|
3 Caps changed - Central IV Care:
|
Facility
OP
|
$334.00
|
|
| Hospital Charge Code |
3025902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$93.52 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Aetna Managed Medicare |
$93.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.32
|
| 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: Dean Health DHI/DHP/ASO |
$186.91
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.50
|
| 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 |
$217.10
|
| Rate for Payer: Quartz Medicare Advantage |
$200.40
|
| Rate for Payer: The Alliance Commercial |
$1,336.00
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
3 Dimensional Simulation
|
Facility
IP
|
$10,251.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
3040377
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$5,022.99 |
| Max. Negotiated Rate |
$9,430.92 |
| Rate for Payer: Aetna Commercial |
$9,225.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,433.03
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Cigna Commercial |
$9,430.92
|
| Rate for Payer: Health EOS Commercial |
$9,123.39
|
| Rate for Payer: HFN Commercial |
$9,430.92
|
| Rate for Payer: Multiplan Commercial |
$8,200.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,430.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,022.99
|
| Rate for Payer: Quartz Commercial |
$6,150.60
|
| Rate for Payer: WEA Trust Commercial |
$5,638.05
|
| Rate for Payer: WPS Commercial |
$7,592.92
|
|
|
3 Dimensional Simulation
|
Facility
OP
|
$10,251.00
|
|
|
Service Code
|
CPT 77295
|
| Hospital Charge Code |
3040377
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$15.88 |
| Max. Negotiated Rate |
$9,430.92 |
| Rate for Payer: Aetna Commercial |
$9,225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,815.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,369.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,135.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,108.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,903.25
|
| Rate for Payer: Anthem Medicare Advantage |
$1,369.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,433.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,369.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,369.56
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Cash Price |
$3,075.30
|
| Rate for Payer: Cigna Commercial |
$9,430.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,369.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,369.56
|
| Rate for Payer: Health EOS Commercial |
$9,123.39
|
| Rate for Payer: HFN Commercial |
$9,430.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,094.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,369.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,369.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,369.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,369.56
|
| Rate for Payer: Multiplan Commercial |
$8,200.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,054.34
|
| Rate for Payer: Preferred Network Access Commercial |
$9,430.92
|
| Rate for Payer: Quartz Beloit One Network |
$5,022.99
|
| Rate for Payer: Quartz Commercial |
$6,663.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,369.56
|
| Rate for Payer: The Alliance Commercial |
$15.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,369.56
|
| Rate for Payer: United Healthcare PPO |
$7,688.25
|
| Rate for Payer: WEA Trust Commercial |
$5,638.05
|
| Rate for Payer: Wellcare Medicare |
$1,369.56
|
| Rate for Payer: WPS Commercial |
$7,592.92
|
|
|
3D Radiotherapy Plan 7729526
|
Professional
|
$3,117.00
|
|
|
Service Code
|
CPT 77295 26
|
| Hospital Charge Code |
5258627
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.08 |
| Max. Negotiated Rate |
$2,961.15 |
| Rate for Payer: Aetna Commercial |
$2,961.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,680.62
|
| Rate for Payer: Aetna Managed Medicare |
$219.08
|
| Rate for Payer: Anthem Medicare Advantage |
$219.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.08
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cash Price |
$935.10
|
| Rate for Payer: Cigna Commercial |
$2,961.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,558.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.08
|
| Rate for Payer: Health EOS Commercial |
$2,836.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$771.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$771.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.08
|
| Rate for Payer: Multiplan Commercial |
$2,493.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,961.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,371.48
|
| Rate for Payer: Quartz Commercial |
$1,776.69
|
| Rate for Payer: Quartz Medicare Advantage |
$219.08
|
| Rate for Payer: The Alliance Commercial |
$832.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.08
|
| Rate for Payer: WEA Trust Commercial |
$1,714.35
|
| Rate for Payer: WPS Commercial |
$1,095.40
|
|
|
3 hours - Respiratory Therapy Treatment Duration
|
Facility
IP
|
$1,546.00
|
|
| Hospital Charge Code |
3023872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$757.54 |
| Max. Negotiated Rate |
$1,422.32 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$927.60
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
3 hours - Respiratory Therapy Treatment Duration
|
Facility
OP
|
$1,546.00
|
|
| Hospital Charge Code |
3023872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$432.88 |
| Max. Negotiated Rate |
$6,184.00 |
| Rate for Payer: Aetna Commercial |
$1,391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Aetna Managed Medicare |
$432.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$773.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$742.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$819.38
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,422.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$865.14
|
