|
EKG Interpretation
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
5376745
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.05
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$170.20
|
| Rate for Payer: Health EOS Commercial |
$164.65
|
| Rate for Payer: HFN Commercial |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: NAPHCARE Commercial |
$111.00
|
| Rate for Payer: Preferred Network Access Commercial |
$170.20
|
| Rate for Payer: Quartz Beloit One Network |
$90.65
|
| Rate for Payer: Quartz Commercial |
$111.00
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: WPS Commercial |
$137.03
|
|
|
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 |
$28.28 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$128.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$128.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.00
|
| Rate for Payer: Health EOS Commercial |
$122.85
|
| Rate for Payer: HFN Commercial |
$128.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.28
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.25
|
| Rate for Payer: Quartz Beloit One Network |
$59.40
|
| Rate for Payer: Quartz Commercial |
$76.95
|
| Rate for Payer: The Alliance Commercial |
$67.50
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
ELA2 Sequence Analysis
|
Professional
|
Both
|
$2,062.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3177491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$907.28 |
| Max. Negotiated Rate |
$1,958.90 |
| Rate for Payer: Aetna Commercial |
$1,958.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.32
|
| Rate for Payer: Cash Price |
$618.60
|
| Rate for Payer: Cigna Commercial |
$1,958.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,031.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,237.20
|
| Rate for Payer: Health EOS Commercial |
$1,876.42
|
| Rate for Payer: HFN Commercial |
$1,958.90
|
| Rate for Payer: Multiplan Commercial |
$1,649.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,958.90
|
| Rate for Payer: Quartz Beloit One Network |
$907.28
|
| Rate for Payer: Quartz Commercial |
$1,175.34
|
| Rate for Payer: The Alliance Commercial |
$1,031.00
|
| Rate for Payer: WEA Trust Commercial |
$1,134.10
|
| Rate for Payer: WPS Commercial |
$1,527.32
|
|
|
ELA2 Sequence Analysis
|
Facility
|
OP
|
$2,118.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3177491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$593.04 |
| Max. Negotiated Rate |
$8,472.00 |
| Rate for Payer: Aetna Commercial |
$1,906.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,821.48
|
| Rate for Payer: Aetna Managed Medicare |
$593.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,376.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,059.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,016.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.54
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$1,948.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,185.23
|
| Rate for Payer: Health EOS Commercial |
$1,885.02
|
| Rate for Payer: HFN Commercial |
$1,948.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,588.50
|
| Rate for Payer: Multiplan Commercial |
$1,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,270.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,948.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.82
|
| Rate for Payer: Quartz Commercial |
$1,376.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,270.80
|
| Rate for Payer: The Alliance Commercial |
$8,472.00
|
| Rate for Payer: United Healthcare PPO |
$1,588.50
|
| Rate for Payer: WEA Trust Commercial |
$1,164.90
|
| Rate for Payer: WPS Commercial |
$1,568.80
|
|
|
ELA2 Sequence Analysis
|
Facility
|
IP
|
$2,118.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
3177491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,037.82 |
| Max. Negotiated Rate |
$1,948.56 |
| Rate for Payer: Aetna Commercial |
$1,906.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,821.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,122.54
|
| Rate for Payer: Cash Price |
$635.40
|
| Rate for Payer: Cigna Commercial |
$1,948.56
|
| Rate for Payer: Health EOS Commercial |
$1,885.02
|
| Rate for Payer: HFN Commercial |
$1,948.56
|
| Rate for Payer: Multiplan Commercial |
$1,694.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,270.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,948.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,037.82
|
| Rate for Payer: Quartz Commercial |
$1,270.80
|
| Rate for Payer: WEA Trust Commercial |
$1,164.90
|
| Rate for Payer: WPS Commercial |
$1,568.80
|
|
|
ELASTIC NAIL 2.0 X 440 475.920S
|
Facility
|
OP
|
$3,823.00
|
|
| Hospital Charge Code |
2966286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,070.44 |
| Max. Negotiated Rate |
$15,292.00 |
| Rate for Payer: Aetna Commercial |
$3,440.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,287.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,070.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,484.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,911.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,026.19
|
| Rate for Payer: Cash Price |
$1,146.90
|
| Rate for Payer: Cigna Commercial |
$3,517.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,139.35
|
| Rate for Payer: Health EOS Commercial |
$3,402.47
|
| Rate for Payer: HFN Commercial |
$3,517.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,867.25
|
| Rate for Payer: Multiplan Commercial |
$3,058.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,293.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,517.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,873.27
|
| Rate for Payer: Quartz Commercial |
