|
Straitional Antibody
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Straitional Antibody
|
Professional
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$47.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$53.02
|
|
|
Straitional Antibody
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
STRAP ANKLE DISTRACTOR 014407
|
Facility
IP
|
$941.00
|
|
| Hospital Charge Code |
2965968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.09 |
| Max. Negotiated Rate |
$865.72 |
| Rate for Payer: Aetna Commercial |
$846.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.73
|
| Rate for Payer: Cash Price |
$282.30
|
| Rate for Payer: Cigna Commercial |
$865.72
|
| Rate for Payer: Health EOS Commercial |
$837.49
|
| Rate for Payer: HFN Commercial |
$865.72
|
| Rate for Payer: Multiplan Commercial |
$752.80
|
| Rate for Payer: NAPHCARE Commercial |
$564.60
|
| Rate for Payer: Preferred Network Access Commercial |
$865.72
|
| Rate for Payer: Quartz Beloit One Network |
$461.09
|
| Rate for Payer: Quartz Commercial |
$564.60
|
| Rate for Payer: WEA Trust Commercial |
$517.55
|
| Rate for Payer: WPS Commercial |
$697.00
|
|
|
STRAP ANKLE DISTRACTOR 014407
|
Facility
OP
|
$941.00
|
|
| Hospital Charge Code |
2965968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.48 |
| Max. Negotiated Rate |
$3,764.00 |
| Rate for Payer: Aetna Commercial |
$846.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$809.26
|
| Rate for Payer: Aetna Managed Medicare |
$263.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$611.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$470.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$451.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$498.73
|
| Rate for Payer: Cash Price |
$282.30
|
| Rate for Payer: Cigna Commercial |
$865.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$526.58
|
| Rate for Payer: Health EOS Commercial |
$837.49
|
| Rate for Payer: HFN Commercial |
$865.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$705.75
|
| Rate for Payer: Multiplan Commercial |
$752.80
|
| Rate for Payer: NAPHCARE Commercial |
$564.60
|
| Rate for Payer: Preferred Network Access Commercial |
$865.72
|
| Rate for Payer: Quartz Beloit One Network |
$461.09
|
| Rate for Payer: Quartz Commercial |
$611.65
|
| Rate for Payer: Quartz Medicare Advantage |
$564.60
|
| Rate for Payer: The Alliance Commercial |
$3,764.00
|
| Rate for Payer: WEA Trust Commercial |
$517.55
|
| Rate for Payer: WPS Commercial |
$697.00
|
|
|
STRAP ANKLE DISTRACTOR AR-1712
|
Facility
OP
|
$1,031.00
|
|
| Hospital Charge Code |
5457016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.68 |
| Max. Negotiated Rate |
$4,124.00 |
| Rate for Payer: Aetna Commercial |
$927.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.66
|
| Rate for Payer: Aetna Managed Medicare |
$288.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$670.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.43
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$948.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$917.59
|
| Rate for Payer: HFN Commercial |
$948.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$773.25
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: NAPHCARE Commercial |
$618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$948.52
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$670.15
|
| Rate for Payer: Quartz Medicare Advantage |
$618.60
|
| Rate for Payer: The Alliance Commercial |
$4,124.00
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
STRAP ANKLE DISTRACTOR AR-1712
|
Facility
IP
|
$1,031.00
|
|
| Hospital Charge Code |
5457016
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.19 |
| Max. Negotiated Rate |
$948.52 |
| Rate for Payer: Aetna Commercial |
$927.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.43
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$948.52
|
| Rate for Payer: Health EOS Commercial |
$917.59
|
| Rate for Payer: HFN Commercial |
$948.52
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: NAPHCARE Commercial |
$618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$948.52
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$618.60
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
STRAP CIRCUMCISION BOARD PAIR #4749
|
Facility
OP
|
$49.00
|
|
| Hospital Charge Code |
2973388
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.42
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.75
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$29.40
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
STRAP CIRCUMCISION BOARD PAIR #4749
|
Facility
IP
|
$49.00
|
|
| Hospital Charge Code |
2973388
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Strapping Ankle and/or Foot
|
Professional
|
$98.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
2572820
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$16.54
|
| Rate for Payer: Anthem Medicare Advantage |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.54
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.54
|
| Rate for Payer: Health EOS Commercial |
$89.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.54
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Preferred Network Access Commercial |
$93.10
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$55.86
|
| Rate for Payer: Quartz Medicare Advantage |
$16.54
|
| Rate for Payer: The Alliance Commercial |
$70.30
|
| Rate for Payer: United Healthcare Medicaid |
$26.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.54
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$74.43
|
|
|
STRAPPING MATERIAL 1 X 25 YDS #A809-20"
|
Facility
OP
|
$707.00
|
|
| Hospital Charge Code |
2971568
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$2,828.00 |
| Rate for Payer: Aetna Commercial |
