|
2B-1324 1000Cc Sod Chl
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
3101783
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Managed Medicare |
$14.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.98
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$32.50
|
| Rate for Payer: Quartz Medicare Advantage |
$30.00
|
| Rate for Payer: The Alliance Commercial |
$200.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
2B-1324 1000Cc Sod Chl
|
Facility
IP
|
$50.00
|
|
| Hospital Charge Code |
3101783
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
2B2074 5%Dex L. Ringer 1000Cc
|
Facility
IP
|
$70.00
|
|
| Hospital Charge Code |
3101782
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
2B2074 5%Dex L. Ringer 1000Cc
|
Facility
OP
|
$70.00
|
|
| Hospital Charge Code |
3101782
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$19.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.17
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$42.00
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
2C0147 Buretrol Sol Tubing
|
Facility
OP
|
$179.00
|
|
| Hospital Charge Code |
3101777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.12 |
| Max. Negotiated Rate |
$716.00 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Aetna Managed Medicare |
$50.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.17
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.25
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$116.35
|
| Rate for Payer: Quartz Medicare Advantage |
$107.40
|
| Rate for Payer: The Alliance Commercial |
$716.00
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
2C0147 Buretrol Sol Tubing
|
Facility
IP
|
$179.00
|
|
| Hospital Charge Code |
3101777
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$107.40
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
2 Caps changed - Central IV Care:
|
Facility
IP
|
$223.00
|
|
| Hospital Charge Code |
3025903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
2 Caps changed - Central IV Care:
|
Facility
OP
|
$223.00
|
|
| Hospital Charge Code |
3025903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$62.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$133.80
|
| Rate for Payer: The Alliance Commercial |
$892.00
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
2F7114 1000Cc WTR PB
|
Facility
IP
|
$2.00
|
|
| Hospital Charge Code |
3040288
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
2F7114 1000Cc WTR PB
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
3040288
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1.20
|
| Rate for Payer: The Alliance Commercial |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
2 hours - Respiratory Therapy Treatment Duration
|
Facility
IP
|
$1,031.00
|
|
| Hospital Charge Code |
3023874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$505.19 |
| Max. Negotiated Rate |
$948.52 |
| Rate for Payer: Aetna Commercial |
$927.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.43
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$948.52
|
| Rate for Payer: Health EOS Commercial |
$917.59
|
| Rate for Payer: HFN Commercial |
$948.52
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: NAPHCARE Commercial |
$618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$948.52
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$618.60
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
2 hours - Respiratory Therapy Treatment Duration
|
Facility
OP
|
$1,031.00
|
|
| Hospital Charge Code |
3023874
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$288.68 |
| Max. Negotiated Rate |
$4,124.00 |
| Rate for Payer: Aetna Commercial |
$927.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.66
|
| Rate for Payer: Aetna Managed Medicare |
$288.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$670.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.43
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$948.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$917.59
|
| Rate for Payer: HFN Commercial |
$948.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$773.25
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: NAPHCARE Commercial |
$618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$948.52
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$670.15
|
| Rate for Payer: Quartz Medicare Advantage |
$618.60
|
| Rate for Payer: The Alliance Commercial |
$4,124.00
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
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 |
$37.27 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$625.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$481.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$461.76
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$625.30
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$721.50
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$712.55
|
|
|
30 Day Event Monitor Connection, Recording, and Disconnection
|
Professional
|
$962.00
|
|
|
Service Code
