|
EKG Acquisition
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5376740
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
EKG Acquisition
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5376744
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
EKG Acquisition
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5382991
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
EKG Acquisition
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5375810
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
EKG Acquisition
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5375810
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
EKG Acquisition
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5376746
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
EKG Acquisition
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5376744
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
EKG Acquisition
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5383228
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$287.04
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
EKG Acquisition
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 93005
|
| Hospital Charge Code |
5376740
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
EKG Global 93000
|
Professional
|
Both
|
$547.00
|
|
|
Service Code
|
CPT 93000
|
| Hospital Charge Code |
3149608
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$15.10 |
| Max. Negotiated Rate |
$540.44 |
| Rate for Payer: Aetna Commercial |
$540.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$15.10
|
| Rate for Payer: Anthem Medicare Advantage |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$540.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.10
|
| Rate for Payer: Health EOS Commercial |
$517.68
|
| Rate for Payer: HFN Commercial |
$540.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.10
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$22.65
|
| Rate for Payer: Preferred Network Access Commercial |
$540.44
|
| Rate for Payer: Quartz Beloit One Network |
$250.31
|
| Rate for Payer: Quartz Commercial |
$324.26
|
| Rate for Payer: Quartz Medicare Advantage |
$15.10
|
| Rate for Payer: The Alliance Commercial |
$57.38
|
| Rate for Payer: United Healthcare Medicaid |
$19.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.10
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$60.40
|
|
|
EKG Global 93000
|
Facility
|
OP
|
$547.00
|
|
|
Service Code
|
CPT 93000
|
| Hospital Charge Code |
3149608
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$60.40 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$159.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$273.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.35
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.66
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$341.33
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$369.77
|
| Rate for Payer: Quartz Medicare Advantage |
$341.33
|
| Rate for Payer: The Alliance Commercial |
$60.40
|
| Rate for Payer: United Healthcare PPO |
$426.66
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
EKG Global 93000
|
Facility
|
IP
|
$547.00
|
|
|
Service Code
|
CPT 93000
|
| Hospital Charge Code |
3149608
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$341.33
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
EKG Interpretation
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
5376745
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
EKG Interpretation
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
5376745
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$33.36 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$53.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.67
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.30
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$115.44
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$125.06
|
| Rate for Payer: Quartz Medicare Advantage |
$115.44
|
| Rate for Payer: The Alliance Commercial |
$33.36
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
EKG Interpretation W/Initial Exam G0405
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
HCPCS G0405
|
| Hospital Charge Code |
4213330
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.34 |
| 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 |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| 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 |
$70.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$127.76
|
| Rate for Payer: HFN Commercial |
$133.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$112.32
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| 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 |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$22.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$77.22
|
| Rate for Payer: WPS Commercial |
$14.60
|
|
|
ELA2 Sequence Analysis
|
Facility
|
IP
|
$2,118.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3177491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,079.33 |
| Max. Negotiated Rate |
$2,026.50 |
| Rate for Payer: Aetna Commercial |
$1,982.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,894.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.44
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$2,026.50
|
| Rate for Payer: Health EOS Commercial |
$1,960.42
|
| Rate for Payer: HFN Commercial |
$2,026.50
|
| Rate for Payer: Multiplan Commercial |
$1,762.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,026.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,079.33
|
| Rate for Payer: Quartz Commercial |
$1,321.63
|
| Rate for Payer: WEA Trust Commercial |
$1,211.50
|
| Rate for Payer: WPS Commercial |
$1,631.50
|
|
|
ELA2 Sequence Analysis
|
Facility
|
OP
|
$2,118.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3177491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$616.76 |
| Max. Negotiated Rate |
$2,026.50 |
| Rate for Payer: Aetna Commercial |
$1,982.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,894.34
|
| Rate for Payer: Aetna Managed Medicare |
