|
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
|
|
|
3 Dimensional Simulation
|
Facility
|
OP
|
$10,251.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
3040377
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,456.64 |
| Max. Negotiated Rate |
$9,808.16 |
| Rate for Payer: Aetna Commercial |
$9,594.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,168.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,341.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,273.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,059.38
|
| Rate for Payer: Anthem Medicare Advantage |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,650.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,456.64
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Cigna Commercial |
$9,808.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,456.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,966.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,456.64
|
| Rate for Payer: Health EOS Commercial |
$9,488.33
|
| Rate for Payer: HFN Commercial |
$9,808.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,418.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,456.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,456.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,456.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,456.64
|
| Rate for Payer: Multiplan Commercial |
$8,528.83
|
| Rate for Payer: NAPHCARE Commercial |
$2,184.97
|
| Rate for Payer: Preferred Network Access Commercial |
$9,808.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,223.91
|
| Rate for Payer: Quartz Commercial |
$6,929.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,456.64
|
| Rate for Payer: The Alliance Commercial |
$5,826.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,456.64
|
| Rate for Payer: United Healthcare PPO |
$7,995.78
|
| Rate for Payer: WEA Trust Commercial |
$5,863.57
|
| Rate for Payer: Wellcare Medicare |
$1,456.64
|
| Rate for Payer: WPS Commercial |
$7,896.35
|
|
|
3 Dimensional Simulation
|
Facility
|
IP
|
$10,251.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
3040377
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,223.91 |
| Max. Negotiated Rate |
$9,808.16 |
| Rate for Payer: Aetna Commercial |
$9,594.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,168.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,650.35
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Cigna Commercial |
$9,808.16
|
| Rate for Payer: Health EOS Commercial |
$9,488.33
|
| Rate for Payer: HFN Commercial |
$9,808.16
|
| Rate for Payer: Multiplan Commercial |
$8,528.83
|
| Rate for Payer: Preferred Network Access Commercial |
$9,808.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,223.91
|
| Rate for Payer: Quartz Commercial |
$6,396.62
|
| Rate for Payer: WEA Trust Commercial |
$5,863.57
|
| Rate for Payer: WPS Commercial |
$7,896.35
|
|
|
3D Radiotherapy Plan 7729526
|
Professional
|
Both
|
$3,117.00
|
|
|
Service Code
|
CPT 77295 26
|
| Hospital Charge Code |
5258627
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$225.99 |
| Max. Negotiated Rate |
$3,079.60 |
| Rate for Payer: Aetna Commercial |
$3,079.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,787.84
|
| Rate for Payer: Aetna Managed Medicare |
$225.99
|
| Rate for Payer: Anthem Medicare Advantage |
$225.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$225.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$225.99
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cigna Commercial |
$3,079.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,620.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.99
|
| Rate for Payer: Health EOS Commercial |
$2,949.93
|
| Rate for Payer: HFN Commercial |
$3,079.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$802.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$802.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$225.99
|
| Rate for Payer: Multiplan Commercial |
$2,593.34
|
| Rate for Payer: NAPHCARE Commercial |
$338.99
|
| Rate for Payer: Preferred Network Access Commercial |
$3,079.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,426.34
|
| Rate for Payer: Quartz Commercial |
$1,847.76
|
| Rate for Payer: Quartz Medicare Advantage |
$225.99
|
| Rate for Payer: The Alliance Commercial |
$858.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$225.99
|
| Rate for Payer: WEA Trust Commercial |
$1,782.92
|
| Rate for Payer: WPS Commercial |
$1,129.96
|
|
|
3 hours - Respiratory Therapy Treatment Duration
|
Facility
|
OP
|
$1,546.00
|
|
| Hospital Charge Code |
3023872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$450.20 |
| Max. Negotiated Rate |
$1,479.21 |
| Rate for Payer: Aetna Commercial |
$1,447.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Aetna Managed Medicare |
$450.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,045.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$803.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$771.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.16
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,479.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$899.77
|
| Rate for Payer: Health EOS Commercial |
$1,430.98
|
| Rate for Payer: HFN Commercial |
$1,479.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,205.88
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: NAPHCARE Commercial |
$964.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.21
|
| Rate for Payer: Quartz Beloit One Network |
$787.84
|
| Rate for Payer: Quartz Commercial |
$1,045.10
|
| Rate for Payer: Quartz Medicare Advantage |
$964.70
|
| Rate for Payer: The Alliance Commercial |
$803.92
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: WPS Commercial |
$1,190.88
|
|
|
3 hours - Respiratory Therapy Treatment Duration
|
Facility
|
IP
|
$1,546.00
|
|
| Hospital Charge Code |