|
CPT 93270
|
| Hospital Charge Code |
5382946
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$7.83 |
| Max. Negotiated Rate |
$913.90 |
| Rate for Payer: Aetna Commercial |
$913.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$827.32
|
| Rate for Payer: Aetna Managed Medicare |
$7.83
|
| Rate for Payer: Anthem Medicare Advantage |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.83
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$913.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$481.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.83
|
| Rate for Payer: Health EOS Commercial |
$875.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.83
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: Preferred Network Access Commercial |
$913.90
|
| Rate for Payer: Quartz Beloit One Network |
$423.28
|
| Rate for Payer: Quartz Commercial |
$548.34
|
| Rate for Payer: Quartz Medicare Advantage |
$7.83
|
| Rate for Payer: The Alliance Commercial |
$29.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.83
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$31.32
|
|
|
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 |
$471.38 |
| Max. Negotiated Rate |
$885.04 |
| Rate for Payer: Aetna Commercial |
$865.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$509.86
|
| Rate for Payer: Cash Price |
$288.60
|
| Rate for Payer: Cigna Commercial |
$885.04
|
| Rate for Payer: Health EOS Commercial |
$856.18
|
| Rate for Payer: HFN Commercial |
$885.04
|
| Rate for Payer: Multiplan Commercial |
$769.60
|
| Rate for Payer: NAPHCARE Commercial |
$577.20
|
| Rate for Payer: Preferred Network Access Commercial |
$885.04
|
| Rate for Payer: Quartz Beloit One Network |
$471.38
|
| Rate for Payer: Quartz Commercial |
$577.20
|
| Rate for Payer: WEA Trust Commercial |
$529.10
|
| Rate for Payer: WPS Commercial |
$712.55
|
|
|
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 |
$187.88 |
| Max. Negotiated Rate |
$2,684.00 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.06
|
| Rate for Payer: Aetna Managed Medicare |
$187.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.25
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$436.15
|
| Rate for Payer: Quartz Medicare Advantage |
$402.60
|
| Rate for Payer: The Alliance Commercial |
$2,684.00
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
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 |
$328.79 |
| Max. Negotiated Rate |
$617.32 |
| Rate for Payer: Aetna Commercial |
$603.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.63
|
| Rate for Payer: Cash Price |
$201.30
|
| Rate for Payer: Cigna Commercial |
$617.32
|
| Rate for Payer: Health EOS Commercial |
$597.19
|
| Rate for Payer: HFN Commercial |
$617.32
|
| Rate for Payer: Multiplan Commercial |
$536.80
|
| Rate for Payer: NAPHCARE Commercial |
$402.60
|
| Rate for Payer: Preferred Network Access Commercial |
$617.32
|
| Rate for Payer: Quartz Beloit One Network |
$328.79
|
| Rate for Payer: Quartz Commercial |
$402.60
|
| Rate for Payer: WEA Trust Commercial |
$369.05
|
| Rate for Payer: WPS Commercial |
$497.01
|
|
|
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 |
$2,862.09 |
| Max. Negotiated Rate |
$5,373.72 |
| Rate for Payer: Aetna Commercial |
$5,256.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,095.73
|
| Rate for Payer: Cash Price |
$1,752.30
|
| Rate for Payer: Cigna Commercial |
$5,373.72
|
| Rate for Payer: Health EOS Commercial |
$5,198.49
|
| Rate for Payer: HFN Commercial |
$5,373.72
|
| Rate for Payer: Multiplan Commercial |
$4,672.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,504.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,373.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,862.09
|
| Rate for Payer: Quartz Commercial |
$3,504.60
|
| Rate for Payer: WEA Trust Commercial |
$3,212.55
|
| Rate for Payer: WPS Commercial |
$4,326.43
|
|
|
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 |
$95.68 |
| Max. Negotiated Rate |
$5,373.72 |
| Rate for Payer: Aetna Commercial |
$5,256.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,023.26
|
| Rate for Payer: Aetna Managed Medicare |
$95.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,796.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,920.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,803.68
|
| Rate for Payer: Anthem Medicare Advantage |
$95.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,095.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.68
|
| Rate for Payer: Cash Price |
$1,752.30
|
| Rate for Payer: Cash Price |
$1,752.30
|
| Rate for Payer: Cigna Commercial |
$5,373.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$95.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$5,198.49
|
| Rate for Payer: HFN Commercial |
$5,373.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$95.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$4,672.80
|
| Rate for Payer: NAPHCARE Commercial |
