|
Yes - Speech Swallow Disf. Treatment Charges
|
Facility
|
OP
|
$499.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
2987976
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$139.72 |
| Max. Negotiated Rate |
$1,996.00 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Aetna Managed Medicare |
$139.72
|
| 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 |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.24
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$324.35
|
| Rate for Payer: Quartz Medicare Advantage |
$299.40
|
| Rate for Payer: The Alliance Commercial |
$1,996.00
|
| Rate for Payer: United Healthcare PPO |
$374.25
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
Yes - Speech Swallow Disf. Treatment Charges
|
Facility
|
IP
|
$499.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
2987976
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$244.51 |
| Max. Negotiated Rate |
$459.08 |
| Rate for Payer: Aetna Commercial |
$449.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$429.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$264.47
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$459.08
|
| Rate for Payer: Health EOS Commercial |
$444.11
|
| Rate for Payer: HFN Commercial |
$459.08
|
| Rate for Payer: Multiplan Commercial |
$399.20
|
| Rate for Payer: NAPHCARE Commercial |
$299.40
|
| Rate for Payer: Preferred Network Access Commercial |
$459.08
|
| Rate for Payer: Quartz Beloit One Network |
$244.51
|
| Rate for Payer: Quartz Commercial |
$299.40
|
| Rate for Payer: WEA Trust Commercial |
$274.45
|
| Rate for Payer: WPS Commercial |
$369.61
|
|
|
Yes - Sputum Collection Charge
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
2990181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
Yes - Sputum Collection Charge
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
2990181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$617.56 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.04
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| 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 |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| 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 |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
Yes - Sputum Collection with Treatment Charge
|
Facility
|
IP
|
$379.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
2990182
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$185.71 |
| Max. Negotiated Rate |
$348.68 |
| Rate for Payer: Aetna Commercial |
$341.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.87
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$348.68
|
| Rate for Payer: Health EOS Commercial |
$337.31
|
| Rate for Payer: HFN Commercial |
$348.68
|
| Rate for Payer: Multiplan Commercial |
$303.20
|
| Rate for Payer: NAPHCARE Commercial |
$227.40
|
| Rate for Payer: Preferred Network Access Commercial |
$348.68
|
| Rate for Payer: Quartz Beloit One Network |
$185.71
|
| Rate for Payer: Quartz Commercial |
$227.40
|
| Rate for Payer: WEA Trust Commercial |
$208.45
|
| Rate for Payer: WPS Commercial |
$280.73
|
|
|
Yes - Sputum Collection with Treatment Charge
|
Facility
|
OP
|
$379.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
2990182
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$181.92 |
| Max. Negotiated Rate |
$843.28 |
| Rate for Payer: Aetna Commercial |
$341.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.94
|
| Rate for Payer: Aetna Managed Medicare |
$210.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$246.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.92
|
| Rate for Payer: Anthem Medicare Advantage |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.87
|
| 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 |
$113.70
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$348.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.82
|
| Rate for Payer: Health EOS Commercial |
$337.31
|
| Rate for Payer: HFN Commercial |
$348.68
|
| 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 |
$303.20
|
| Rate for Payer: NAPHCARE Commercial |
$316.23
|
| Rate for Payer: Preferred Network Access Commercial |
$348.68
|
| Rate for Payer: Quartz Beloit One Network |
$185.71
|
| Rate for Payer: Quartz Commercial |
$246.35
|
| Rate for Payer: Quartz Medicare Advantage |
$210.82
|
| Rate for Payer: The Alliance Commercial |
$843.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare PPO |
$284.25
|
| Rate for Payer: WEA Trust Commercial |
$208.45
|
| Rate for Payer: Wellcare Medicare |
$210.82
|
| Rate for Payer: WPS Commercial |
$280.73
|
|
|
Yes - Standardized Cognitive Performance Test
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
4163486
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$433.65 |
| Max. Negotiated Rate |
$814.20 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$531.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
Yes - Standardized Cognitive Performance Test
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
4163486
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$3,540.00 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.10
|
| Rate for Payer: Aetna Managed Medicare |
$247.80
|
| 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 |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.25
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$575.25
|
| Rate for Payer: Quartz Medicare Advantage |
$531.00
|
| Rate for Payer: The Alliance Commercial |
$3,540.00
|
| Rate for Payer: United Healthcare PPO |
$663.75
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
Yes - Swallow Evaluation Charge
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4075916
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$365.05 |
| Max. Negotiated Rate |
$685.40 |
| Rate for Payer: Aetna Commercial |
$670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.85
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Health EOS Commercial |
$663.05
|
| Rate for Payer: HFN Commercial |
$685.40
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: NAPHCARE Commercial |
$447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$685.40
|
| Rate for Payer: Quartz Beloit One Network |
$365.05
|
| Rate for Payer: Quartz Commercial |
$447.00
|
| Rate for Payer: WEA Trust Commercial |
$409.75
|
| Rate for Payer: WPS Commercial |
$551.82
|
|
|
Yes - Swallow Evaluation Charge
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4075916
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$2,980.00 |
| Rate for Payer: Aetna Commercial |
$670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.70
|
| Rate for Payer: Aetna Managed Medicare |
$208.60
|
| 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 |
$394.85
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.90
|
| Rate for Payer: Health EOS Commercial |
$663.05
|
| Rate for Payer: HFN Commercial |
$685.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: NAPHCARE Commercial |
$447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$685.40
|
| Rate for Payer: Quartz Beloit One Network |
$365.05
|
| Rate for Payer: Quartz Commercial |
$484.25
|
| Rate for Payer: Quartz Medicare Advantage |
$447.00
|
| Rate for Payer: The Alliance Commercial |
$2,980.00
|
| Rate for Payer: United Healthcare PPO |
$558.75
|
| Rate for Payer: WEA Trust Commercial |
$409.75
|
| Rate for Payer: WPS Commercial |
$551.82
|
|
|
Yes - Tent Canopy Charge
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