$2,484.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,293.80
|
| Rate for Payer: The Alliance Commercial |
$15,292.00
|
| Rate for Payer: WEA Trust Commercial |
$2,102.65
|
| Rate for Payer: WPS Commercial |
$2,831.70
|
|
|
ELASTIC NAIL 2.0 X 440 475.920S
|
Facility
|
IP
|
$3,823.00
|
|
| Hospital Charge Code |
2966286
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,873.27 |
| Max. Negotiated Rate |
$3,517.16 |
| Rate for Payer: Aetna Commercial |
$3,440.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,287.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,026.19
|
| Rate for Payer: Cash Price |
$1,146.90
|
| Rate for Payer: Cigna Commercial |
$3,517.16
|
| Rate for Payer: Health EOS Commercial |
$3,402.47
|
| Rate for Payer: HFN Commercial |
$3,517.16
|
| Rate for Payer: Multiplan Commercial |
$3,058.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,293.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,517.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,873.27
|
| Rate for Payer: Quartz Commercial |
$2,293.80
|
| Rate for Payer: WEA Trust Commercial |
$2,102.65
|
| Rate for Payer: WPS Commercial |
$2,831.70
|
|
|
Elastic wrap bandage charge
|
Facility
|
OP
|
$82.00
|
|
| Hospital Charge Code |
2844905
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$49.20
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Elastic wrap bandage charge
|
Facility
|
IP
|
$82.00
|
|
| Hospital Charge Code |
2844905
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
ELASTOMER PUTTY 50/50 MIX
|
Facility
|
OP
|
$583.00
|
|
| Hospital Charge Code |
2971437
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$2,332.00 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Aetna Managed Medicare |
$163.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.25
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.25
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$378.95
|
| Rate for Payer: Quartz Medicare Advantage |
$349.80
|
| Rate for Payer: The Alliance Commercial |
$2,332.00
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
ELASTOMER PUTTY 50/50 MIX
|
Facility
|
IP
|
$583.00
|
|
| Hospital Charge Code |
2971437
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$536.36 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$349.80
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
ELBOW ARTHRODESIS
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2959817
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.80 |
| Max. Negotiated Rate |
$18,240.00 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,188.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,551.78
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,420.00
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,736.00
|
| Rate for Payer: The Alliance Commercial |
$18,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
ELBOW ARTHRODESIS
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2959817
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.40 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
Elbow Arthrography
|
Professional
|
Both
|
$1,697.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
3072659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$399.03 |
| Max. Negotiated Rate |
$1,612.15 |
| Rate for Payer: Aetna Commercial |
$1,612.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.42
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cigna Commercial |
$1,612.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$848.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,018.20
|
| Rate for Payer: Health EOS Commercial |
$1,544.27
|
| Rate for Payer: HFN Commercial |
$1,612.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.03
|
| Rate for Payer: Multiplan Commercial |
$1,357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.15
|
| Rate for Payer: Quartz Beloit One Network |
$746.68
|
| Rate for Payer: Quartz Commercial |
$967.29
|
| Rate for Payer: The Alliance Commercial |
$848.50
|
| Rate for Payer: WEA Trust Commercial |
$933.35
|
| Rate for Payer: WPS Commercial |
$1,256.97
|
|
|
Elbow Arthrography
|
Facility
|
OP
|
$1,697.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
3072659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,561.24 |
| Rate for Payer: Aetna Commercial |
$1,527.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.42
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,425.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.34
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| 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 |
$1,561.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$1,510.33
|
| Rate for Payer: HFN Commercial |
$1,561.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$1,357.60
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.24
|
| Rate for Payer: Quartz Beloit One Network |
$831.53
|
| Rate for Payer: Quartz Commercial |
$1,103.05
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$933.35
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$1,256.97
|
|
|
Elbow Arthrography
|
Facility
|
IP
|
$1,697.00
|
|
|
Service Code
|
CPT 73085
|
| Hospital Charge Code |
3072659
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$831.53 |
| Max. Negotiated Rate |
$1,561.24 |
| Rate for Payer: Aetna Commercial |
$1,527.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,459.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$899.41
|
| Rate for Payer: Cash Price |
$509.10
|
| Rate for Payer: Cigna Commercial |
$1,561.24
|
| Rate for Payer: Health EOS Commercial |
$1,510.33
|
| Rate for Payer: HFN Commercial |
$1,561.24
|
| Rate for Payer: Multiplan Commercial |
$1,357.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,018.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,561.24
