|
2B-1324 1000Cc Sod Chl
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
3101783
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
2B-1324 1000Cc Sod Chl
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
3101783
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$14.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.20
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
2B2074 5%Dex L. Ringer 1000Cc
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
3101782
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
2B2074 5%Dex L. Ringer 1000Cc
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
3101782
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
2C0147 Buretrol Sol Tubing
|
Facility
|
OP
|
$179.00
|
|
| Hospital Charge Code |
3101777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.12 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$52.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.62
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$111.70
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$111.70
|
| Rate for Payer: The Alliance Commercial |
$93.08
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
2C0147 Buretrol Sol Tubing
|
Facility
|
IP
|
$179.00
|
|
| Hospital Charge Code |
3101777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
2 Caps changed - Central IV Care:
|
Facility
|
OP
|
$223.00
|
|
| Hospital Charge Code |
3025903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$64.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.94
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$139.15
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$139.15
|
| Rate for Payer: The Alliance Commercial |
$115.96
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
2 Caps changed - Central IV Care:
|
Facility
|
IP
|
$223.00
|
|
| Hospital Charge Code |
3025903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
2F7114 1000Cc WTR PB
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
3040288
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
2F7114 1000Cc WTR PB
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
3040288
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
2 hours - Respiratory Therapy Treatment Duration
|
Facility
|
IP
|
$1,031.00
|
|
| Hospital Charge Code |
3023874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$525.40 |
| Max. Negotiated Rate |
$986.46 |
| Rate for Payer: Aetna Commercial |
$965.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.29
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Health EOS Commercial |
$954.29
|
| Rate for Payer: HFN Commercial |
$986.46
|
| Rate for Payer: Multiplan Commercial |
$857.79
|
| Rate for Payer: Preferred Network Access Commercial |
$986.46
|
| Rate for Payer: Quartz Beloit One Network |
$525.40
|
| Rate for Payer: Quartz Commercial |
$643.34
|
| Rate for Payer: WEA Trust Commercial |
$589.73
|
| Rate for Payer: WPS Commercial |
$794.18
|
|
|
2 hours - Respiratory Therapy Treatment Duration
|
Facility
|
OP
|
$1,031.00
|
|
| Hospital Charge Code |
3023874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$300.23 |
| Max. Negotiated Rate |
$986.46 |
| Rate for Payer: Aetna Commercial |
$965.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.13
|
| Rate for Payer: Aetna Managed Medicare |
$300.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$536.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$514.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.29
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.04
|
| Rate for Payer: Health EOS Commercial |
$954.29
|
| Rate for Payer: HFN Commercial |
$986.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$804.18
|
| Rate for Payer: Multiplan Commercial |
$857.79
|
| Rate for Payer: NAPHCARE Commercial |
$643.34
|
| Rate for Payer: Preferred Network Access Commercial |
$986.46
|
| Rate for Payer: Quartz Beloit One Network |
$525.40
|
| Rate for Payer: Quartz Commercial |
$696.96
|
| Rate for Payer: Quartz Medicare Advantage |
$643.34
|
| Rate for Payer: The Alliance Commercial |
$536.12
|
| Rate for Payer: WEA Trust Commercial |
$589.73
|
| Rate for Payer: WPS Commercial |
$794.18
|
|
|
30 Day Event Monitor Connection, Recording, and Disconnection
|
Professional
|
Both
|
$962.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
5382946
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$950.46 |
| Rate for Payer: Aetna Commercial |
$950.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Aetna Managed Medicare |
$8.09
|
| Rate for Payer: Anthem Medicare Advantage |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.09
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$950.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$910.44
|
| Rate for Payer: HFN Commercial |
$950.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$950.46
|
| Rate for Payer: Quartz Beloit One Network |
$440.21
|
| Rate for Payer: Quartz Commercial |
$570.27
|
| Rate for Payer: Quartz Medicare Advantage |
$8.09
|
| Rate for Payer: The Alliance Commercial |
$30.75
|
| Rate for Payer: United Healthcare Medicaid |
$47.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$32.36
|
|
|
30 Day Event Monitor Connection, Recording, and Disconnection
