|
Yes - Continuous Nebulizer, subsequent Charge
|
Facility
OP
|
$2,210.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
3006934
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$618.80 |
| Max. Negotiated Rate |
$2,033.20 |
| Rate for Payer: Aetna Commercial |
$1,989.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,900.60
|
| Rate for Payer: Aetna Managed Medicare |
$618.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,436.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,060.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,171.30
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$2,033.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,236.72
|
| Rate for Payer: Health EOS Commercial |
$1,966.90
|
| Rate for Payer: HFN Commercial |
$2,033.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,657.50
|
| Rate for Payer: Multiplan Commercial |
$1,768.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,326.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,033.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,082.90
|
| Rate for Payer: Quartz Commercial |
$1,436.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,326.00
|
| Rate for Payer: United Healthcare PPO |
$1,657.50
|
| Rate for Payer: WEA Trust Commercial |
$1,215.50
|
| Rate for Payer: WPS Commercial |
$1,636.95
|
|
|
Yes - Continuous Oximeter Monitor Charge
|
Facility
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
3023868
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$546.35 |
| Max. Negotiated Rate |
$1,025.80 |
| Rate for Payer: Aetna Commercial |
$1,003.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$590.95
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,025.80
|
| Rate for Payer: Health EOS Commercial |
$992.35
|
| Rate for Payer: HFN Commercial |
$1,025.80
|
| Rate for Payer: Multiplan Commercial |
$892.00
|
| Rate for Payer: NAPHCARE Commercial |
$669.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,025.80
|
| Rate for Payer: Quartz Beloit One Network |
$546.35
|
| Rate for Payer: Quartz Commercial |
$669.00
|
| Rate for Payer: WEA Trust Commercial |
$613.25
|
| Rate for Payer: WPS Commercial |
$825.88
|
|
|
Yes - Continuous Oximeter Monitor Charge
|
Facility
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
3023868
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$312.20 |
| Max. Negotiated Rate |
$1,025.80 |
| Rate for Payer: Aetna Commercial |
$1,003.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$958.90
|
| Rate for Payer: Aetna Managed Medicare |
$312.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$724.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$557.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$535.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$590.95
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,025.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$623.95
|
| Rate for Payer: Health EOS Commercial |
$992.35
|
| Rate for Payer: HFN Commercial |
$1,025.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$836.25
|
| Rate for Payer: Multiplan Commercial |
$892.00
|
| Rate for Payer: NAPHCARE Commercial |
$669.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,025.80
|
| Rate for Payer: Quartz Beloit One Network |
$546.35
|
| Rate for Payer: Quartz Commercial |
$724.75
|
| Rate for Payer: Quartz Medicare Advantage |
$669.00
|
| Rate for Payer: United Healthcare PPO |
$836.25
|
| Rate for Payer: WEA Trust Commercial |
$613.25
|
| Rate for Payer: WPS Commercial |
$825.88
|
|
|
Yes - Corrugated Tubing Charge
|
Facility
IP
|
$25.00
|
|
| Hospital Charge Code |
3006949
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Yes - Corrugated Tubing Charge
|
Facility
OP
|
$25.00
|
|
| Hospital Charge Code |
3006949
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Managed Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$15.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Yes - CPAP Nasal Mask Charge
|
Facility
OP
|
$266.00
|
|
| Hospital Charge Code |
3004216
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$74.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$172.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.85
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.50
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$172.90
|
| Rate for Payer: Quartz Medicare Advantage |
$159.60
|
| Rate for Payer: The Alliance Commercial |
$1,064.00
|
| Rate for Payer: United Healthcare PPO |
$199.50
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Yes - CPAP Nasal Mask Charge
|
Facility
IP
|
$266.00
|
|
| Hospital Charge Code |
3004216
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Yes - CPT Palm Percussor Charge
|
Facility
OP
|
$28.00
|
|
| Hospital Charge Code |
2990206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Managed Medicare |
$7.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.67
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$18.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.80
|
| Rate for Payer: The Alliance Commercial |
$112.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
Yes - CPT Palm Percussor Charge
|
Facility
IP
|
$28.00
|
|
| Hospital Charge Code |
2990206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$16.80
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
Yes - CPT Vest Charge
|
Facility
IP
|
$156.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
3006947
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Yes - CPT Vest Charge
|
Facility
OP
|
$156.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
3006947
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$74.88 |
| Max. Negotiated Rate |
$784.25 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$210.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Anthem Medicare Advantage |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.82
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.82
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$210.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$210.82
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$316.23
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare PPO |
$117.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: Wellcare Medicare |
$210.82
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Yes - Disposable BFlex Bronchoscope
|
Facility
IP
|
$3,389.00
|
|
| Hospital Charge Code |
5478913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,660.61 |
