|
Strapping of Ankle and/or FT 2954050
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 29540 50
|
| Hospital Charge Code |
3165550
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna Commercial |
$191.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$191.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.06
|
| Rate for Payer: Health EOS Commercial |
$183.60
|
| Rate for Payer: HFN Commercial |
$191.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.34
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$191.67
|
| Rate for Payer: Quartz Beloit One Network |
$88.77
|
| Rate for Payer: Quartz Commercial |
$115.00
|
| Rate for Payer: The Alliance Commercial |
$100.88
|
| Rate for Payer: United Healthcare Medicaid |
$28.05
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
Strapping of Ankle and/or ft 29540PP
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 29540
|
| Hospital Charge Code |
3108802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.18 |
| Max. Negotiated Rate |
$96.82 |
| Rate for Payer: Aetna Commercial |
$96.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$15.18
|
| Rate for Payer: Anthem Medicare Advantage |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.18
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$96.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.18
|
| Rate for Payer: Health EOS Commercial |
$92.75
|
| Rate for Payer: HFN Commercial |
$96.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.18
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$22.78
|
| Rate for Payer: Preferred Network Access Commercial |
$96.82
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$58.09
|
| Rate for Payer: Quartz Medicare Advantage |
$15.18
|
| Rate for Payer: The Alliance Commercial |
$64.53
|
| Rate for Payer: United Healthcare Medicaid |
$28.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.18
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$68.33
|
|
|
STRAPPING OF ELBOW OR WRIST 29260
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
CPT 29260
|
| Hospital Charge Code |
3014297
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.75 |
| Max. Negotiated Rate |
$133.38 |
| Rate for Payer: Aetna Commercial |
$133.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.74
|
| Rate for Payer: Aetna Managed Medicare |
$15.75
|
| Rate for Payer: Anthem Medicare Advantage |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.75
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$133.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.75
|
| Rate for Payer: Health EOS Commercial |
$127.76
|
| Rate for Payer: HFN Commercial |
$133.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$112.32
|
| Rate for Payer: NAPHCARE Commercial |
$23.62
|
| Rate for Payer: Preferred Network Access Commercial |
$133.38
|
| Rate for Payer: Quartz Beloit One Network |
$61.78
|
| Rate for Payer: Quartz Commercial |
$80.03
|
| Rate for Payer: Quartz Medicare Advantage |
$15.75
|
| Rate for Payer: The Alliance Commercial |
$66.92
|
| Rate for Payer: United Healthcare Medicaid |
$15.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$77.22
|
| Rate for Payer: WPS Commercial |
$70.86
|
|
|
STRAPPING OF HIP 29520
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
CPT 29520
|
| Hospital Charge Code |
3014305
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.64 |
| Max. Negotiated Rate |
$156.10 |
| Rate for Payer: Aetna Commercial |
$156.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$15.64
|
| Rate for Payer: Anthem Medicare Advantage |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.64
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$156.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.64
|
| Rate for Payer: Health EOS Commercial |
$149.53
|
| Rate for Payer: HFN Commercial |
$156.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.64
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$23.46
|
| Rate for Payer: Preferred Network Access Commercial |
$156.10
|
| Rate for Payer: Quartz Beloit One Network |
$72.30
|
| Rate for Payer: Quartz Commercial |
$93.66
|
| Rate for Payer: Quartz Medicare Advantage |
$15.64
|
| Rate for Payer: The Alliance Commercial |
$66.48
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.64
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$70.39
|
|
|
Strapping of Toes
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
2572821
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$9.55
|
| Rate for Payer: Anthem Medicare Advantage |
$9.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.55
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.55
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.55
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$14.32
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$9.55
|
| Rate for Payer: The Alliance Commercial |
$40.58
|
| Rate for Payer: United Healthcare Medicaid |
$30.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.55
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
Strapping of Toes 29550PP
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 29550
|
| Hospital Charge Code |
3850019
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.55 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$9.55
|
| Rate for Payer: Anthem Medicare Advantage |
$9.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.55
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$149.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.55
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.55
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$14.32
|
| Rate for Payer: Preferred Network Access Commercial |
$149.19
|
| Rate for Payer: Quartz Beloit One Network |
$69.10
|
| Rate for Payer: Quartz Commercial |
$89.51
|
| Rate for Payer: Quartz Medicare Advantage |
$9.55
|
| Rate for Payer: The Alliance Commercial |
$40.58
|
| Rate for Payer: United Healthcare Medicaid |
$30.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.55
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$42.96
|
|
|
STRAPPING; UNNA BOOT
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 29580
