|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$29,899.94
|
|
|
Service Code
|
APR-DRG 3244
|
| Min. Negotiated Rate |
$26,558.99 |
| Max. Negotiated Rate |
$29,899.94 |
| Rate for Payer: Anthem Medicaid |
$28,630.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28,630.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28,630.84
|
| Rate for Payer: Dean Health Medicaid |
$28,630.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,558.99
|
| Rate for Payer: Managed Health Services Medicaid |
$29,899.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,630.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28,630.84
|
| Rate for Payer: United Healthcare Medicaid |
$28,630.84
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$21,394.68
|
|
|
Service Code
|
APR-DRG 3243
|
| Min. Negotiated Rate |
$19,004.09 |
| Max. Negotiated Rate |
$21,394.68 |
| Rate for Payer: Anthem Medicaid |
$20,486.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,486.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,486.58
|
| Rate for Payer: Dean Health Medicaid |
$20,486.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,004.09
|
| Rate for Payer: Managed Health Services Medicaid |
$21,394.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,486.58
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,486.58
|
| Rate for Payer: United Healthcare Medicaid |
$20,486.58
|
|
|
ELECTIVE HIP JOINT REPLACEMENT
|
Facility
|
IP
|
$14,380.03
|
|
|
Service Code
|
APR-DRG 3242
|
| Min. Negotiated Rate |
$12,773.24 |
| Max. Negotiated Rate |
$14,380.03 |
| Rate for Payer: Anthem Medicaid |
$13,769.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,769.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,769.67
|
| Rate for Payer: Dean Health Medicaid |
$13,769.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,773.24
|
| Rate for Payer: Managed Health Services Medicaid |
$14,380.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,769.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,769.67
|
| Rate for Payer: United Healthcare Medicaid |
$13,769.67
|
|
|
ELECTIVE KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$11,661.85
|
|
|
Service Code
|
APR-DRG 3261
|
| Min. Negotiated Rate |
$10,358.78 |
| Max. Negotiated Rate |
$11,661.85 |
| Rate for Payer: Anthem Medicaid |
$11,166.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,166.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,166.87
|
| Rate for Payer: Dean Health Medicaid |
$11,166.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,358.78
|
| Rate for Payer: Managed Health Services Medicaid |
$11,661.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,166.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,166.87
|
| Rate for Payer: United Healthcare Medicaid |
$11,166.87
|
|
|
ELECTIVE KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$18,062.72
|
|
|
Service Code
|
APR-DRG 3263
|
| Min. Negotiated Rate |
$16,044.43 |
| Max. Negotiated Rate |
$18,062.72 |
| Rate for Payer: Anthem Medicaid |
$17,296.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,296.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,296.05
|
| Rate for Payer: Dean Health Medicaid |
$17,296.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,044.43
|
| Rate for Payer: Managed Health Services Medicaid |
$18,062.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,296.05
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,296.05
|
| Rate for Payer: United Healthcare Medicaid |
$17,296.05
|
|
|
ELECTIVE KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$28,409.32
|
|
|
Service Code
|
APR-DRG 3264
|
| Min. Negotiated Rate |
$25,234.93 |
| Max. Negotiated Rate |
$28,409.32 |
| Rate for Payer: Anthem Medicaid |
$27,203.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$27,203.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27,203.49
|
| Rate for Payer: Dean Health Medicaid |
$27,203.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25,234.93
|
| Rate for Payer: Managed Health Services Medicaid |
$28,409.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,203.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27,203.49
|
| Rate for Payer: United Healthcare Medicaid |
$27,203.49
|
|
|
ELECTIVE KNEE JOINT REPLACEMENT
|
Facility
|
IP
|
$13,152.47
|
|
|
Service Code
|
APR-DRG 3262
|
| Min. Negotiated Rate |
$11,682.84 |
| Max. Negotiated Rate |
$13,152.47 |
| Rate for Payer: Anthem Medicaid |
$12,594.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,594.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,594.21
|
| Rate for Payer: Dean Health Medicaid |
$12,594.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,682.84
|
| Rate for Payer: Managed Health Services Medicaid |
$13,152.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,594.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,594.21
|
| Rate for Payer: United Healthcare Medicaid |
$12,594.21
|
|
|
ELECTRICAL BONE STIMULATION 20974
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
CPT 20974
|
| Hospital Charge Code |
3013718
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.85 |
| Max. Negotiated Rate |
$215.33 |
| Rate for Payer: Aetna Commercial |
$139.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Aetna Managed Medicare |
$47.85
|
| Rate for Payer: Anthem Medicare Advantage |
$47.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.85
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$139.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.85
|
| Rate for Payer: Health EOS Commercial |
$133.44
|
| Rate for Payer: HFN Commercial |
$139.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$170.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.85
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: NAPHCARE Commercial |
$71.78
|
| Rate for Payer: Preferred Network Access Commercial |
$139.31
|
| Rate for Payer: Quartz Beloit One Network |
$64.52
|
| Rate for Payer: Quartz Commercial |