3023872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$787.84 |
| Max. Negotiated Rate |
$1,479.21 |
| Rate for Payer: Aetna Commercial |
$1,447.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.16
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,479.21
|
| Rate for Payer: Health EOS Commercial |
$1,430.98
|
| Rate for Payer: HFN Commercial |
$1,479.21
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.21
|
| Rate for Payer: Quartz Beloit One Network |
$787.84
|
| Rate for Payer: Quartz Commercial |
$964.70
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: WPS Commercial |
$1,190.88
|
|
|
3- Way* - Urinary catheter type:
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.28 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.28
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
3- Way* - Urinary catheter type:
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
3- Way - Urinary Catheter Type
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
3025947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.28 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.28
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
3- Way - Urinary Catheter Type
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
3025947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
3- Way* - Urinary Catheter Type:
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.28 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.28
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
3- Way* - Urinary Catheter Type:
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
4FR-11CM Glide Sheath-.021
|
Facility
|
OP
|
$867.00
|
|
| Hospital Charge Code |
4606628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.47 |
| Max. Negotiated Rate |
$829.55 |
| Rate for Payer: Aetna Commercial |
$811.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$775.44
|
| Rate for Payer: Aetna Managed Medicare |
$252.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$586.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.89
|
| Rate for Payer: Cash Price |
$260.10
|
| Rate for Payer: Cigna Commercial |
$829.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.59
|
| Rate for Payer: Health EOS Commercial |
$802.50
|
| Rate for Payer: HFN Commercial |
$829.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$676.26
|
| Rate for Payer: Multiplan Commercial |
$721.34
|
| Rate for Payer: NAPHCARE Commercial |
$541.01
|
| Rate for Payer: Preferred Network Access Commercial |
$829.55
|
| Rate for Payer: Quartz Beloit One Network |
$441.82
|
| Rate for Payer: Quartz Commercial |
$586.09
|
| Rate for Payer: Quartz Medicare Advantage |
$541.01
|
| Rate for Payer: The Alliance Commercial |
$450.84
|
| Rate for Payer: WEA Trust Commercial |
$495.92
|
| Rate for Payer: WPS Commercial |
$667.85
|
|
|
4FR-11CM Glide Sheath-.021
|
Facility
|
IP
|
$867.00
|
|
| Hospital Charge Code |
4606628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$441.82 |
| Max. Negotiated Rate |
$829.55 |
| Rate for Payer: Aetna Commercial |
$811.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$775.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.89
|
| Rate for Payer: Cash Price |
$260.10
|
| Rate for Payer: Cigna Commercial |
$829.55
|
| Rate for Payer: Health EOS Commercial |
$802.50
|
| Rate for Payer: HFN Commercial |
$829.55
|
| Rate for Payer: Multiplan Commercial |
$721.34
|
| Rate for Payer: Preferred Network Access Commercial |
$829.55
|
| Rate for Payer: Quartz Beloit One Network |
$441.82
|
| Rate for Payer: Quartz Commercial |
$541.01
|
| Rate for Payer: WEA Trust Commercial |
$495.92
|
| Rate for Payer: WPS Commercial |
$667.85
|
|
|
500cc. %Dex. H20
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
3101784
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
500cc. %Dex. H20
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
3101784
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
5% dextrose/water J7060
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
3493527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$7.28 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.48
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$7.28
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.68
|
|
|
5% dextrose/water J7060
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
3493527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
5% dextrose/water J7060
|
Professional
|
Both
|
$6.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
3493527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.82 |
| Max. Negotiated Rate |
$5.93 |
| Rate for Payer: Aetna Commercial |
$5.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.82
|
| Rate for Payer: Anthem Medicare Advantage |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.82
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.87
|
| Rate for Payer: Health EOS Commercial |
$5.68
|
| Rate for Payer: HFN Commercial |
$5.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.82
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$2.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5.93
|
| Rate for Payer: Quartz Beloit One Network |
$2.75
|
| Rate for Payer: Quartz Commercial |
$3.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1.82
|
| Rate for Payer: The Alliance Commercial |
$5.00
|
| Rate for Payer: United Healthcare Medicaid |
$1.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.82
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.68
|
|
|
5FR Josephson 6EP Catheter
|
Facility
|
IP
|
$2,439.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
4534613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,242.91 |
| Max. Negotiated Rate |
$2,333.64 |
| Rate for Payer: Aetna Commercial |
$2,282.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.38
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,333.64
|
| Rate for Payer: Health EOS Commercial |
$2,257.54
|