| Max. Negotiated Rate |
$3,117.88 |
| Rate for Payer: Aetna Commercial |
$3,050.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.17
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,117.88
|
| Rate for Payer: Health EOS Commercial |
$3,016.21
|
| Rate for Payer: HFN Commercial |
$3,117.88
|
| Rate for Payer: Multiplan Commercial |
$2,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,033.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,117.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.61
|
| Rate for Payer: Quartz Commercial |
$2,033.40
|
| Rate for Payer: WEA Trust Commercial |
$1,863.95
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
Yes - Disposable BFlex Bronchoscope
|
Facility
OP
|
$3,389.00
|
|
| Hospital Charge Code |
5478913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$948.92 |
| Max. Negotiated Rate |
$13,556.00 |
| Rate for Payer: Aetna Commercial |
$3,050.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,914.54
|
| Rate for Payer: Aetna Managed Medicare |
$948.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,202.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,694.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,626.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,796.17
|
| Rate for Payer: Cash Price |
$1,016.70
|
| Rate for Payer: Cigna Commercial |
$3,117.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,896.48
|
| Rate for Payer: Health EOS Commercial |
$3,016.21
|
| Rate for Payer: HFN Commercial |
$3,117.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,541.75
|
| Rate for Payer: Multiplan Commercial |
$2,711.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,033.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,117.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,660.61
|
| Rate for Payer: Quartz Commercial |
$2,202.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,033.40
|
| Rate for Payer: The Alliance Commercial |
$13,556.00
|
| Rate for Payer: WEA Trust Commercial |
$1,863.95
|
| Rate for Payer: WPS Commercial |
$2,510.23
|
|
|
Yes - Disposable Brochoscopy Cytology Charge
|
Facility
IP
|
$138.00
|
|
| Hospital Charge Code |
2990202
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Yes - Disposable Brochoscopy Cytology Charge
|
Facility
OP
|
$138.00
|
|
| Hospital Charge Code |
2990202
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$82.80
|
| Rate for Payer: The Alliance Commercial |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Yes - Disposable Brochoscopy Forceps Charge
|
Facility
IP
|
$138.00
|
|
| Hospital Charge Code |
2990203
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Yes - Disposable Brochoscopy Forceps Charge
|
Facility
OP
|
$138.00
|
|
| Hospital Charge Code |
2990203
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.64 |
| Max. Negotiated Rate |
$552.00 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.50
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$82.80
|
| Rate for Payer: The Alliance Commercial |
$552.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
Yes - Disposable EBUS Needle 22g
|
Facility
OP
|
$2,436.00
|
|
| Hospital Charge Code |
5476743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$682.08 |
| Max. Negotiated Rate |
$9,744.00 |
| Rate for Payer: Aetna Commercial |
$2,192.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,094.96
|
| Rate for Payer: Aetna Managed Medicare |
$682.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,583.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,218.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,169.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,291.08
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$2,241.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,363.19
|
| Rate for Payer: Health EOS Commercial |
$2,168.04
|
| Rate for Payer: HFN Commercial |
$2,241.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,827.00
|
| Rate for Payer: Multiplan Commercial |
$1,948.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,241.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.64
|
| Rate for Payer: Quartz Commercial |
$1,583.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,461.60
|
| Rate for Payer: The Alliance Commercial |
$9,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,339.80
|
| Rate for Payer: WPS Commercial |
$1,804.35
|
|
|
Yes - Disposable EBUS Needle 22g
|
Facility
IP
|
$2,436.00
|
|
| Hospital Charge Code |
5476743
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,193.64 |
| Max. Negotiated Rate |
$2,241.12 |
| Rate for Payer: Aetna Commercial |
$2,192.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,291.08
|
| Rate for Payer: Cash Price |
$730.80
|
| Rate for Payer: Cigna Commercial |
$2,241.12
|
| Rate for Payer: Health EOS Commercial |
$2,168.04
|
| Rate for Payer: HFN Commercial |
$2,241.12
|
| Rate for Payer: Multiplan Commercial |
$1,948.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,461.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,241.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,193.64
|
| Rate for Payer: Quartz Commercial |
$1,461.60
|
| Rate for Payer: WEA Trust Commercial |
$1,339.80
|
| Rate for Payer: WPS Commercial |
$1,804.35
|
|
|
Yes - Disposable EBUS Needle 22g - Procore
|
Facility
IP
|
$2,953.00
|
|
| Hospital Charge Code |
5476744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,446.97 |
| Max. Negotiated Rate |
$2,716.76 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,771.80
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
Yes - Disposable EBUS Needle 22g - Procore
|
Facility
OP
|
$2,953.00
|
|
| Hospital Charge Code |
5476744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$826.84 |
| Max. Negotiated Rate |
$11,812.00 |
| Rate for Payer: Aetna Commercial |
$2,657.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,539.58
|
| Rate for Payer: Aetna Managed Medicare |
$826.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,919.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,476.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,417.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,565.09
|
| Rate for Payer: Cash Price |
$885.90
|
| Rate for Payer: Cigna Commercial |
$2,716.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,652.50
|
| Rate for Payer: Health EOS Commercial |
$2,628.17
|
| Rate for Payer: HFN Commercial |
$2,716.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,214.75