3006975
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Yes - Tent Canopy Charge
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
3006975
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: United Healthcare PPO |
$117.75
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Yes - Thoracentesis Charge
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
3006938
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$358.19 |
| Max. Negotiated Rate |
$672.52 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$628.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.43
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cigna Commercial |
$672.52
|
| Rate for Payer: Health EOS Commercial |
$650.59
|
| Rate for Payer: HFN Commercial |
$672.52
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: NAPHCARE Commercial |
$438.60
|
| Rate for Payer: Preferred Network Access Commercial |
$672.52
|
| Rate for Payer: Quartz Beloit One Network |
$358.19
|
| Rate for Payer: Quartz Commercial |
$438.60
|
| Rate for Payer: WEA Trust Commercial |
$402.05
|
| Rate for Payer: WPS Commercial |
$541.45
|
|
|
Yes - Thoracentesis Charge
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
3006938
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$358.19 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$657.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$628.66
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cigna Commercial |
$672.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Health EOS Commercial |
$650.59
|
| Rate for Payer: HFN Commercial |
$672.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: Multiplan Commercial |
$584.80
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$672.52
|
| Rate for Payer: Quartz Beloit One Network |
$358.19
|
| Rate for Payer: Quartz Commercial |
$475.15
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$2,483.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: WEA Trust Commercial |
$402.05
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$541.45
|
|
|
Yes - Tracheostomy Mask Charge
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
3006976
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Yes - Tracheostomy Mask Charge
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
3006976
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$21.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.09
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.75
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$46.20
|
| Rate for Payer: The Alliance Commercial |
$308.00
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Yes - Training ST Generating Device Charges
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
2989781
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$126.28 |
| Max. Negotiated Rate |
$1,804.00 |
| Rate for Payer: Aetna Commercial |
$405.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.86
|
| Rate for Payer: Aetna Managed Medicare |
$126.28
|
| 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 |
$239.03
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$414.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.38
|
| Rate for Payer: Health EOS Commercial |
$401.39
|
| Rate for Payer: HFN Commercial |
$414.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$360.80
|
| Rate for Payer: NAPHCARE Commercial |
$270.60
|
| Rate for Payer: Preferred Network Access Commercial |
$414.92
|
| Rate for Payer: Quartz Beloit One Network |
$220.99
|
| Rate for Payer: Quartz Commercial |
$293.15
|
| Rate for Payer: Quartz Medicare Advantage |
$270.60
|
| Rate for Payer: The Alliance Commercial |
$1,804.00
|
| Rate for Payer: United Healthcare PPO |
$338.25
|
| Rate for Payer: WEA Trust Commercial |
$248.05
|
| Rate for Payer: WPS Commercial |
$334.06
|
|
|
Yes - Training ST Generating Device Charges
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
2989781
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$220.99 |
| Max. Negotiated Rate |
$414.92 |
| Rate for Payer: Aetna Commercial |
$405.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.03
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$414.92
|
| Rate for Payer: Health EOS Commercial |
$401.39
|
| Rate for Payer: HFN Commercial |
$414.92
|
| Rate for Payer: Multiplan Commercial |
$360.80
|
| Rate for Payer: NAPHCARE Commercial |
$270.60
|
| Rate for Payer: Preferred Network Access Commercial |
$414.92
|
| Rate for Payer: Quartz Beloit One Network |
$220.99
|
| Rate for Payer: Quartz Commercial |
$270.60
|
| Rate for Payer: WEA Trust Commercial |
$248.05
|
| Rate for Payer: WPS Commercial |
$334.06
|
|
|
Yes - Ventilator Circuit Charge
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
3006978
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Yes - Ventilator Circuit Charge
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3006978
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
Yes - Venti-Mask Charge
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
3006977
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Yes - Venti-Mask Charge
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
3006977
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$21.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.09
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.75
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$46.20
|
| Rate for Payer: The Alliance Commercial |
$308.00
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Yes - Video Swallow Eval Charge (Motion)
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4075915
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$365.05 |
| Max. Negotiated Rate |
$685.40 |
| Rate for Payer: Aetna Commercial |
$670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.85
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Health EOS Commercial |
$663.05
|
| Rate for Payer: HFN Commercial |
$685.40
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: NAPHCARE Commercial |
$447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$685.40
|
| Rate for Payer: Quartz Beloit One Network |
$365.05
|
| Rate for Payer: Quartz Commercial |
$447.00
|
| Rate for Payer: WEA Trust Commercial |
$409.75
|
| Rate for Payer: WPS Commercial |
$551.82
|
|
|
Yes - Video Swallow Eval Charge (Motion)
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4075915
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$2,980.00 |
| Rate for Payer: Aetna Commercial |
$670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.70
|
| Rate for Payer: Aetna Managed Medicare |
$208.60
|
| 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 |
$394.85
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.90
|
| Rate for Payer: Health EOS Commercial |
$663.05
|
| Rate for Payer: HFN Commercial |
$685.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: NAPHCARE Commercial |
$447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$685.40
|
| Rate for Payer: Quartz Beloit One Network |
$365.05
|
| Rate for Payer: Quartz Commercial |
$484.25
|
| Rate for Payer: Quartz Medicare Advantage |
$447.00
|
| Rate for Payer: The Alliance Commercial |
$2,980.00
|
| Rate for Payer: United Healthcare PPO |
$558.75
|
| Rate for Payer: WEA Trust Commercial |
$409.75
|
| Rate for Payer: WPS Commercial |
$551.82
|
|
|
Yes - Video Swallow Eval (Flexible Fiberoptic)
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
2989780
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