|
| Rate for Payer: Quartz Beloit One Network |
$831.53
|
| Rate for Payer: Quartz Commercial |
$1,018.20
|
| Rate for Payer: WEA Trust Commercial |
$933.35
|
| Rate for Payer: WPS Commercial |
$1,256.97
|
|
|
ELBOW ARTHROPLASTY
|
Facility
|
OP
|
$8,012.00
|
|
| Hospital Charge Code |
2960441
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,243.36 |
| Max. Negotiated Rate |
$32,048.00 |
| Rate for Payer: Aetna Commercial |
$7,210.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,890.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,243.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,207.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,006.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,845.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,246.36
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,371.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,483.52
|
| Rate for Payer: Health EOS Commercial |
$7,130.68
|
| Rate for Payer: HFN Commercial |
$7,371.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,009.00
|
| Rate for Payer: Multiplan Commercial |
$6,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,807.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,371.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,925.88
|
| Rate for Payer: Quartz Commercial |
$5,207.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,807.20
|
| Rate for Payer: The Alliance Commercial |
$32,048.00
|
| Rate for Payer: WEA Trust Commercial |
$4,406.60
|
| Rate for Payer: WPS Commercial |
$5,934.49
|
|
|
ELBOW ARTHROPLASTY
|
Facility
|
IP
|
$8,012.00
|
|
| Hospital Charge Code |
2960441
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,925.88 |
| Max. Negotiated Rate |
$7,371.04 |
| Rate for Payer: Aetna Commercial |
$7,210.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,890.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,246.36
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,371.04
|
| Rate for Payer: Health EOS Commercial |
$7,130.68
|
| Rate for Payer: HFN Commercial |
$7,371.04
|
| Rate for Payer: Multiplan Commercial |
$6,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,807.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,371.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,925.88
|
| Rate for Payer: Quartz Commercial |
$4,807.20
|
| Rate for Payer: WEA Trust Commercial |
$4,406.60
|
| Rate for Payer: WPS Commercial |
$5,934.49
|
|
|
ELBOW ARTHROSCOPY
|
Facility
|
OP
|
$7,950.00
|
|
| Hospital Charge Code |
2959827
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,226.00 |
| Max. Negotiated Rate |
$31,800.00 |
| Rate for Payer: Aetna Commercial |
$7,155.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,837.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,226.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,167.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,816.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,213.50
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,314.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,448.82
|
| Rate for Payer: Health EOS Commercial |
$7,075.50
|
| Rate for Payer: HFN Commercial |
$7,314.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,962.50
|
| Rate for Payer: Multiplan Commercial |
$6,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,770.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,314.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,895.50
|
| Rate for Payer: Quartz Commercial |
$5,167.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,770.00
|
| Rate for Payer: The Alliance Commercial |
$31,800.00
|
| Rate for Payer: WEA Trust Commercial |
$4,372.50
|
| Rate for Payer: WPS Commercial |
$5,888.56
|
|
|
ELBOW ARTHROSCOPY
|
Facility
|
IP
|
$7,950.00
|
|
| Hospital Charge Code |
2959827
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,895.50 |
| Max. Negotiated Rate |
$7,314.00 |
| Rate for Payer: Aetna Commercial |
$7,155.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,837.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,213.50
|
| Rate for Payer: Cash Price |
$2,385.00
|
| Rate for Payer: Cigna Commercial |
$7,314.00
|
| Rate for Payer: Health EOS Commercial |
$7,075.50
|
| Rate for Payer: HFN Commercial |
$7,314.00
|
| Rate for Payer: Multiplan Commercial |
$6,360.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,770.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,314.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,895.50
|
| Rate for Payer: Quartz Commercial |
$4,770.00
|
| Rate for Payer: WEA Trust Commercial |
$4,372.50
|
| Rate for Payer: WPS Commercial |
$5,888.56
|
|
|
ELBOW BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959857
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
ELBOW BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959857
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
ELBOW OSTEOTOMY
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.40 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
ELBOW OSTEOTOMY
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960286
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.80 |
| Max. Negotiated Rate |
$18,240.00 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,188.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,551.78
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,420.00
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,736.00
|
| Rate for Payer: The Alliance Commercial |
$18,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
ELBOW SLEEVE NEOPREN MED #781007
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2970726
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