$83.58
|
| Rate for Payer: Quartz Medicare Advantage |
$47.85
|
| Rate for Payer: The Alliance Commercial |
$203.36
|
| Rate for Payer: United Healthcare Medicaid |
$113.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.85
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: WPS Commercial |
$215.33
|
|
|
Electrical Stimulation for Guidance w Chemodenervation 95873
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
CPT 95873
|
| Hospital Charge Code |
5072640
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.36 |
| Max. Negotiated Rate |
$812.14 |
| Rate for Payer: Aetna Commercial |
$812.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Aetna Managed Medicare |
$76.17
|
| Rate for Payer: Anthem Medicare Advantage |
$76.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.17
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$812.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.17
|
| Rate for Payer: Health EOS Commercial |
$777.94
|
| Rate for Payer: HFN Commercial |
$812.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$283.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.17
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: NAPHCARE Commercial |
$114.25
|
| Rate for Payer: Preferred Network Access Commercial |
$812.14
|
| Rate for Payer: Quartz Beloit One Network |
$376.15
|
| Rate for Payer: Quartz Commercial |
$487.28
|
| Rate for Payer: Quartz Medicare Advantage |
$76.17
|
| Rate for Payer: The Alliance Commercial |
$190.42
|
| Rate for Payer: United Healthcare Medicaid |
$25.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.17
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: WPS Commercial |
$304.68
|
|
|
Electrical Stimulation for Guidance w Chemodenervation 9587326
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
CPT 95873 26
|
| Hospital Charge Code |
5072662
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.54 |
| Max. Negotiated Rate |
$812.14 |
| Rate for Payer: Aetna Commercial |
$812.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Aetna Managed Medicare |
$20.27
|
| Rate for Payer: Anthem Medicare Advantage |
$20.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.27
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$812.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.27
|
| Rate for Payer: Health EOS Commercial |
$777.94
|
| Rate for Payer: HFN Commercial |
$812.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.27
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: NAPHCARE Commercial |
$30.40
|
| Rate for Payer: Preferred Network Access Commercial |
$812.14
|
| Rate for Payer: Quartz Beloit One Network |
$376.15
|
| Rate for Payer: Quartz Commercial |
$487.28
|
| Rate for Payer: Quartz Medicare Advantage |
$20.27
|
| Rate for Payer: The Alliance Commercial |
$50.67
|
| Rate for Payer: United Healthcare Medicaid |
$18.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.27
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: WPS Commercial |
$81.08
|
|
|
ELECTRIC DEODORIZER
|
Facility
|
OP
|
$229.00
|
|
| Hospital Charge Code |
3075878
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$66.68 |
| Max. Negotiated Rate |
$219.11 |
| Rate for Payer: Aetna Commercial |
$214.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Aetna Managed Medicare |
$66.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$154.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$119.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$114.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.22
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$219.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.28
|
| Rate for Payer: Health EOS Commercial |
$211.96
|
| Rate for Payer: HFN Commercial |
$219.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.62
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: NAPHCARE Commercial |
$142.90
|
| Rate for Payer: Preferred Network Access Commercial |
$219.11
|
| Rate for Payer: Quartz Beloit One Network |
$116.70
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: Quartz Medicare Advantage |
$142.90
|
| Rate for Payer: The Alliance Commercial |
$119.08
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: WPS Commercial |
$176.40
|
|
|
ELECTRIC DEODORIZER
|
Facility
|
IP
|
$229.00
|
|
| Hospital Charge Code |
3075878
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$219.11 |
| Rate for Payer: Aetna Commercial |
$214.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.22
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$219.11
|
| Rate for Payer: Health EOS Commercial |
$211.96
|
| Rate for Payer: HFN Commercial |
$219.11
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: Preferred Network Access Commercial |
$219.11
|
| Rate for Payer: Quartz Beloit One Network |
$116.70
|
| Rate for Payer: Quartz Commercial |
$142.90
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: WPS Commercial |
$176.40
|
|
|
Electric deodorizer - Devices and Equipment
|
Facility
|
IP
|
$238.00
|
|
| Hospital Charge Code |
3002383
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$121.28 |
| Max. Negotiated Rate |
$227.72 |
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$212.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.19
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$227.72
|
| Rate for Payer: Health EOS Commercial |
$220.29
|
| Rate for Payer: HFN Commercial |
$227.72
|
| Rate for Payer: Multiplan Commercial |
$198.02
|
| Rate for Payer: Preferred Network Access Commercial |
$227.72
|
| Rate for Payer: Quartz Beloit One Network |
$121.28
|
| Rate for Payer: Quartz Commercial |
$148.51
|
| Rate for Payer: WEA Trust Commercial |
$136.14
|
| Rate for Payer: WPS Commercial |
$183.33
|
|
|
Electric deodorizer - Devices and Equipment
|
Facility
|
OP
|
$238.00
|
|
| Hospital Charge Code |
3002383
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$227.72 |
