|
Yes - GI Oxygen Charge
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
2990192
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.15
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$23.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.60
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
Yes - Group Speech Language Therapy Charges
|
Facility
IP
|
$386.00
|
|
|
Service Code
|
CPT 92508 GN
|
| Hospital Charge Code |
2987977
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$355.12 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$231.60
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
Yes - Group Speech Language Therapy Charges
|
Facility
OP
|
$386.00
|
|
|
Service Code
|
CPT 92508 GN
|
| Hospital Charge Code |
2987977
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$108.08 |
| Max. Negotiated Rate |
$1,544.00 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Aetna Managed Medicare |
$108.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$216.01
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$250.90
|
| Rate for Payer: Quartz Medicare Advantage |
$231.60
|
| Rate for Payer: The Alliance Commercial |
$1,544.00
|
| Rate for Payer: United Healthcare PPO |
$289.50
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
Yes - HME Charge
|
Facility
IP
|
$61.00
|
|
| Hospital Charge Code |
3006954
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
Yes - HME Charge
|
Facility
OP
|
$61.00
|
|
| Hospital Charge Code |
3006954
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
Yes - Home Oxygen Setup Charge
|
Facility
OP
|
$142.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
2990196
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$68.16 |
| Max. Negotiated Rate |
$574.33 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.16
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$92.30
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$106.50
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
Yes - Home Oxygen Setup Charge
|
Facility
IP
|
$142.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
2990196
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$85.20
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$85.20
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
Yes - Incentive Spirometry Device
|
Facility
IP
|
$30.00
|
|
| Hospital Charge Code |
3031046
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Yes - Incentive Spirometry Device
|
Facility
OP
|
$30.00
|
|
| Hospital Charge Code |
3031046
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Yes - Infant Cannulaide Charge
|
Facility
IP
|
$10.00
|
|
| Hospital Charge Code |
3006982
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Yes - Infant Cannulaide Charge
|
Facility
OP
|
$10.00
|
|
| Hospital Charge Code |
3006982
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Yes - Infant Mini Whiskers Charge
|
Facility
IP
|
$19.00
|
|
| Hospital Charge Code |
3006959
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.07
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$17.48
|
| Rate for Payer: Health EOS Commercial |
$16.91
|
| Rate for Payer: HFN Commercial |
$17.48
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.48
|
| Rate for Payer: Quartz Beloit One Network |
$9.31
|
| Rate for Payer: Quartz Commercial |
$11.40
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
|
Yes - Infant Mini Whiskers Charge
|
Facility
OP
|
$19.00
|
|
| Hospital Charge Code |
3006959
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.07
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$17.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.63
|
| Rate for Payer: Health EOS Commercial |
$16.91
|
| Rate for Payer: HFN Commercial |
$17.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.48
|
| Rate for Payer: Quartz Beloit One Network |
$9.31
|
| Rate for Payer: Quartz Commercial |
$12.35
|
| Rate for Payer: Quartz Medicare Advantage |
$11.40
|
| Rate for Payer: The Alliance Commercial |
$76.00
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
|
Yes - In-line Suction Catheter 24 hr Charge
|
Facility
OP
|
$326.00
|
|
| Hospital Charge Code |
3006957
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.28 |
| Max. Negotiated Rate |
$1,304.00 |
| Rate for Payer: Aetna Commercial |
$293.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Aetna Managed Medicare |
$91.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$211.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.78
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$299.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.43
|
| Rate for Payer: Health EOS Commercial |
$290.14
|
| Rate for Payer: HFN Commercial |
$299.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.50
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: NAPHCARE Commercial |
$195.60
|
| Rate for Payer: Preferred Network Access Commercial |
$299.92
|
| Rate for Payer: Quartz Beloit One Network |
$159.74
|
| Rate for Payer: Quartz Commercial |
$211.90
|
| Rate for Payer: Quartz Medicare Advantage |
$195.60
|
| Rate for Payer: The Alliance Commercial |
$1,304.00
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: WPS Commercial |
$241.47
|
|
|
Yes - In-line Suction Catheter 24 hr Charge
|
Facility
IP
|
$326.00
|
|
| Hospital Charge Code |
3006957
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$159.74 |
| Max. Negotiated Rate |
$299.92 |
| Rate for Payer: Aetna Commercial |
$293.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.78
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$299.92
|
| Rate for Payer: Health EOS Commercial |
$290.14
|
| Rate for Payer: HFN Commercial |
$299.92
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: NAPHCARE Commercial |
$195.60
|
| Rate for Payer: Preferred Network Access Commercial |
$299.92
|
| Rate for Payer: Quartz Beloit One Network |
$159.74
|
| Rate for Payer: Quartz Commercial |
$195.60
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: WPS Commercial |
$241.47
|
|
|
Yes - In-line Suction Catheter 72 hr Charge
|
Facility
OP
|
$396.00
|
|
| Hospital Charge Code |
3006958
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$110.88 |
| Max. Negotiated Rate |
$1,584.00 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$110.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$257.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.60
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.00
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$257.40
|
| Rate for Payer: Quartz Medicare Advantage |
$237.60
|
| Rate for Payer: The Alliance Commercial |
$1,584.00
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
Yes - In-line Suction Catheter 72 hr Charge
|
Facility
IP
|
$396.00
|
|
| Hospital Charge Code |
3006958
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$194.04 |
| Max. Negotiated Rate |
$364.32 |
| Rate for Payer: Aetna Commercial |
$356.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.88
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$364.32
|
| Rate for Payer: Health EOS Commercial |
$352.44
|
| Rate for Payer: HFN Commercial |
$364.32
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: NAPHCARE Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$364.32