$143.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,373.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,862.09
|
| Rate for Payer: Quartz Commercial |
$3,796.65
|
| Rate for Payer: Quartz Medicare Advantage |
$95.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.68
|
| Rate for Payer: WEA Trust Commercial |
$3,212.55
|
| Rate for Payer: Wellcare Medicare |
$95.68
|
| Rate for Payer: WPS Commercial |
$4,326.43
|
|
|
30 Day Inclusive
|
Professional
|
$601.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
2982427
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.61 |
| Max. Negotiated Rate |
$686.44 |
| Rate for Payer: Aetna Commercial |
$570.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Aetna Managed Medicare |
$171.61
|
| Rate for Payer: Anthem Medicare Advantage |
$171.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.61
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$570.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.61
|
| Rate for Payer: Health EOS Commercial |
$546.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$671.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.61
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: Preferred Network Access Commercial |
$570.95
|
| Rate for Payer: Quartz Beloit One Network |
$264.44
|
| Rate for Payer: Quartz Commercial |
$342.57
|
| Rate for Payer: Quartz Medicare Advantage |
$171.61
|
| Rate for Payer: The Alliance Commercial |
$652.12
|
| Rate for Payer: United Healthcare Medicaid |
$240.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.61
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: WPS Commercial |
$686.44
|
|
|
30 Day Inclusive
|
Facility
OP
|
$7,349.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
2982427
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,057.72 |
| Max. Negotiated Rate |
$29,396.00 |
| Rate for Payer: Aetna Commercial |
$6,614.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,320.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,057.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,776.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,674.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,527.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,894.97
|
| Rate for Payer: Cash Price |
$2,204.70
|
| Rate for Payer: Cash Price |
$2,204.70
|
| Rate for Payer: Cigna Commercial |
$6,761.08
|
| Rate for Payer: Health EOS Commercial |
$6,540.61
|
| Rate for Payer: HFN Commercial |
$6,761.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,511.75
|
| Rate for Payer: Multiplan Commercial |
$5,879.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,409.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,761.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,601.01
|
| Rate for Payer: Quartz Commercial |
$4,776.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,409.40
|
| Rate for Payer: The Alliance Commercial |
$29,396.00
|
| Rate for Payer: WEA Trust Commercial |
$4,041.95
|
| Rate for Payer: WPS Commercial |
$5,443.40
|
|
|
30 Day Inclusive
|
Facility
IP
|
$7,349.00
|
|
|
Service Code
|
CPT 93268
|
| Hospital Charge Code |
2982427
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3,601.01 |
| Max. Negotiated Rate |
$6,761.08 |
| Rate for Payer: Aetna Commercial |
$6,614.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,894.97
|
| Rate for Payer: Cash Price |
$2,204.70
|
| Rate for Payer: Cigna Commercial |
$6,761.08
|
| Rate for Payer: Health EOS Commercial |
$6,540.61
|
| Rate for Payer: HFN Commercial |
$6,761.08
|
| Rate for Payer: Multiplan Commercial |
$5,879.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,409.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,761.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,601.01
|
| Rate for Payer: Quartz Commercial |
$4,409.40
|
| Rate for Payer: WEA Trust Commercial |
$4,041.95
|
| Rate for Payer: WPS Commercial |
$5,443.40
|
|
|
30 min - Respiratory Therapy Treatment Duration
|
Facility
OP
|
$258.00
|
|
| Hospital Charge Code |
3023871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.24 |
| Max. Negotiated Rate |
$1,032.00 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$72.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.38
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.50
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$167.70
|
| Rate for Payer: Quartz Medicare Advantage |
$154.80
|
| Rate for Payer: The Alliance Commercial |
$1,032.00
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
30 min - Respiratory Therapy Treatment Duration
|
Facility
IP
|
$258.00
|
|
| Hospital Charge Code |
3023871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$126.42 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
3 Caps changed - Central IV Care:
|
Facility
IP
|
$334.00
|
|
| Hospital Charge Code |
3025902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$163.66 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$200.40
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