|
Facility
|
OP
|
$962.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
5382946
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$650.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$500.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$480.23
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$559.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$650.31
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$750.36
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
30 Day Event Monitor Connection, Recording, and Disconnection
|
Facility
|
IP
|
$962.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
5382946
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$490.24 |
| Max. Negotiated Rate |
$920.44 |
| Rate for Payer: Aetna Commercial |
$900.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.25
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$920.44
|
| Rate for Payer: Health EOS Commercial |
$890.43
|
| Rate for Payer: HFN Commercial |
$920.44
|
| Rate for Payer: Multiplan Commercial |
$800.38
|
| Rate for Payer: Preferred Network Access Commercial |
$920.44
|
| Rate for Payer: Quartz Beloit One Network |
$490.24
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: WEA Trust Commercial |
$550.26
|
| Rate for Payer: WPS Commercial |
$741.03
|
|
|
30 Day Event Monitor Physician Review And Interpretation
|
Facility
|
OP
|
$671.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
2982419
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$95.68 |
| Max. Negotiated Rate |
$642.01 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Aetna Managed Medicare |
$195.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$453.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.52
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.38
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: NAPHCARE Commercial |
$418.70
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$453.60
|
| Rate for Payer: Quartz Medicare Advantage |
$418.70
|
| Rate for Payer: The Alliance Commercial |
$95.68
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
30 Day Event Monitor Physician Review And Interpretation
|
Facility
|
IP
|
$671.00
|
|
|
Service Code
|
CPT 93272
|
| Hospital Charge Code |
2982419
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$341.94 |
| Max. Negotiated Rate |
$642.01 |
| Rate for Payer: Aetna Commercial |
$628.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.86
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$642.01
|
| Rate for Payer: Health EOS Commercial |
$621.08
|
| Rate for Payer: HFN Commercial |
$642.01
|
| Rate for Payer: Multiplan Commercial |
$558.27
|
| Rate for Payer: Preferred Network Access Commercial |
$642.01
|
| Rate for Payer: Quartz Beloit One Network |
$341.94
|
| Rate for Payer: Quartz Commercial |
$418.70
|
| Rate for Payer: WEA Trust Commercial |
$383.81
|
| Rate for Payer: WPS Commercial |
$516.87
|
|
|
30 Day Event Monitor Transmission Download And Analysis
|
Facility
|
OP
|
$5,841.00
|
|
|
Service Code
|
CPT 93271
|
| Hospital Charge Code |
2982418
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.05 |
| Max. Negotiated Rate |
$5,588.67 |
| Rate for Payer: Aetna Commercial |
$5,467.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,224.19
|
| Rate for Payer: Aetna Managed Medicare |
$100.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,948.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,037.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,915.83
|
| Rate for Payer: Anthem Medicare Advantage |
$100.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,219.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.05
|
| Rate for Payer: Cash Price |
$1,752.30
|
| Rate for Payer: Cash Price |
$1,752.30
|
| Rate for Payer: Cigna Commercial |
$5,588.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$100.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,399.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$100.05
|
| Rate for Payer: Health EOS Commercial |
$5,406.43
|
| Rate for Payer: HFN Commercial |
$5,588.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$372.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$100.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$100.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$100.05
|
| Rate for Payer: Multiplan Commercial |
$4,859.71
|
| Rate for Payer: NAPHCARE Commercial |
$150.07
|
| Rate for Payer: Preferred Network Access Commercial |
$5,588.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,976.57
|
| Rate for Payer: Quartz Commercial |
$3,948.52
|
| Rate for Payer: Quartz Medicare Advantage |
$100.05
|
| Rate for Payer: The Alliance Commercial |
$400.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.05
|
| Rate for Payer: WEA Trust Commercial |
$3,341.05
|
| Rate for Payer: Wellcare Medicare |
$100.05
|
| Rate for Payer: WPS Commercial |
$4,499.32
|
|
|
30 Day Event Monitor Transmission Download And Analysis
|
Facility
|
IP
|
$5,841.00
|
|
|
Service Code
|
CPT 93271
|
| Hospital Charge Code |
2982418
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,976.57 |
| Max. Negotiated Rate |
$5,588.67 |
| Rate for Payer: Aetna Commercial |