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$237.60
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$293.32
|
|
|
Yes - Inspiratory Muscle Trainer Charge
|
Facility
IP
|
$128.00
|
|
| Hospital Charge Code |
3006956
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Yes - Inspiratory Muscle Trainer Charge
|
Facility
OP
|
$128.00
|
|
| Hospital Charge Code |
3006956
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.84 |
| Max. Negotiated Rate |
$512.00 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$35.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.63
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.00
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$76.80
|
| Rate for Payer: The Alliance Commercial |
$512.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Yes - Laryngeal Video Stroboscopy Charges
|
Facility
OP
|
$643.00
|
|
|
Service Code
|
CPT 31579 GN
|
| Hospital Charge Code |
2987978
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$180.04 |
| Max. Negotiated Rate |
$2,572.00 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.98
|
| Rate for Payer: Aetna Managed Medicare |
$180.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$417.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$308.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.79
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$591.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$359.82
|
| Rate for Payer: Health EOS Commercial |
$572.27
|
| Rate for Payer: HFN Commercial |
$591.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.25
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: NAPHCARE Commercial |
$385.80
|
| Rate for Payer: Preferred Network Access Commercial |
$591.56
|
| Rate for Payer: Quartz Beloit One Network |
$315.07
|
| Rate for Payer: Quartz Commercial |
$417.95
|
| Rate for Payer: Quartz Medicare Advantage |
$385.80
|
| Rate for Payer: The Alliance Commercial |
$2,572.00
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
Yes - Laryngeal Video Stroboscopy Charges
|
Facility
IP
|
$643.00
|
|
|
Service Code
|
CPT 31579 GN
|
| Hospital Charge Code |
2987978
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$315.07 |
| Max. Negotiated Rate |
$591.56 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.79
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$591.56
|
| Rate for Payer: Health EOS Commercial |
$572.27
|
| Rate for Payer: HFN Commercial |
$591.56
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: NAPHCARE Commercial |
$385.80
|
| Rate for Payer: Preferred Network Access Commercial |
$591.56
|
| Rate for Payer: Quartz Beloit One Network |
$315.07
|
| Rate for Payer: Quartz Commercial |
$385.80
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
Yes - Maintenance Of Wakefullness Test Charge
|
Facility
OP
|
$3,781.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3004223
|
| Min. Negotiated Rate |
$529.77 |
| Max. Negotiated Rate |
$3,478.52 |
| Rate for Payer: Aetna Commercial |
$3,402.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,251.66
|
| Rate for Payer: Aetna Managed Medicare |
$529.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,457.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,890.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,814.88
|
| Rate for Payer: Anthem Medicare Advantage |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,003.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$529.77
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cigna Commercial |
$3,478.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$529.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,115.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$529.77
|
| Rate for Payer: Health EOS Commercial |
$3,365.09
|
| Rate for Payer: HFN Commercial |
$3,478.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,970.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$529.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$529.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$529.77
|
| Rate for Payer: Multiplan Commercial |
$3,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$794.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,478.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,852.69
|
| Rate for Payer: Quartz Commercial |
$2,457.65
|
| Rate for Payer: Quartz Medicare Advantage |
$529.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.77
|
| Rate for Payer: WEA Trust Commercial |
$2,079.55
|
| Rate for Payer: Wellcare Medicare |
$529.77
|
| Rate for Payer: WPS Commercial |
$2,800.59
|
|
|
Yes - Maintenance Of Wakefullness Test Charge
|
Facility
IP
|
$3,781.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3004223
|
| Min. Negotiated Rate |
$1,852.69 |
| Max. Negotiated Rate |
$3,478.52 |
| Rate for Payer: Aetna Commercial |
$3,402.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,003.93
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cigna Commercial |
$3,478.52
|
| Rate for Payer: Health EOS Commercial |
$3,365.09
|
| Rate for Payer: HFN Commercial |
$3,478.52
|
| Rate for Payer: Multiplan Commercial |
$3,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,268.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,478.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,852.69
|
| Rate for Payer: Quartz Commercial |
$2,268.60
|
| Rate for Payer: WEA Trust Commercial |
$2,079.55
|
| Rate for Payer: WPS Commercial |
$2,800.59
|
|
|
Yes - Mechanical Traction Charge
|
Facility
OP
|
$232.00
|
|
|
Service Code
|
CPT 97012 GP
|
| Hospital Charge Code |
2989810
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$64.96 |
| Max. Negotiated Rate |
$928.00 |
| Rate for Payer: Aetna Commercial |
$208.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Aetna Managed Medicare |
$64.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.96
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$213.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.83
|
| Rate for Payer: Health EOS Commercial |
$206.48
|
| Rate for Payer: HFN Commercial |
$213.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: NAPHCARE Commercial |
$139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$213.44
|
| Rate for Payer: Quartz Beloit One Network |
$113.68
|
| Rate for Payer: Quartz Commercial |
$150.80
|
| Rate for Payer: Quartz Medicare Advantage |
$139.20
|
| Rate for Payer: The Alliance Commercial |
$928.00
|
| Rate for Payer: United Healthcare PPO |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
Yes - Mechanical Traction Charge
|
Professional
|
$232.00
|
|
|
Service Code
|
CPT 97012 GP
|
| Hospital Charge Code |
2989810
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$102.08 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Aetna Commercial |
$220.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$220.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.20
|
| Rate for Payer: Health EOS Commercial |
$211.12
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$220.40
|
| Rate for Payer: Quartz Beloit One Network |
$102.08
|
| Rate for Payer: Quartz Commercial |
$132.24
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