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$212.87
|
| Rate for Payer: Aetna Managed Medicare |
$69.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$123.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$118.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.19
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$227.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.52
|
| Rate for Payer: Health EOS Commercial |
$220.29
|
| Rate for Payer: HFN Commercial |
$227.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.64
|
| Rate for Payer: Multiplan Commercial |
$198.02
|
| Rate for Payer: NAPHCARE Commercial |
$148.51
|
| Rate for Payer: Preferred Network Access Commercial |
$227.72
|
| Rate for Payer: Quartz Beloit One Network |
$121.28
|
| Rate for Payer: Quartz Commercial |
$160.89
|
| Rate for Payer: Quartz Medicare Advantage |
$148.51
|
| Rate for Payer: The Alliance Commercial |
$123.76
|
| Rate for Payer: WEA Trust Commercial |
$136.14
|
| Rate for Payer: WPS Commercial |
$183.33
|
|
|
Electroacoustic Evaluation For Hearing Aid; Monaural
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
1230814
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$73.22 |
| Max. Negotiated Rate |
$158.08 |
| Rate for Payer: Aetna Commercial |
$158.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$158.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.84
|
| Rate for Payer: Health EOS Commercial |
$151.42
|
| Rate for Payer: HFN Commercial |
$158.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.35
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Preferred Network Access Commercial |
$158.08
|
| Rate for Payer: Quartz Beloit One Network |
$73.22
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: The Alliance Commercial |
$83.20
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
Electroacoustic Evaluation For Hearing Aid; Monaural
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
1230814
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
Electroacoustic Evaluation For Hearing Aid; Monaural
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 92594
|
| Hospital Charge Code |
1230814
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$46.59 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$46.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.12
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.80
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$108.16
|
| Rate for Payer: Quartz Medicare Advantage |
$99.84
|
| Rate for Payer: The Alliance Commercial |
$83.20
|
| Rate for Payer: United Healthcare PPO |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
Electrocardiogram, Interpretation & Report Only 93010
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
1188837
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| 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 |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$189.28
|
| Rate for Payer: HFN Commercial |
$197.60
|
| 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 |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$197.60
|
| Rate for Payer: Quartz Beloit One Network |
$91.52
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$31.70
|
| Rate for Payer: United Healthcare Medicaid |
$9.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$33.36
|
|
|
ELECTROCONVULSIVE THERAPY
|
Facility
|
OP
|
$275.16
|
|
|
Service Code
|
EAPG 00212
|
| Min. Negotiated Rate |
$264.58 |
| Max. Negotiated Rate |
$275.16 |
| Rate for Payer: Anthem Medicaid |
$264.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$264.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$264.58
|
| Rate for Payer: Dean Health Medicaid |
$264.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$264.58
|
| Rate for Payer: Managed Health Services Medicaid |
$275.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$264.58
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$264.58
|
| Rate for Payer: United Healthcare Medicaid |
$264.58
|
|
|
ELECTRODE 10/10MM LOOP DLP-S11
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2967374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE 10/10MM LOOP DLP-S11
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2967374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE 15/12MM LOOP DLP-M11
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2967375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE 15/12MM LOOP DLP-M11
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2967375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE 20/12MM LOOP DLP-W11
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2967376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.91 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$221.52
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
|
ELECTRODE 20/12MM LOOP DLP-W11
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2967376
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.38 |
| Max. Negotiated Rate |
$339.66 |
| Rate for Payer: Aetna Commercial |
$332.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$317.51
|
| Rate for Payer: Aetna Managed Medicare |
$103.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.68
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$339.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.61
|
| Rate for Payer: Health EOS Commercial |
$328.59
|
| Rate for Payer: HFN Commercial |
$339.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.90
|
| Rate for Payer: Multiplan Commercial |
$295.36
|
| Rate for Payer: NAPHCARE Commercial |
$221.52
|
| Rate for Payer: Preferred Network Access Commercial |
$339.66
|
| Rate for Payer: Quartz Beloit One Network |
$180.91
|
| Rate for Payer: Quartz Commercial |
$239.98
|
| Rate for Payer: Quartz Medicare Advantage |
$221.52
|
| Rate for Payer: The Alliance Commercial |
$184.60
|
| Rate for Payer: WEA Trust Commercial |
$203.06
|
| Rate for Payer: WPS Commercial |
$273.46
|
|