$616.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,101.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,057.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,167.44
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$2,026.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,232.68
|
| Rate for Payer: Health EOS Commercial |
$1,960.42
|
| Rate for Payer: HFN Commercial |
$2,026.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,652.04
|
| Rate for Payer: Multiplan Commercial |
$1,762.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,321.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,026.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,079.33
|
| Rate for Payer: Quartz Commercial |
$1,431.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,321.63
|
| Rate for Payer: The Alliance Commercial |
$1,101.36
|
| Rate for Payer: United Healthcare PPO |
$1,652.04
|
| Rate for Payer: WEA Trust Commercial |
$1,211.50
|
| Rate for Payer: WPS Commercial |
$1,631.50
|
|
|
ELA2 Sequence Analysis
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3177491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$943.57 |
| Max. Negotiated Rate |
$2,037.26 |
| Rate for Payer: Aetna Commercial |
$2,037.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,844.25
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$2,037.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,072.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,286.69
|
| Rate for Payer: Health EOS Commercial |
$1,951.48
|
| Rate for Payer: HFN Commercial |
$2,037.26
|
| Rate for Payer: Multiplan Commercial |
$1,715.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,037.26
|
| Rate for Payer: Quartz Beloit One Network |
$943.57
|
| Rate for Payer: Quartz Commercial |
$1,222.35
|
| Rate for Payer: The Alliance Commercial |
$1,072.24
|
| Rate for Payer: WEA Trust Commercial |
$1,179.46
|
| Rate for Payer: WPS Commercial |
$1,588.36
|
|
|
ELASTIC NAIL 2.0 X 440 475.920S
|
Facility
|
OP
|
$3,823.00
|
|
| Hospital Charge Code |
2966286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.26 |
| Max. Negotiated Rate |
$3,657.85 |
| Rate for Payer: Aetna Commercial |
$3,578.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,419.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,113.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,584.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,987.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,908.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.24
|
| Rate for Payer: Cash Price |
$1,146.90
|
| Rate for Payer: Cigna Commercial |
$3,657.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,224.99
|
| Rate for Payer: Health EOS Commercial |
$3,538.57
|
| Rate for Payer: HFN Commercial |
$3,657.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,981.94
|
| Rate for Payer: Multiplan Commercial |
$3,180.74
|
| Rate for Payer: NAPHCARE Commercial |
$2,385.55
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.20
|
| Rate for Payer: Quartz Commercial |
$2,584.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,385.55
|
| Rate for Payer: The Alliance Commercial |
$1,987.96
|
| Rate for Payer: WEA Trust Commercial |
$2,186.76
|
| Rate for Payer: WPS Commercial |
$2,944.86
|
|
|
ELASTIC NAIL 2.0 X 440 475.920S
|
Facility
|
IP
|
$3,823.00
|
|
| Hospital Charge Code |
2966286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,948.20 |
| Max. Negotiated Rate |
$3,657.85 |
| Rate for Payer: Aetna Commercial |
$3,578.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,419.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,107.24
|
| Rate for Payer: Cash Price |
$1,146.90
|
| Rate for Payer: Cigna Commercial |
$3,657.85
|
| Rate for Payer: Health EOS Commercial |
$3,538.57
|
| Rate for Payer: HFN Commercial |
$3,657.85
|
| Rate for Payer: Multiplan Commercial |
$3,180.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,657.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,948.20
|
| Rate for Payer: Quartz Commercial |
$2,385.55
|
| Rate for Payer: WEA Trust Commercial |
$2,186.76
|
| Rate for Payer: WPS Commercial |
$2,944.86
|
|
|
Elastic wrap bandage charge
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
2844905
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Elastic wrap bandage charge
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
2844905
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.88 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$23.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$51.17
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$51.17
|
| Rate for Payer: The Alliance Commercial |
$42.64
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
ELASTOMER PUTTY 50/50 MIX
|
Facility
|
IP
|
$583.00
|
|
| Hospital Charge Code |
2971437
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$297.10 |
| Max. Negotiated Rate |
$557.81 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| Rate for Payer: Multiplan Commercial |
$485.06
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$363.79
|
| Rate for Payer: WEA Trust Commercial |
$333.48
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
ELASTOMER PUTTY 50/50 MIX
|
Facility
|
OP
|
$583.00
|
|
| Hospital Charge Code |
2971437
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$169.77 |
| Max. Negotiated Rate |
$557.81 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Aetna Managed Medicare |
$169.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$394.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.31
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.74
|
| Rate for Payer: Multiplan Commercial |
$485.06
|
| Rate for Payer: NAPHCARE Commercial |
$363.79
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$394.11
|
| Rate for Payer: Quartz Medicare Advantage |
$363.79
|
| Rate for Payer: The Alliance Commercial |
$303.16
|
| Rate for Payer: WEA Trust Commercial |
$333.48
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
ELBOW ARTHRODESIS
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2959817
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
