|
ELBOW ARTHRODESIS
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2959817
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| 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: 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: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| 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 |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
Elbow Arthrography
|
Professional
|
Both
|
$1,697.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
3072659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.71 |
| Max. Negotiated Rate |
$1,676.64 |
| Rate for Payer: Aetna Commercial |
$1,676.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,517.80
|
| Rate for Payer: Aetna Managed Medicare |
$95.71
|
| Rate for Payer: Anthem Medicare Advantage |
$95.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.71
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cigna Commercial |
$1,676.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$882.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.71
|
| Rate for Payer: Health EOS Commercial |
$1,606.04
|
| Rate for Payer: HFN Commercial |
$1,676.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$414.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.71
|
| Rate for Payer: Multiplan Commercial |
$1,411.90
|
| Rate for Payer: NAPHCARE Commercial |
$143.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,676.64
|
| Rate for Payer: Quartz Beloit One Network |
$776.55
|
| Rate for Payer: Quartz Commercial |
$1,005.98
|
| Rate for Payer: Quartz Medicare Advantage |
$95.71
|
| Rate for Payer: The Alliance Commercial |
$363.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.71
|
| Rate for Payer: WEA Trust Commercial |
$970.68
|
| Rate for Payer: WPS Commercial |
$478.56
|
|
|
Elbow Arthrography
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
3072659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,623.69 |
| Rate for Payer: Aetna Commercial |
$1,588.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,517.80
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,482.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,185.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,126.68
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$935.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cigna Commercial |
$1,623.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$987.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$1,570.74
|
| Rate for Payer: HFN Commercial |
$1,623.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$1,411.90
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,623.69
|
| Rate for Payer: Quartz Beloit One Network |
$864.79
|
| Rate for Payer: Quartz Commercial |
$1,147.17
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$970.68
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$1,307.20
|
|
|
Elbow Arthrography
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
3072659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$864.79 |
| Max. Negotiated Rate |
$1,623.69 |
| Rate for Payer: Aetna Commercial |
$1,588.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,517.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$935.39
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cigna Commercial |
$1,623.69
|
| Rate for Payer: Health EOS Commercial |
$1,570.74
|
| Rate for Payer: HFN Commercial |
$1,623.69
|
| Rate for Payer: Multiplan Commercial |
$1,411.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,623.69
|
| Rate for Payer: Quartz Beloit One Network |
$864.79
|
| Rate for Payer: Quartz Commercial |
$1,058.93
|
| Rate for Payer: WEA Trust Commercial |
$970.68
|
| Rate for Payer: WPS Commercial |
$1,307.20
|
|
|
ELBOW ARTHROPLASTY
|
Facility
|
OP
|
$8,012.00
|
|
| Hospital Charge Code |
2960441
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,333.09 |
| Max. Negotiated Rate |
$7,665.88 |
| Rate for Payer: Aetna Commercial |
$7,499.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,165.93
|
| Rate for Payer: Aetna Managed Medicare |
$2,333.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,416.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,166.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,999.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.21
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,665.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,662.98
|
| Rate for Payer: Health EOS Commercial |
$7,415.91
|
| Rate for Payer: HFN Commercial |
$7,665.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,249.36
|
| Rate for Payer: Multiplan Commercial |
$6,665.98
|
| Rate for Payer: NAPHCARE Commercial |
$4,999.49
|
| Rate for Payer: Preferred Network Access Commercial |
$7,665.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,082.92
|
| Rate for Payer: Quartz Commercial |
$5,416.11
|
| Rate for Payer: Quartz Medicare Advantage |
$4,999.49
|
| Rate for Payer: The Alliance Commercial |
$4,166.24
|
| Rate for Payer: WEA Trust Commercial |
$4,582.86
|
| Rate for Payer: WPS Commercial |
$6,171.64
|
|
|
ELBOW ARTHROPLASTY
|
Facility
|
IP
|
$8,012.00
|
|
| Hospital Charge Code |
2960441
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,082.92 |
| Max. Negotiated Rate |
$7,665.88 |
| Rate for Payer: Aetna Commercial |
$7,499.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,165.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,416.21
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,665.88
|
| Rate for Payer: Health EOS Commercial |
$7,415.91
|
| Rate for Payer: HFN Commercial |
$7,665.88
|
| Rate for Payer: Multiplan Commercial |
$6,665.98
|
| Rate for Payer: Preferred Network Access Commercial |
$7,665.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,082.92
|
| Rate for Payer: Quartz Commercial |
$4,999.49
|
| Rate for Payer: WEA Trust Commercial |
$4,582.86
|
| Rate for Payer: WPS Commercial |
$6,171.64
|
|
|
ELBOW ARTHROSCOPY
|
Facility
|
IP
|
$7,950.00
|
|
| Hospital Charge Code |
2959827
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,051.32 |
| Max. Negotiated Rate |
$7,606.56 |
| Rate for Payer: Aetna Commercial |
$7,441.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,110.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,606.56
|
| Rate for Payer: Health EOS Commercial |
$7,358.52
|
| Rate for Payer: HFN Commercial |
$7,606.56
|
| Rate for Payer: Multiplan Commercial |
$6,614.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,606.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,051.32
|
| Rate for Payer: Quartz Commercial |
$4,960.80
|
| Rate for Payer: WEA Trust Commercial |
$4,547.40
|
| Rate for Payer: WPS Commercial |
$6,123.89
|
|
|
ELBOW ARTHROSCOPY
|
Facility
|
OP
|
$7,950.00
|
|
| Hospital Charge Code |
2959827
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,315.04 |
| Max. Negotiated Rate |
$7,606.56 |
| Rate for Payer: Aetna Commercial |
$7,441.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,110.48
|
| Rate for Payer: Aetna Managed Medicare |
$2,315.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,374.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,134.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,968.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,382.04
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,606.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,626.90
|
| Rate for Payer: Health EOS Commercial |
$7,358.52
|
| Rate for Payer: HFN Commercial |
$7,606.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,201.00
|
| Rate for Payer: Multiplan Commercial |
$6,614.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,960.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,606.56
|
| Rate for Payer: Quartz Beloit One Network |
$4,051.32
|
| Rate for Payer: Quartz Commercial |
$5,374.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,960.80
|
| Rate for Payer: The Alliance Commercial |
$4,134.00
|
| Rate for Payer: WEA Trust Commercial |
