payer: Health EOS Commercial |
$414.96
|
| Rate for Payer: HFN Commercial |
$433.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.01
|
| Rate for Payer: Multiplan Commercial |
$364.80
|
| Rate for Payer: Preferred Network Access Commercial |
$433.20
|
| Rate for Payer: Quartz Beloit One Network |
$200.64
|
| Rate for Payer: Quartz Commercial |
$259.92
|
| Rate for Payer: The Alliance Commercial |
$228.00
|
| Rate for Payer: United Healthcare Medicaid |
$40.18
|
| Rate for Payer: WEA Trust Commercial |
$250.80
|
| Rate for Payer: WPS Commercial |
$337.76
|
|
|
FINE NEEDLE ASPIRATION BX W/US GDN 1ST LESION 10005
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
CPT 10005
|
| Hospital Charge Code |
5464668
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.26 |
| Max. Negotiated Rate |
$525.35 |
| Rate for Payer: Aetna Commercial |
$525.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.58
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$525.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.80
|
| Rate for Payer: Health EOS Commercial |
$503.23
|
| Rate for Payer: HFN Commercial |
$525.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.32
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: Preferred Network Access Commercial |
$525.35
|
| Rate for Payer: Quartz Beloit One Network |
$243.32
|
| Rate for Payer: Quartz Commercial |
$315.21
|
| Rate for Payer: The Alliance Commercial |
$276.50
|
| Rate for Payer: United Healthcare Medicaid |
$98.26
|
| Rate for Payer: WEA Trust Commercial |
$304.15
|
| Rate for Payer: WPS Commercial |
$409.61
|
|
|
FINE NEEDLE ASPIRATION BX W/US GDN EA ADDL 10006
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
CPT 10006
|
| Hospital Charge Code |
5464669
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$248.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$248.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.20
|
| Rate for Payer: Health EOS Commercial |
$238.42
|
| Rate for Payer: HFN Commercial |
$248.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$169.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$169.76
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Preferred Network Access Commercial |
$248.90
|
| Rate for Payer: Quartz Beloit One Network |
$115.28
|
| Rate for Payer: Quartz Commercial |
$149.34
|
| Rate for Payer: The Alliance Commercial |
$131.00
|
| Rate for Payer: United Healthcare Medicaid |
$46.68
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
Fine Needle Aspiration - Quest
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
3114201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.12 |
| Max. Negotiated Rate |
$741.95 |
| Rate for Payer: Aetna Commercial |
$741.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.66
|
| Rate for Payer: Anthem Commercial |
$23.12
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$741.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$390.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$468.60
|
| Rate for Payer: Health EOS Commercial |
$710.71
|
| Rate for Payer: HFN Commercial |
$741.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$526.11
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: Preferred Network Access Commercial |
$741.95
|
| Rate for Payer: Quartz Beloit One Network |
$343.64
|
| Rate for Payer: Quartz Commercial |
$445.17
|
| Rate for Payer: The Alliance Commercial |
$390.50
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
Fine Needle Aspiration - Quest
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
3114201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$718.52 |
| Rate for Payer: Aetna Commercial |
$702.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.66
|
| Rate for Payer: Aetna Managed Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.91
|
| Rate for Payer: Anthem Medicare Advantage |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.56
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$718.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.56
|
| Rate for Payer: Health EOS Commercial |
$695.09
|
| Rate for Payer: HFN Commercial |
$718.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: NAPHCARE Commercial |
$80.34
|
| Rate for Payer: Preferred Network Access Commercial |
$718.52
|
| Rate for Payer: Quartz Beloit One Network |
$382.69
|
| Rate for Payer: Quartz Commercial |
$507.65
|
| Rate for Payer: Quartz Medicare Advantage |
$53.56
|
| Rate for Payer: The Alliance Commercial |
$214.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare PPO |
$585.75
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: Wellcare Medicare |
$53.56
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
Fine Needle Aspiration - Quest
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
CPT 88173
|
| Hospital Charge Code |
3114201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$382.69 |
| Max. Negotiated Rate |
$718.52 |
| Rate for Payer: Aetna Commercial |
$702.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.93
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$718.52
|
| Rate for Payer: Health EOS Commercial |
$695.09
|
| Rate for Payer: HFN Commercial |
$718.52
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: NAPHCARE Commercial |
$468.60
|
| Rate for Payer: Preferred Network Access Commercial |
$718.52
|
| Rate for Payer: Quartz Beloit One Network |
$382.69
|
| Rate for Payer: Quartz Commercial |
$468.60
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
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 |