| Rate for Payer: HFN Commercial |
$2,333.64
|
| Rate for Payer: Multiplan Commercial |
$2,029.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.91
|
| Rate for Payer: Quartz Commercial |
$1,521.94
|
| Rate for Payer: WEA Trust Commercial |
$1,395.11
|
| Rate for Payer: WPS Commercial |
$1,878.76
|
|
|
5FR Josephson 6EP Catheter
|
Facility
|
OP
|
$2,439.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
4534613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.24 |
| Max. Negotiated Rate |
$2,333.64 |
| Rate for Payer: Aetna Commercial |
$2,282.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,181.44
|
| Rate for Payer: Aetna Managed Medicare |
$710.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,648.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,217.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.38
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,333.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,419.50
|
| Rate for Payer: Health EOS Commercial |
$2,257.54
|
| Rate for Payer: HFN Commercial |
$2,333.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,902.42
|
| Rate for Payer: Multiplan Commercial |
$2,029.25
|
| Rate for Payer: NAPHCARE Commercial |
$1,521.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,333.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,242.91
|
| Rate for Payer: Quartz Commercial |
$1,648.76
|
| Rate for Payer: Quartz Medicare Advantage |
$1,521.94
|
| Rate for Payer: The Alliance Commercial |
$1,268.28
|
| Rate for Payer: WEA Trust Commercial |
$1,395.11
|
| Rate for Payer: WPS Commercial |
$1,878.76
|
|
|
5FR Quad EP Catheter
|
Facility
|
OP
|
$2,055.00
|
|
| Hospital Charge Code |
4534611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.42 |
| Max. Negotiated Rate |
$1,966.22 |
| Rate for Payer: Aetna Commercial |
$1,923.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.99
|
| Rate for Payer: Aetna Managed Medicare |
$598.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,068.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,025.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.72
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna Commercial |
$1,966.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.01
|
| Rate for Payer: Health EOS Commercial |
$1,902.11
|
| Rate for Payer: HFN Commercial |
$1,966.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,602.90
|
| Rate for Payer: Multiplan Commercial |
$1,709.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.23
|
| Rate for Payer: Quartz Commercial |
$1,389.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.32
|
| Rate for Payer: The Alliance Commercial |
$1,068.60
|
| Rate for Payer: WEA Trust Commercial |
$1,175.46
|
| Rate for Payer: WPS Commercial |
$1,582.97
|
|
|
5FR Quad EP Catheter
|
Facility
|
IP
|
$2,055.00
|
|
| Hospital Charge Code |
4534611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,047.23 |
| Max. Negotiated Rate |
$1,966.22 |
| Rate for Payer: Aetna Commercial |
$1,923.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,837.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,132.72
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna Commercial |
$1,966.22
|
| Rate for Payer: Health EOS Commercial |
$1,902.11
|
| Rate for Payer: HFN Commercial |
$1,966.22
|
| Rate for Payer: Multiplan Commercial |
$1,709.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,966.22
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.23
|
| Rate for Payer: Quartz Commercial |
$1,282.32
|
| Rate for Payer: WEA Trust Commercial |
$1,175.46
|
| Rate for Payer: WPS Commercial |
$1,582.97
|
|
|
5Fr Temp Balloon Pace
|
Facility
|
OP
|
$2,369.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
2550868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$689.85 |
| Max. Negotiated Rate |
$2,266.66 |
| Rate for Payer: Aetna Commercial |
$2,217.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,118.83
|
| Rate for Payer: Aetna Managed Medicare |
$689.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,601.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,231.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,182.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,305.79
|
| Rate for Payer: Cash Price |
$710.70
|
| Rate for Payer: Cigna Commercial |
$2,266.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,378.76
|
| Rate for Payer: Health EOS Commercial |
$2,192.75
|
| Rate for Payer: HFN Commercial |
$2,266.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,847.82
|
| Rate for Payer: Multiplan Commercial |
$1,971.01
|
| Rate for Payer: NAPHCARE Commercial |
$1,478.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,266.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,207.24
|
| Rate for Payer: Quartz Commercial |
$1,601.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,478.26
|
| Rate for Payer: The Alliance Commercial |
$1,231.88
|
| Rate for Payer: WEA Trust Commercial |
$1,355.07
|
| Rate for Payer: WPS Commercial |
$1,824.84
|
|
|
5Fr Temp Balloon Pace
|
Facility
|
IP
|
$2,369.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
2550868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,207.24 |
| Max. Negotiated Rate |
$2,266.66 |
| Rate for Payer: Aetna Commercial |
$2,217.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,118.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,305.79
|
| Rate for Payer: Cash Price |
$710.70
|
| Rate for Payer: Cigna Commercial |
$2,266.66
|
| Rate for Payer: Health EOS Commercial |
$2,192.75
|
| Rate for Payer: HFN Commercial |
$2,266.66
|
| Rate for Payer: Multiplan Commercial |
$1,971.01
|
| Rate for Payer: Preferred Network Access Commercial |
$2,266.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,207.24
|
| Rate for Payer: Quartz Commercial |
$1,478.26
|
| Rate for Payer: WEA Trust Commercial |
$1,355.07
|
| Rate for Payer: WPS Commercial |
$1,824.84
|
|
