|
ELBOW SLEEVE NEOPREN MED #781007
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2970726
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$65.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$151.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.84
|
| 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: Dean Health DHI/DHP/ASO |
$130.39
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.75
|
| 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 |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$139.80
|
| Rate for Payer: The Alliance Commercial |
$932.00
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
ELBOW SLEEVE NEOPREN SMALL #781006
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2970725
|
|
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
|
|
|
ELBOW SLEEVE NEOPREN SMALL #781006
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2970725
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$65.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$151.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.84
|
| 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: Dean Health DHI/DHP/ASO |
$130.39
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.75
|
| 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 |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$139.80
|
| Rate for Payer: The Alliance Commercial |
$932.00
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
ELBOW SUPPORT NEOPRENE X-LARGE #A919-04
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2970230
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
ELBOW SUPPORT NEOPRENE X-LARGE #A919-04
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2970230
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
ELBOW, TENDON & NERVE REPAIR
|
Facility
|
IP
|
$4,492.00
|
|
| Hospital Charge Code |
2960417
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,201.08 |
| Max. Negotiated Rate |
$4,132.64 |
| Rate for Payer: Aetna Commercial |
$4,042.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,380.76
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,132.64
|
| Rate for Payer: Health EOS Commercial |
$3,997.88
|
| Rate for Payer: HFN Commercial |
$4,132.64
|
| Rate for Payer: Multiplan Commercial |
$3,593.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,132.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.08
|
| Rate for Payer: Quartz Commercial |
$2,695.20
|
| Rate for Payer: WEA Trust Commercial |
$2,470.60
|
| Rate for Payer: WPS Commercial |
$3,327.22
|
|
|
ELBOW, TENDON & NERVE REPAIR
|
Facility
|
OP
|
$4,492.00
|
|
| Hospital Charge Code |
2960417
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,257.76 |
| Max. Negotiated Rate |
$17,968.00 |
| Rate for Payer: Aetna Commercial |
$4,042.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,863.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,257.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,919.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,246.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,156.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,380.76
|
| Rate for Payer: Cash Price |
$1,347.60
|
| Rate for Payer: Cigna Commercial |
$4,132.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,513.72
|
| Rate for Payer: Health EOS Commercial |
$3,997.88
|
| Rate for Payer: HFN Commercial |
$4,132.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,369.00
|
| Rate for Payer: Multiplan Commercial |
$3,593.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,695.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,132.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,201.08
|
| Rate for Payer: Quartz Commercial |
$2,919.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,695.20
|
| Rate for Payer: The Alliance Commercial |
$17,968.00
|
| Rate for Payer: WEA Trust Commercial |
$2,470.60
|
| Rate for Payer: WPS Commercial |
$3,327.22
|
|
|
ELBOW TENNIS STRAP BLK
|
Facility
|
OP
|
$256.00
|
|
| Hospital Charge Code |
2970317
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$1,024.00 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Aetna Managed Medicare |
$71.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.26
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$166.40
|
| Rate for Payer: Quartz Medicare Advantage |
$153.60
|
| Rate for Payer: The Alliance Commercial |
$1,024.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
ELBOW TENNIS STRAP BLK
|
Facility
|
IP
|
$256.00
|
|
| Hospital Charge Code |
2970317
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$153.60
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Elbow Trough
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
2989897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$177.87 |
| Max. Negotiated Rate |
$333.96 |
| Rate for Payer: Aetna Commercial |
$326.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.39
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$333.96
|
| Rate for Payer: Health EOS Commercial |
$323.07
|
| Rate for Payer: HFN Commercial |
$333.96
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: NAPHCARE Commercial |
$217.80
|
| Rate for Payer: Preferred Network Access Commercial |
$333.96
|
| Rate for Payer: Quartz Beloit One Network |
$177.87
|
| Rate for Payer: Quartz Commercial |
$217.80
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
Elbow Trough
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
2989897
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$101.64 |
| Max. Negotiated Rate |
$1,452.00 |
| Rate for Payer: Aetna Commercial |
$326.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.18
|
| Rate for Payer: Aetna Managed Medicare |
$101.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.39
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$333.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.13
|
| Rate for Payer: Health EOS Commercial |
$323.07
|
| Rate for Payer: HFN Commercial |
$333.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$272.25
|
| Rate for Payer: Multiplan Commercial |
$290.40
|
| Rate for Payer: NAPHCARE Commercial |
$217.80
|
| Rate for Payer: Preferred Network Access Commercial |
$333.96
|
| Rate for Payer: Quartz Beloit One Network |
$177.87
|
| Rate for Payer: Quartz Commercial |
$235.95
|
| Rate for Payer: Quartz Medicare Advantage |
$217.80
|
| Rate for Payer: The Alliance Commercial |
$1,452.00
|
| Rate for Payer: WEA Trust Commercial |
$199.65
|
| Rate for Payer: WPS Commercial |
$268.87
|
|
|
ELECTRICAL BONE STIMULATION 20974
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
CPT 20974
|
| Hospital Charge Code |
3013718
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$164.22 |
| Rate for Payer: Aetna Commercial |
$133.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.60
|
| Rate for Payer: Health EOS Commercial |
$128.31
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$164.22
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$62.04