| Rate for Payer: Health EOS Commercial |
$1,375.94
|
| Rate for Payer: HFN Commercial |
$1,422.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,159.50
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: NAPHCARE Commercial |
$927.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,422.32
|
| Rate for Payer: Quartz Beloit One Network |
$757.54
|
| Rate for Payer: Quartz Commercial |
$1,004.90
|
| Rate for Payer: Quartz Medicare Advantage |
$927.60
|
| Rate for Payer: The Alliance Commercial |
$6,184.00
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
3- Way* - Urinary catheter type:
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$6,179.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.08
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$6,179.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
3- Way* - Urinary catheter type:
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877761
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
3- Way - Urinary Catheter Type
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
3025947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
3- Way - Urinary Catheter Type
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
3025947
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$6,179.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.08
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$6,179.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
3- Way* - Urinary Catheter Type:
|
Facility
OP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$6,179.00 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.08
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$6,179.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
3- Way* - Urinary Catheter Type:
|
Facility
IP
|
$271.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5510855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
4FR-11CM Glide Sheath-.021
|
Facility
OP
|
$867.00
|
|
| Hospital Charge Code |
4606628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$242.76 |
| Max. Negotiated Rate |
$3,468.00 |
| Rate for Payer: Aetna Commercial |
$780.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$745.62
|
| Rate for Payer: Aetna Managed Medicare |
$242.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$563.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$433.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$416.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$459.51
|
| Rate for Payer: Cash Price |
$260.10
|
| Rate for Payer: Cigna Commercial |
$797.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$485.17
|
| Rate for Payer: Health EOS Commercial |
$771.63
|
| Rate for Payer: HFN Commercial |
$797.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$650.25
|
| Rate for Payer: Multiplan Commercial |
$693.60
|
| Rate for Payer: NAPHCARE Commercial |
$520.20
|
| Rate for Payer: Preferred Network Access Commercial |
$797.64
|
| Rate for Payer: Quartz Beloit One Network |
$424.83
|
| Rate for Payer: Quartz Commercial |
$563.55
|
| Rate for Payer: Quartz Medicare Advantage |
$520.20
|
| Rate for Payer: The Alliance Commercial |
$3,468.00
|
| Rate for Payer: WEA Trust Commercial |
$476.85
|
| Rate for Payer: WPS Commercial |
$642.19
|
|
|
4FR-11CM Glide Sheath-.021
|
Facility
IP
|
$867.00
|
|
| Hospital Charge Code |
4606628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.83 |
| Max. Negotiated Rate |
$797.64 |
| Rate for Payer: Aetna Commercial |
$780.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$459.51
|
| Rate for Payer: Cash Price |
$260.10
|
| Rate for Payer: Cigna Commercial |
$797.64
|
| Rate for Payer: Health EOS Commercial |
$771.63
|
| Rate for Payer: HFN Commercial |
$797.64
|
| Rate for Payer: Multiplan Commercial |
$693.60
|
| Rate for Payer: NAPHCARE Commercial |
$520.20
|
| Rate for Payer: Preferred Network Access Commercial |
$797.64
|
| Rate for Payer: Quartz Beloit One Network |
$424.83
|
| Rate for Payer: Quartz Commercial |
$520.20
|
| Rate for Payer: WEA Trust Commercial |
$476.85
|
| Rate for Payer: WPS Commercial |
$642.19
|
|
|
500cc. %Dex. H20
|
Facility
IP
|
$50.00
|
|
| Hospital Charge Code |
3101784
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
500cc. %Dex. H20
|
Facility
OP
|
$50.00
|
|
| Hospital Charge Code |
3101784
|
|
Hospital Revenue Code
|
271
|
| 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
|
|
|
5% dextrose/water J7060
|
Facility
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
3493527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.60
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
5% dextrose/water J7060
|
Facility
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
3493527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$700.24 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Aetna Managed Medicare |
$1.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.38
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3.60
|
| Rate for Payer: The Alliance Commercial |
$700.24
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.50
|
|
|
5% dextrose/water J7060
|
Professional
|
$6.00
|
|
|
Service Code
|
HCPCS J7060
|
| Hospital Charge Code |
3493527
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.80 |
| Max. Negotiated Rate |
$5.70 |
| Rate for Payer: Aetna Commercial |
$5.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Aetna Managed Medicare |
$1.81
|
| Rate for Payer: Anthem Medicare Advantage |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.81
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.80
|
| Rate for Payer: Health EOS Commercial |
$5.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.81
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5.70
|
| Rate for Payer: Quartz Beloit One Network |
$2.64
|
| Rate for Payer: Quartz Commercial |
$3.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1.81
|
| Rate for Payer: The Alliance Commercial |
$4.98
|
| Rate for Payer: United Healthcare Medicaid |