$4,547.40
|
| Rate for Payer: WPS Commercial |
$6,123.89
|
|
|
ELBOW BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959857
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
ELBOW BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959857
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
ELBOW OSTEOTOMY
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960286
|
|
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
|
|
|
ELBOW OSTEOTOMY
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| 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: 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: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| 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 |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
ELBOW SLEEVE NEOPREN MED #781007
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2970726
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.85 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.61
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.74
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$145.39
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| Rate for Payer: Quartz Medicare Advantage |
$145.39
|
| Rate for Payer: The Alliance Commercial |
$121.16
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
ELBOW SLEEVE NEOPREN MED #781007
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2970726
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
ELBOW SLEEVE NEOPREN SMALL #781006
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2970725
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
ELBOW SLEEVE NEOPREN SMALL #781006
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2970725
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.85 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.61
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.74
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$145.39
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| Rate for Payer: Quartz Medicare Advantage |
$145.39
|
| Rate for Payer: The Alliance Commercial |
$121.16
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
ELBOW SUPPORT NEOPRENE X-LARGE #A919-04
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2970230
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
ELBOW SUPPORT NEOPRENE X-LARGE #A919-04
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2970230
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
ELBOW, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$4,492.00
|
|
| Hospital Charge Code |
2960417
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,308.07 |
| Max. Negotiated Rate |
$4,297.95 |
| Rate for Payer: Aetna Commercial |
$4,204.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,017.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,308.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,036.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,335.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,242.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,475.99
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,297.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,614.34
|
| Rate for Payer: Health EOS Commercial |
$4,157.80
|
| Rate for Payer: HFN Commercial |
$4,297.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,503.76
|
| Rate for Payer: Multiplan Commercial |
$3,737.34
|
| Rate for Payer: NAPHCARE Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$4,297.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,289.12
|
| Rate for Payer: Quartz Commercial |
$3,036.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,803.01
|
| Rate for Payer: The Alliance Commercial |
$2,335.84
|
| Rate for Payer: WEA Trust Commercial |
$2,569.42
|
| Rate for Payer: WPS Commercial |
$3,460.19
|
|
|
ELBOW, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,492.00
|
|
| Hospital Charge Code |
2960417
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,289.12 |
| Max. Negotiated Rate |
$4,297.95 |
| Rate for Payer: Aetna Commercial |
$4,204.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,017.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,475.99
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,297.95
|
| Rate for Payer: Health EOS Commercial |
$4,157.80
|
| Rate for Payer: HFN Commercial |
$4,297.95
|
| Rate for Payer: Multiplan Commercial |
$3,737.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,297.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,289.12
|
| Rate for Payer: Quartz Commercial |
$2,803.01
|
| Rate for Payer: WEA Trust Commercial |
$2,569.42
|
| Rate for Payer: WPS Commercial |
$3,460.19
|
|
|
ELBOW TENNIS STRAP BLK
|
Facility
|
OP
|
$256.00
|
|
| Hospital Charge Code |
2970317
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Aetna Managed Medicare |
$74.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$173.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.99
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.68
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: NAPHCARE Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$173.06
|
| Rate for Payer: Quartz Medicare Advantage |
$159.74
|
| Rate for Payer: The Alliance Commercial |
$133.12
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
ELBOW TENNIS STRAP BLK
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
2970317
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$159.74
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
Elbow Trough
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
2989897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$105.71 |
| Max. Negotiated Rate |
$1,343.56 |
| Rate for Payer: Aetna Commercial |
$339.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Aetna Managed Medicare |
$105.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$134.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.09
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$347.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.27
|
| Rate for Payer: Health EOS Commercial |
$335.99
|
| Rate for Payer: HFN Commercial |
$347.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.14
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: NAPHCARE Commercial |
$226.51
|
| Rate for Payer: Preferred Network Access Commercial |
$347.32
|
| Rate for Payer: Quartz Beloit One Network |
$184.98
|
| Rate for Payer: Quartz Commercial |
$245.39
|
| Rate for Payer: Quartz Medicare Advantage |
$226.51
|
| Rate for Payer: The Alliance Commercial |
$1,343.56
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$279.62
|
|
|
Elbow Trough
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
2989897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$184.98 |
| Max. Negotiated Rate |
$347.32 |
| Rate for Payer: Aetna Commercial |
$339.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.09
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$347.32
|
| Rate for Payer: Health EOS Commercial |
$335.99
|
| Rate for Payer: HFN Commercial |
$347.32
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$347.32
|
| Rate for Payer: Quartz Beloit One Network |
$184.98
|
| Rate for Payer: Quartz Commercial |
$226.51
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$279.62
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$11,749.54
|
|
|
Service Code
|
APR-DRG 3241
|
| Min. Negotiated Rate |
$10,436.67 |
| Max. Negotiated Rate |
$11,749.54 |
| Rate for Payer: Anthem Medicaid |
$11,250.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,250.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,250.83
|
| Rate for Payer: Dean Health Medicaid |
$11,250.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,436.67
|
| Rate for Payer: Managed Health Services Medicaid |
$11,749.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,250.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,250.83
|
| Rate for Payer: United Healthcare Medicaid |
$11,250.83
|
|