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$171.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$171.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.02
|
| Rate for Payer: NAPHCARE Commercial |
$256.53
|
| Rate for Payer: Quartz Medicare Advantage |
$171.02
|
| Rate for Payer: The Alliance Commercial |
$684.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.02
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$171.02
|
|
|
STRAP PIP/DIP FINGER FLEXION #550539
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
2970722
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
STRAP PIP/DIP FINGER FLEXION #550539
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
2970722
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$20.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.82
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$43.06
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$46.64
|
| Rate for Payer: Quartz Medicare Advantage |
$43.06
|
| Rate for Payer: The Alliance Commercial |
$35.88
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
STRAP SHOULDER X-LG
|
Facility
|
OP
|
$148.00
|
|
| Hospital Charge Code |
2964011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$43.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.14
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$100.05
|
| Rate for Payer: Quartz Medicare Advantage |
$92.35
|
| Rate for Payer: The Alliance Commercial |
$76.96
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
STRAP SHOULDER X-LG
|
Facility
|
IP
|
$148.00
|
|
| Hospital Charge Code |
2964011
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
STRAPS LEG SML FRABRIC #9342
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2974513
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
STRAPS LEG SML FRABRIC #9342
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2974513
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
STRAP ULNAR DEVIATION #A309-9
|
Facility
|
IP
|
$371.00
|
|
| Hospital Charge Code |
2971022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$231.50
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
STRAP ULNAR DEVIATION #A309-9
|
Facility
|
OP
|
$371.00
|
|
| Hospital Charge Code |
2971022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.92
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.38
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$231.50
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: Quartz Medicare Advantage |
$231.50
|
| Rate for Payer: The Alliance Commercial |
$192.92
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
STRASSBURG SOCK LARGE
|
Facility
|
IP
|
$513.00
|
|
| Hospital Charge Code |
2971342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$261.42 |
| Max. Negotiated Rate |
$490.84 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.77
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$490.84
|
| Rate for Payer: Health EOS Commercial |
$474.83
|
| Rate for Payer: HFN Commercial |
$490.84
|
| Rate for Payer: Multiplan Commercial |
$426.82
|
| Rate for Payer: Preferred Network Access Commercial |
$490.84
|
| Rate for Payer: Quartz Beloit One Network |
$261.42
|
| Rate for Payer: Quartz Commercial |
$320.11
|
| Rate for Payer: WEA Trust Commercial |
$293.44
|
| Rate for Payer: WPS Commercial |
$395.16
|
|
|
STRASSBURG SOCK LARGE
|
Facility
|
OP
|
$513.00
|
|
| Hospital Charge Code |
2971342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$149.39 |
| Max. Negotiated Rate |
$490.84 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.83
|
| Rate for Payer: Aetna Managed Medicare |
$149.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$346.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$266.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.77
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$490.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.57
|
| Rate for Payer: Health EOS Commercial |
$474.83
|
| Rate for Payer: HFN Commercial |
$490.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.14
|
| Rate for Payer: Multiplan Commercial |
$426.82
|
| Rate for Payer: NAPHCARE Commercial |
$320.11
|
| Rate for Payer: Preferred Network Access Commercial |
$490.84
|
| Rate for Payer: Quartz Beloit One Network |
$261.42
|
| Rate for Payer: Quartz Commercial |
$346.79
|
| Rate for Payer: Quartz Medicare Advantage |
$320.11
|
| Rate for Payer: The Alliance Commercial |
$266.76
|
| Rate for Payer: WEA Trust Commercial |
$293.44
|
| Rate for Payer: WPS Commercial |
$395.16
|
|
|
STRASSBURG SOCK ( MIN 5) REGULAR
|
Facility
|
OP
|
$487.00
|
|
| Hospital Charge Code |
2971206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$141.81 |
| Max. Negotiated Rate |
$465.96 |
| Rate for Payer: Aetna Commercial |
$455.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.57
|
| Rate for Payer: Aetna Managed Medicare |
$141.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$329.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$243.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.43
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cigna Commercial |
$465.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$283.43
|
| Rate for Payer: Health EOS Commercial |
$450.77
|
| Rate for Payer: HFN Commercial |
$465.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.86
|
| Rate for Payer: Multiplan Commercial |
$405.18
|
| Rate for Payer: NAPHCARE Commercial |
$303.89
|
| Rate for Payer: Preferred Network Access Commercial |
$465.96
|
| Rate for Payer: Quartz Beloit One Network |
$248.18
|
| Rate for Payer: Quartz Commercial |
$329.21
|
| Rate for Payer: Quartz Medicare Advantage |
$303.89
|
| Rate for Payer: The Alliance Commercial |
$253.24
|
| Rate for Payer: WEA Trust Commercial |
$278.56
|
| Rate for Payer: WPS Commercial |
$375.14
|
|
|
STRASSBURG SOCK ( MIN 5) REGULAR
|
Facility
|
IP
|
$487.00
|
|
| Hospital Charge Code |
2971206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$248.18 |
| Max. Negotiated Rate |
$465.96 |
| Rate for Payer: Aetna Commercial |
$455.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$435.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.43
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cigna Commercial |