$1.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.81
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.50
|
|
|
5FR Josephson 6EP Catheter
|
Facility
OP
|
$2,439.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
4534613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$682.92 |
| Max. Negotiated Rate |
$2,243.88 |
| Rate for Payer: Aetna Commercial |
$2,195.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,097.54
|
| Rate for Payer: Aetna Managed Medicare |
$682.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,585.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,170.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.67
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,243.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,364.86
|
| Rate for Payer: Health EOS Commercial |
$2,170.71
|
| Rate for Payer: HFN Commercial |
$2,243.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,829.25
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.11
|
| Rate for Payer: Quartz Commercial |
$1,585.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,463.40
|
| Rate for Payer: WEA Trust Commercial |
$1,341.45
|
| Rate for Payer: WPS Commercial |
$1,806.57
|
|
|
5FR Josephson 6EP Catheter
|
Facility
IP
|
$2,439.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
4534613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.11 |
| Max. Negotiated Rate |
$2,243.88 |
| Rate for Payer: Aetna Commercial |
$2,195.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,292.67
|
| Rate for Payer: Cash Price |
$731.70
|
| Rate for Payer: Cigna Commercial |
$2,243.88
|
| Rate for Payer: Health EOS Commercial |
$2,170.71
|
| Rate for Payer: HFN Commercial |
$2,243.88
|
| Rate for Payer: Multiplan Commercial |
$1,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,463.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,243.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.11
|
| Rate for Payer: Quartz Commercial |
$1,463.40
|
| Rate for Payer: WEA Trust Commercial |
$1,341.45
|
| Rate for Payer: WPS Commercial |
$1,806.57
|
|
|
5FR Quad EP Catheter
|
Facility
IP
|
$2,055.00
|
|
| Hospital Charge Code |
4534611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,006.95 |
| Max. Negotiated Rate |
$1,890.60 |
| Rate for Payer: Aetna Commercial |
$1,849.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.15
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna Commercial |
$1,890.60
|
| Rate for Payer: Health EOS Commercial |
$1,828.95
|
| Rate for Payer: HFN Commercial |
$1,890.60
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,890.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.95
|
| Rate for Payer: Quartz Commercial |
$1,233.00
|
| Rate for Payer: WEA Trust Commercial |
$1,130.25
|
| Rate for Payer: WPS Commercial |
$1,522.14
|
|
|
5FR Quad EP Catheter
|
Facility
OP
|
$2,055.00
|
|
| Hospital Charge Code |
4534611
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$575.40 |
| Max. Negotiated Rate |
$8,220.00 |
| Rate for Payer: Aetna Commercial |
$1,849.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,767.30
|
| Rate for Payer: Aetna Managed Medicare |
$575.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,335.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,027.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$986.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.15
|
| Rate for Payer: Cash Price |
$616.50
|
| Rate for Payer: Cigna Commercial |
$1,890.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,149.98
|
| Rate for Payer: Health EOS Commercial |
$1,828.95
|
| Rate for Payer: HFN Commercial |
$1,890.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,541.25
|
| Rate for Payer: Multiplan Commercial |
$1,644.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,890.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,006.95
|
| Rate for Payer: Quartz Commercial |
$1,335.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,233.00
|
| Rate for Payer: The Alliance Commercial |
$8,220.00
|
| Rate for Payer: WEA Trust Commercial |
$1,130.25
|
| Rate for Payer: WPS Commercial |
$1,522.14
|
|
|
5Fr Temp Balloon Pace
|
Professional
|
$2,369.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
2550868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,042.36 |
| Max. Negotiated Rate |
$2,250.55 |
| Rate for Payer: Aetna Commercial |
$2,250.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,037.34
|
| Rate for Payer: Cash Price |
$710.70
|
| Rate for Payer: Cigna Commercial |
$2,250.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,184.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,421.40
|
| Rate for Payer: Health EOS Commercial |
$2,155.79
|
| Rate for Payer: Multiplan Commercial |
$1,895.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,250.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,042.36
|
| Rate for Payer: Quartz Commercial |
$1,350.33
|
| Rate for Payer: The Alliance Commercial |
$1,184.50
|
| Rate for Payer: WEA Trust Commercial |
$1,302.95
|
| Rate for Payer: WPS Commercial |
$1,754.72
|
|
|
5Fr Temp Balloon Pace
|
Facility
IP
|
$2,369.00
|
|
|
Service Code
|
HCPCS C1779
|
| Hospital Charge Code |
2550868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,160.81 |
| Max. Negotiated Rate |
$2,179.48 |
| Rate for Payer: Aetna Commercial |
$2,132.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,255.57
|
| Rate for Payer: Cash Price |
$710.70
|
| Rate for Payer: Cigna Commercial |
$2,179.48
|
| Rate for Payer: Health EOS Commercial |
$2,108.41
|
| Rate for Payer: HFN Commercial |
$2,179.48
|
| Rate for Payer: Multiplan Commercial |
$1,895.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,421.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,179.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,160.81
|
| Rate for Payer: Quartz Commercial |
$1,421.40
|
| Rate for Payer: WEA Trust Commercial |
$1,302.95
|
| Rate for Payer: WPS Commercial |
$1,754.72
|
|