$5,467.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,224.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,219.56
|
| Rate for Payer: Cash Price |
$1,752.30
|
| Rate for Payer: Cigna Commercial |
$5,588.67
|
| Rate for Payer: Health EOS Commercial |
$5,406.43
|
| Rate for Payer: HFN Commercial |
$5,588.67
|
| Rate for Payer: Multiplan Commercial |
$4,859.71
|
| Rate for Payer: Preferred Network Access Commercial |
$5,588.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,976.57
|
| Rate for Payer: Quartz Commercial |
$3,644.78
|
| Rate for Payer: WEA Trust Commercial |
$3,341.05
|
| Rate for Payer: WPS Commercial |
$4,499.32
|
|
|
30 Day Inclusive
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
2982427
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.90 |
| Max. Negotiated Rate |
$698.04 |
| Rate for Payer: Aetna Commercial |
$593.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$537.53
|
| Rate for Payer: Aetna Managed Medicare |
$168.90
|
| Rate for Payer: Anthem Medicare Advantage |
$168.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.90
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$593.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.90
|
| Rate for Payer: Health EOS Commercial |
$568.79
|
| Rate for Payer: HFN Commercial |
$593.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$698.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.90
|
| Rate for Payer: Multiplan Commercial |
$500.03
|
| Rate for Payer: NAPHCARE Commercial |
$253.34
|
| Rate for Payer: Preferred Network Access Commercial |
$593.79
|
| Rate for Payer: Quartz Beloit One Network |
$275.02
|
| Rate for Payer: Quartz Commercial |
$356.27
|
| Rate for Payer: Quartz Medicare Advantage |
$168.90
|
| Rate for Payer: The Alliance Commercial |
$641.80
|
| Rate for Payer: United Healthcare Medicaid |
$250.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.90
|
| Rate for Payer: WEA Trust Commercial |
$343.77
|
| Rate for Payer: WPS Commercial |
$675.58
|
|
|
30 Day Inclusive
|
Facility
|
OP
|
$7,349.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
2982427
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$675.58 |
| Max. Negotiated Rate |
$7,031.52 |
| Rate for Payer: Aetna Commercial |
$6,878.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,572.95
|
| Rate for Payer: Aetna Managed Medicare |
$2,140.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,967.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,821.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,668.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,050.77
|
| Rate for Payer: Cash Price |
$2,204.70
|
| Rate for Payer: Cash Price |
$2,204.70
|
| Rate for Payer: Cigna Commercial |
$7,031.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,277.12
|
| Rate for Payer: Health EOS Commercial |
$6,802.23
|
| Rate for Payer: HFN Commercial |
$7,031.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,732.22
|
| Rate for Payer: Multiplan Commercial |
$6,114.37
|
| Rate for Payer: NAPHCARE Commercial |
$4,585.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,031.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,745.05
|
| Rate for Payer: Quartz Commercial |
$4,967.92
|
| Rate for Payer: Quartz Medicare Advantage |
$4,585.78
|
| Rate for Payer: The Alliance Commercial |
$675.58
|
| Rate for Payer: WEA Trust Commercial |
$4,203.63
|
| Rate for Payer: WPS Commercial |
$5,660.93
|
|
|
30 Day Inclusive
|
Facility
|
IP
|
$7,349.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
2982427
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,745.05 |
| Max. Negotiated Rate |
$7,031.52 |
| Rate for Payer: Aetna Commercial |
$6,878.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,572.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,050.77
|
| Rate for Payer: Cash Price |
$2,204.70
|
| Rate for Payer: Cigna Commercial |
$7,031.52
|
| Rate for Payer: Health EOS Commercial |
$6,802.23
|
| Rate for Payer: HFN Commercial |
$7,031.52
|
| Rate for Payer: Multiplan Commercial |
$6,114.37
|
| Rate for Payer: Preferred Network Access Commercial |
$7,031.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,745.05
|
| Rate for Payer: Quartz Commercial |
$4,585.78
|
| Rate for Payer: WEA Trust Commercial |
$4,203.63
|
| Rate for Payer: WPS Commercial |
$5,660.93
|
|
|
30 min - Respiratory Therapy Treatment Duration
|
Facility
|
IP
|
$258.00
|
|
| Hospital Charge Code |
3023871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
30 min - Respiratory Therapy Treatment Duration
|
Facility
|
OP
|
$258.00
|
|
| Hospital Charge Code |
3023871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.13 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$75.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.24
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$160.99
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$160.99
|
| Rate for Payer: The Alliance Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
3 Caps changed - Central IV Care:
|
Facility
|
IP
|
$334.00
|
|
| Hospital Charge Code |
3025902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$208.42
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