|
| Rate for Payer: Multiplan Commercial |
$2,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,771.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,716.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,446.97
|
| Rate for Payer: Quartz Commercial |
$1,919.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,771.80
|
| Rate for Payer: The Alliance Commercial |
$11,812.00
|
| Rate for Payer: WEA Trust Commercial |
$1,624.15
|
| Rate for Payer: WPS Commercial |
$2,187.29
|
|
|
Yes - EMS Arrival with Notification Level 1*
|
Facility
IP
|
$3,987.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
4962606
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$1,953.63 |
| Max. Negotiated Rate |
$3,668.04 |
| Rate for Payer: Aetna Commercial |
$3,588.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,113.11
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cigna Commercial |
$3,668.04
|
| Rate for Payer: Health EOS Commercial |
$3,548.43
|
| Rate for Payer: HFN Commercial |
$3,668.04
|
| Rate for Payer: Multiplan Commercial |
$3,189.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,392.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,668.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,953.63
|
| Rate for Payer: Quartz Commercial |
$2,392.20
|
| Rate for Payer: WEA Trust Commercial |
$2,192.85
|
| Rate for Payer: WPS Commercial |
$2,953.17
|
|
|
Yes - EMS Arrival with Notification Level 1*
|
Facility
OP
|
$3,987.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
4962606
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$595.32 |
| Max. Negotiated Rate |
$5,034.02 |
| Rate for Payer: Aetna Commercial |
$3,588.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,428.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,353.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,591.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,993.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,913.76
|
| Rate for Payer: Anthem Medicare Advantage |
$1,353.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,113.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,353.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,353.23
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cash Price |
$1,196.10
|
| Rate for Payer: Cigna Commercial |
$3,668.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,353.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,231.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,353.23
|
| Rate for Payer: Health EOS Commercial |
$3,548.43
|
| Rate for Payer: HFN Commercial |
$3,668.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,034.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,353.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,353.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,353.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,353.23
|
| Rate for Payer: Multiplan Commercial |
$3,189.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,029.84
|
| Rate for Payer: Preferred Network Access Commercial |
$3,668.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,953.63
|
| Rate for Payer: Quartz Commercial |
$2,591.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,353.23
|
| Rate for Payer: The Alliance Commercial |
$595.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,353.23
|
| Rate for Payer: WEA Trust Commercial |
$2,192.85
|
| Rate for Payer: Wellcare Medicare |
$1,353.23
|
| Rate for Payer: WPS Commercial |
$2,953.17
|
|
|
Yes - EMS Arrival with Notification Level 2*
|
Facility
IP
|
$2,991.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
4962607
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$1,465.59 |
| Max. Negotiated Rate |
$2,751.72 |
| Rate for Payer: Aetna Commercial |
$2,691.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.23
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Cigna Commercial |
$2,751.72
|
| Rate for Payer: Health EOS Commercial |
$2,661.99
|
| Rate for Payer: HFN Commercial |
$2,751.72
|
| Rate for Payer: Multiplan Commercial |
$2,392.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,794.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,751.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,465.59
|
| Rate for Payer: Quartz Commercial |
$1,794.60
|
| Rate for Payer: WEA Trust Commercial |
$1,645.05
|
| Rate for Payer: WPS Commercial |
$2,215.43
|
|
|
Yes - EMS Arrival with Notification Level 2*
|
Facility
OP
|
$2,991.00
|
|
|
Service Code
|
HCPCS G0390
|
| Hospital Charge Code |
4962607
|
|
Hospital Revenue Code
|
683
|
| Min. Negotiated Rate |
$595.32 |
| Max. Negotiated Rate |
$5,034.02 |
| Rate for Payer: Aetna Commercial |
$2,691.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,572.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,353.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,944.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,435.68
|
| Rate for Payer: Anthem Medicare Advantage |
$1,353.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,585.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,353.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,353.23
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Cash Price |
$897.30
|
| Rate for Payer: Cigna Commercial |
$2,751.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,353.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,673.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,353.23
|
| Rate for Payer: Health EOS Commercial |
$2,661.99
|
| Rate for Payer: HFN Commercial |
$2,751.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,034.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,353.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,353.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,353.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,353.23
|
| Rate for Payer: Multiplan Commercial |
$2,392.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,029.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,751.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,465.59
|
| Rate for Payer: Quartz Commercial |
$1,944.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,353.23
|
| Rate for Payer: The Alliance Commercial |
$595.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,353.23
|
| Rate for Payer: WEA Trust Commercial |
$1,645.05
|
| Rate for Payer: Wellcare Medicare |
$1,353.23
|
| Rate for Payer: WPS Commercial |
$2,215.43
|
|