$465.96
|
| Rate for Payer: Health EOS Commercial |
$450.77
|
| Rate for Payer: HFN Commercial |
$465.96
|
| Rate for Payer: Multiplan Commercial |
$405.18
|
| Rate for Payer: Preferred Network Access Commercial |
$465.96
|
| Rate for Payer: Quartz Beloit One Network |
$248.18
|
| Rate for Payer: Quartz Commercial |
$303.89
|
| Rate for Payer: WEA Trust Commercial |
$278.56
|
| Rate for Payer: WPS Commercial |
$375.14
|
|
|
.Stratify JCV Ab Inhibition Assay
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
6187226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$780.52 |
| Rate for Payer: Aetna Commercial |
$780.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.57
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$780.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.57
|
| Rate for Payer: Health EOS Commercial |
$747.66
|
| Rate for Payer: HFN Commercial |
$780.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.57
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$26.35
|
| Rate for Payer: Preferred Network Access Commercial |
$780.52
|
| Rate for Payer: Quartz Beloit One Network |
$361.50
|
| Rate for Payer: Quartz Commercial |
$468.31
|
| Rate for Payer: Quartz Medicare Advantage |
$17.57
|
| Rate for Payer: The Alliance Commercial |
$69.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.57
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$77.29
|
|
|
.Stratify JCV Ab Inhibition Assay
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
6187226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$17.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.16
|
| Rate for Payer: Anthem Medicare Advantage |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.57
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.57
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.57
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$26.35
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$534.04
|
| Rate for Payer: Quartz Medicare Advantage |
$17.57
|
| Rate for Payer: The Alliance Commercial |
$70.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.57
|
| Rate for Payer: United Healthcare PPO |
$616.20
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: Wellcare Medicare |
$17.57
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
.Stratify JCV Ab Inhibition Assay
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
6187226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$402.58 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$492.96
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
Stratify JCV Antibody w/Rfx Inhibition Assay
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
4622700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$2,320.24 |
| Rate for Payer: Aetna Commercial |
$2,269.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.92
|
| Rate for Payer: Aetna Managed Medicare |
$17.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.16
|
| Rate for Payer: Anthem Medicare Advantage |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,336.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.57
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cigna Commercial |
$2,320.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,411.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.57
|
| Rate for Payer: Health EOS Commercial |
$2,244.58
|
| Rate for Payer: HFN Commercial |
$2,320.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.57
|
| Rate for Payer: Multiplan Commercial |
$2,017.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,320.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.78
|
| Rate for Payer: Quartz Commercial |
$1,639.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17.57
|
| Rate for Payer: The Alliance Commercial |
$70.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.57
|
| Rate for Payer: United Healthcare PPO |
$1,891.50
|
| Rate for Payer: WEA Trust Commercial |
$1,387.10
|
| Rate for Payer: Wellcare Medicare |
$17.57
|
| Rate for Payer: WPS Commercial |
$1,867.98
|
|
|
Stratify JCV Antibody w/Rfx Inhibition Assay
|
Professional
|
Both
|
$2,425.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
4622700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$2,395.90 |
| Rate for Payer: Aetna Commercial |
$2,395.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.92
|
| Rate for Payer: Aetna Managed Medicare |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.57
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cigna Commercial |
$2,395.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,261.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.57
|
| Rate for Payer: Health EOS Commercial |
$2,295.02
|
| Rate for Payer: HFN Commercial |
$2,395.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.57
|
| Rate for Payer: Multiplan Commercial |
$2,017.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.35
|
| Rate for Payer: Preferred Network Access Commercial |
$2,395.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,109.68
|
| Rate for Payer: Quartz Commercial |
$1,437.54
|
| Rate for Payer: Quartz Medicare Advantage |
$17.57
|
| Rate for Payer: The Alliance Commercial |
$69.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.57
|
| Rate for Payer: WEA Trust Commercial |
$1,387.10
|
| Rate for Payer: WPS Commercial |
$77.29
|
|
|
Stratify JCV Antibody w/Rfx Inhibition Assay
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
4622700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,235.78 |
| Max. Negotiated Rate |
$2,320.24 |
| Rate for Payer: Aetna Commercial |
$2,269.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,336.66
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cigna Commercial |
$2,320.24
|
| Rate for Payer: Health EOS Commercial |
$2,244.58
|
| Rate for Payer: HFN Commercial |
$2,320.24
|
| Rate for Payer: Multiplan Commercial |
$2,017.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,320.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,235.78
|
| Rate for Payer: Quartz Commercial |
$1,513.20
|
| Rate for Payer: WEA Trust Commercial |
$1,387.10
|
| Rate for Payer: WPS Commercial |
$1,867.98
|
|