|
| Rate for Payer: Quartz Commercial |
$80.37
|
| Rate for Payer: The Alliance Commercial |
$70.50
|
| Rate for Payer: United Healthcare Medicaid |
$109.38
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
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 |
$24.38 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Aetna Commercial |
$780.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.92
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$780.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$493.20
|
| Rate for Payer: Health EOS Commercial |
$748.02
|
| Rate for Payer: HFN Commercial |
$780.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$272.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$272.20
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: Preferred Network Access Commercial |
$780.90
|
| Rate for Payer: Quartz Beloit One Network |
$361.68
|
| Rate for Payer: Quartz Commercial |
$468.54
|
| Rate for Payer: The Alliance Commercial |
$411.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.38
|
| Rate for Payer: WEA Trust Commercial |
$452.10
|
| Rate for Payer: WPS Commercial |
$608.86
|
|
|
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 |
$69.15 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Aetna Commercial |
$780.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.92
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$780.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$411.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$493.20
|
| Rate for Payer: Health EOS Commercial |
$748.02
|
| Rate for Payer: HFN Commercial |
$780.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.15
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: Preferred Network Access Commercial |
$780.90
|
| Rate for Payer: Quartz Beloit One Network |
$361.68
|
| Rate for Payer: Quartz Commercial |
$468.54
|
| Rate for Payer: The Alliance Commercial |
$411.00
|
| Rate for Payer: WEA Trust Commercial |
$452.10
|
| Rate for Payer: WPS Commercial |
$608.86
|
|
|
ELECTRIC DEODORIZER
|
Facility
|
OP
|
$229.00
|
|
| Hospital Charge Code |
3075878
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.12 |
| Max. Negotiated Rate |
$916.00 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Aetna Managed Medicare |
$64.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.15
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$171.75
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$148.85
|
| Rate for Payer: Quartz Medicare Advantage |
$137.40
|
| Rate for Payer: The Alliance Commercial |
$916.00
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
ELECTRIC DEODORIZER
|
Facility
|
IP
|
$229.00
|
|
| Hospital Charge Code |
3075878
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$112.21 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$137.40
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
Electric deodorizer - Devices and Equipment
|
Facility
|
OP
|
$238.00
|
|
| Hospital Charge Code |
3002383
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$952.00 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Aetna Managed Medicare |
$66.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$154.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$114.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.18
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$178.50
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$142.80
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$154.70
|
| Rate for Payer: Quartz Medicare Advantage |
$142.80
|
| Rate for Payer: The Alliance Commercial |
$952.00
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
Electric deodorizer - Devices and Equipment
|
Facility
|
IP
|
$238.00
|
|
| Hospital Charge Code |
3002383
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$218.96 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$142.80
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$142.80
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
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 |
$44.80 |
| Max. Negotiated Rate |
$640.00 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Aetna Managed Medicare |
$44.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.54
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.00
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$104.00
|
| Rate for Payer: Quartz Medicare Advantage |
$96.00
|
| Rate for Payer: The Alliance Commercial |
$640.00
|
| Rate for Payer: United Healthcare PPO |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
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 |
$70.40 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna Commercial |
$152.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.00
|
| Rate for Payer: Health EOS Commercial |
$145.60
|
| Rate for Payer: HFN Commercial |
$152.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.53
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$152.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.40
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: The Alliance Commercial |
$80.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
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 |
$78.40 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
Electrocardiogram, Interpretation & Report Only 93010
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
CPT 93010
|
| Hospital Charge Code |
1188837
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$190.00 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$190.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.00
|
| Rate for Payer: Health EOS Commercial |
$182.00
|
| Rate for Payer: HFN Commercial |
$190.00
|
| 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 |
$160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$190.00
|
| Rate for Payer: Quartz Beloit One Network |
$88.00
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
ELECTRODE 10/10MM LOOP DLP-S11
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2967374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$99.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.66
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$266.25
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$213.00
|
| Rate for Payer: The Alliance Commercial |
$1,420.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
ELECTRODE 10/10MM LOOP DLP-S11
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2967374
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
ELECTRODE 15/12MM LOOP DLP-M11
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2967375
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$99.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.66
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$266.25
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$213.00
|
| Rate for Payer: The Alliance Commercial |
$1,420.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