$75.54 |
| Max. Negotiated Rate |
$556.70 |
| Rate for Payer: Aetna Commercial |
$556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.96
|
| 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 |
$556.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$351.60
|
| Rate for Payer: Health EOS Commercial |
$533.26
|
| Rate for Payer: HFN Commercial |
$556.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$183.03
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$556.70
|
| Rate for Payer: Quartz Beloit One Network |
$257.84
|
| Rate for Payer: Quartz Commercial |
$334.02
|
| Rate for Payer: The Alliance Commercial |
$293.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.54
|
| Rate for Payer: WEA Trust Commercial |
$322.30
|
| Rate for Payer: WPS Commercial |
$434.05
|
|
|
FINGER ARTHRODESIS
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2959818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,375.36 |
| Max. Negotiated Rate |
$19,648.00 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,375.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,192.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,357.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,748.76
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,684.00
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$3,192.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,947.20
|
| Rate for Payer: The Alliance Commercial |
$19,648.00
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
FINGER ARTHRODESIS
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2959818
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,406.88 |
| Max. Negotiated Rate |
$4,519.04 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$2,947.20
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
FINGER ARTHROPLASTY
|
Facility
|
OP
|
$8,629.00
|
|
| Hospital Charge Code |
2960442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,416.12 |
| Max. Negotiated Rate |
$34,516.00 |
| Rate for Payer: Aetna Commercial |
$7,766.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,420.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,416.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,608.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,314.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,141.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,573.37
|
| Rate for Payer: Cash Price |
$2,588.70
|
| Rate for Payer: Cigna Commercial |
$7,938.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,828.79
|
| Rate for Payer: Health EOS Commercial |
$7,679.81
|
| Rate for Payer: HFN Commercial |
$7,938.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,471.75
|
| Rate for Payer: Multiplan Commercial |
$6,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,177.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,938.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,228.21
|
| Rate for Payer: Quartz Commercial |
$5,608.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,177.40
|
| Rate for Payer: The Alliance Commercial |
$34,516.00
|
| Rate for Payer: WEA Trust Commercial |
$4,745.95
|
| Rate for Payer: WPS Commercial |
$6,391.50
|
|
|
FINGER ARTHROPLASTY
|
Facility
|
IP
|
$8,629.00
|
|
| Hospital Charge Code |
2960442
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,228.21 |
| Max. Negotiated Rate |
$7,938.68 |
| Rate for Payer: Aetna Commercial |
$7,766.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,420.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,573.37
|
| Rate for Payer: Cash Price |
$2,588.70
|
| Rate for Payer: Cigna Commercial |
$7,938.68
|
| Rate for Payer: Health EOS Commercial |
$7,679.81
|
| Rate for Payer: HFN Commercial |
$7,938.68
|
| Rate for Payer: Multiplan Commercial |
$6,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,177.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,938.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,228.21
|
| Rate for Payer: Quartz Commercial |
$5,177.40
|
| Rate for Payer: WEA Trust Commercial |
$4,745.95
|
| Rate for Payer: WPS Commercial |
$6,391.50
|
|
|
FINGER BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
FINGER BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959860
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
FINGER BUDDY STRAP #A3171
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2969890
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
FINGER BUDDY STRAP #A3171
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2969890
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
FINGER GREAT TOE 4/PK 108
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
2970621
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$49.20
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
FINGER GREAT TOE 4/PK 108
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
2970621
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Finger guard applied - Treatments Done
|
Facility
|
OP
|
$30.00
|
|
| Hospital Charge Code |
3002551
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Finger guard applied - Treatments Done
|
Facility
|
IP
|
$30.00
|
|
| Hospital Charge Code |
3002551
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
FINGER GUARD PLASTIC 4 PRONG
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
2974243
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
FINGER GUARD PLASTIC 4 PRONG
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
2974243
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