$636.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.02
|
| Rate for Payer: Aetna Managed Medicare |
$197.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$459.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$353.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$339.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.71
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$650.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.64
|
| Rate for Payer: Health EOS Commercial |
$629.23
|
| Rate for Payer: HFN Commercial |
$650.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.25
|
| Rate for Payer: Multiplan Commercial |
$565.60
|
| Rate for Payer: NAPHCARE Commercial |
$424.20
|
| Rate for Payer: Preferred Network Access Commercial |
$650.44
|
| Rate for Payer: Quartz Beloit One Network |
$346.43
|
| Rate for Payer: Quartz Commercial |
$459.55
|
| Rate for Payer: Quartz Medicare Advantage |
$424.20
|
| Rate for Payer: The Alliance Commercial |
$2,828.00
|
| Rate for Payer: WEA Trust Commercial |
$388.85
|
| Rate for Payer: WPS Commercial |
$523.67
|
|
|
STRAPPING MATERIAL 1 X 25 YDS #A809-20"
|
Facility
IP
|
$707.00
|
|
| Hospital Charge Code |
2971568
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$346.43 |
| Max. Negotiated Rate |
$650.44 |
| Rate for Payer: Aetna Commercial |
$636.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.71
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$650.44
|
| Rate for Payer: Health EOS Commercial |
$629.23
|
| Rate for Payer: HFN Commercial |
$650.44
|
| Rate for Payer: Multiplan Commercial |
$565.60
|
| Rate for Payer: NAPHCARE Commercial |
$424.20
|
| Rate for Payer: Preferred Network Access Commercial |
$650.44
|
| Rate for Payer: Quartz Beloit One Network |
$346.43
|
| Rate for Payer: Quartz Commercial |
$424.20
|
| Rate for Payer: WEA Trust Commercial |
$388.85
|
| Rate for Payer: WPS Commercial |
$523.67
|
|
|
STRAPPING MATERIAL 2 X 25 YDS #A809-21"
|
Facility
IP
|
$964.00
|
|
| Hospital Charge Code |
2971773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$472.36 |
| Max. Negotiated Rate |
$886.88 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.92
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$886.88
|
| Rate for Payer: Health EOS Commercial |
$857.96
|
| Rate for Payer: HFN Commercial |
$886.88
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: NAPHCARE Commercial |
$578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$886.88
|
| Rate for Payer: Quartz Beloit One Network |
$472.36
|
| Rate for Payer: Quartz Commercial |
$578.40
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
STRAPPING MATERIAL 2 X 25 YDS #A809-21"
|
Facility
OP
|
$964.00
|
|
| Hospital Charge Code |
2971773
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$269.92 |
| Max. Negotiated Rate |
$3,856.00 |
| Rate for Payer: Aetna Commercial |
$867.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.04
|
| Rate for Payer: Aetna Managed Medicare |
$269.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$626.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$482.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$462.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.92
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$886.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$539.45
|
| Rate for Payer: Health EOS Commercial |
$857.96
|
| Rate for Payer: HFN Commercial |
$886.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$723.00
|
| Rate for Payer: Multiplan Commercial |
$771.20
|
| Rate for Payer: NAPHCARE Commercial |
$578.40
|
| Rate for Payer: Preferred Network Access Commercial |
$886.88
|
| Rate for Payer: Quartz Beloit One Network |
$472.36
|
| Rate for Payer: Quartz Commercial |
$626.60
|
| Rate for Payer: Quartz Medicare Advantage |
$578.40
|
| Rate for Payer: The Alliance Commercial |
$3,856.00
|
| Rate for Payer: WEA Trust Commercial |
$530.20
|
| Rate for Payer: WPS Commercial |
$714.03
|
|
|
Strapping of Ankle and/or FT 2954050
|
Professional
|
$194.00
|
|
|
Service Code
|
CPT 29540 50
|
| Hospital Charge Code |
3165550
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna Commercial |
$184.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$184.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Health EOS Commercial |
$176.54
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Preferred Network Access Commercial |
$184.30
|
| Rate for Payer: Quartz Beloit One Network |
$85.36
|
| Rate for Payer: Quartz Commercial |
$110.58
|
| Rate for Payer: The Alliance Commercial |
$97.00
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
Strapping of Ankle and/or ft 29540PP
|
Professional
|
$98.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
3108802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.54 |
| Max. Negotiated Rate |
$93.10 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$16.54
|
| Rate for Payer: Anthem Medicare Advantage |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.54
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.54
|
| Rate for Payer: Health EOS Commercial |
$89.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.54
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Preferred Network Access Commercial |
$93.10
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$55.86
|
| Rate for Payer: Quartz Medicare Advantage |
$16.54
|
| Rate for Payer: The Alliance Commercial |
$70.30
|
| Rate for Payer: United Healthcare Medicaid |
$26.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.54
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$74.43
|
|
|
STRAPPING OF ELBOW OR WRIST 29260
|
Professional
|
$135.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
3014297
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.24 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$128.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Aetna Managed Medicare |
$18.15
|
| Rate for Payer: Anthem Medicare Advantage |
$18.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.15
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$128.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.15
|
| Rate for Payer: Health EOS Commercial |
$122.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.15
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.25
|
| Rate for Payer: Quartz Beloit One Network |
$59.40
|
| Rate for Payer: Quartz Commercial |
$76.95
|
| Rate for Payer: Quartz Medicare Advantage |
$18.15
|
| Rate for Payer: The Alliance Commercial |
$77.14
|
| Rate for Payer: United Healthcare Medicaid |
$15.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.15
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$81.68
|
|
|
STRAPPING OF HIP 29520
|
Professional
|
$158.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
3014305
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.61 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Aetna Commercial |
$150.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Aetna Managed Medicare |
$17.61
|
| Rate for Payer: Anthem Medicare Advantage |
$17.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.61
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$150.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.61
|
| Rate for Payer: Health EOS Commercial |
$143.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.61
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.10
|
| Rate for Payer: Quartz Beloit One Network |
$69.52
|
| Rate for Payer: Quartz Commercial |
$90.06
|
| Rate for Payer: Quartz Medicare Advantage |
$17.61
|
| Rate for Payer: The Alliance Commercial |
$74.84
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.61
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$79.24
|
|
|
Strapping of Toes
|
Professional
|
$93.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
2572821
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna Commercial |
$88.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$10.62
|
| Rate for Payer: Anthem Medicare Advantage |
$10.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.62
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.62
|
| Rate for Payer: Health EOS Commercial |
$84.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.62
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$88.35
|
| Rate for Payer: Quartz Beloit One Network |
$40.92
|
| Rate for Payer: Quartz Commercial |
$53.01
|
| Rate for Payer: Quartz Medicare Advantage |
$10.62
|
| Rate for Payer: The Alliance Commercial |
$45.14
|
| Rate for Payer: United Healthcare Medicaid |
$29.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.62
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$47.79
|
|
|
Strapping of Toes 29550PP
|
Professional
|
$151.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
3850019
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.62 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$10.62
|
| Rate for Payer: Anthem Medicare Advantage |
$10.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.62
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$143.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.62
|
| Rate for Payer: Health EOS Commercial |
$137.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.62
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.45
|
| Rate for Payer: Quartz Beloit One Network |
$66.44
|
| Rate for Payer: Quartz Commercial |
$86.07
|
| Rate for Payer: Quartz Medicare Advantage |
$10.62
|
| Rate for Payer: The Alliance Commercial |
$45.14
|
| Rate for Payer: United Healthcare Medicaid |
$29.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.62
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$47.79
|
|
|
STRAPPING; UNNA BOOT
|
Facility
OP
|
$27,265.32
|
|
|
Service Code
|
CPT 29580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$155.74 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Managed Medicare |
$155.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$155.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$579.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.74
|
| Rate for Payer: NAPHCARE Commercial |
$233.61
|
| Rate for Payer: Quartz Medicare Advantage |
$155.74
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.74
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$155.74
|
|
|
STRAP PIP/DIP FINGER FLEXION #550539
|
Facility
IP
|
$69.00
|
|
| Hospital Charge Code |
2970722
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$41.40
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
STRAP PIP/DIP FINGER FLEXION #550539
|
Facility
OP
|
$69.00
|
|
| Hospital Charge Code |
2970722
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.61
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$44.85
|
| Rate for Payer: Quartz Medicare Advantage |
$41.40
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
STRAP SHOULDER X-LG
|
Facility
OP
|
$148.00
|
|
| Hospital Charge Code |
2964011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.44 |
| Max. Negotiated Rate |
$592.00 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$41.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$96.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.82
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.00
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$96.20
|
| Rate for Payer: Quartz Medicare Advantage |
$88.80
|
| Rate for Payer: The Alliance Commercial |
$592.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
STRAP SHOULDER X-LG
|
Facility
IP
|
$148.00
|
|
| Hospital Charge Code |
2964011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
