|
Yes - PT Ultrasound Charges
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
2989859
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$99.22
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
Yes - PT Ultrasound Charges
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
2989859
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$72.76 |
| Max. Negotiated Rate |
$157.09 |
| Rate for Payer: Aetna Commercial |
$157.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$157.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.22
|
| Rate for Payer: Health EOS Commercial |
$150.48
|
| Rate for Payer: HFN Commercial |
$157.09
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$157.09
|
| Rate for Payer: Quartz Beloit One Network |
$72.76
|
| Rate for Payer: Quartz Commercial |
$94.26
|
| Rate for Payer: The Alliance Commercial |
$82.68
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
Yes - PT Ultrasound Charges
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 97035 GP
|
| Hospital Charge Code |
2989859
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$46.30 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$46.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.54
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$99.22
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$107.48
|
| Rate for Payer: Quartz Medicare Advantage |
$99.22
|
| Rate for Payer: The Alliance Commercial |
$82.68
|
| Rate for Payer: United Healthcare PPO |
$124.02
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
Yes - PT Vasopneumatic Charge
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
2989867
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$129.17
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
Yes - PT Vasopneumatic Charge
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 97018 GP
|
| Hospital Charge Code |
2989867
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Aetna Managed Medicare |
$60.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.47
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: NAPHCARE Commercial |
$129.17
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$139.93
|
| Rate for Payer: Quartz Medicare Advantage |
$129.17
|
| Rate for Payer: The Alliance Commercial |
$107.64
|
| Rate for Payer: United Healthcare PPO |
$161.46
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
Yes - PT Whirlpool Charge
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
2989850
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$85.11 |
| Max. Negotiated Rate |
$183.77 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.06
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: The Alliance Commercial |
$96.72
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Yes - PT Whirlpool Charge
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
2989850
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Yes - PT Whirlpool Charge
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 97022 GP
|
| Hospital Charge Code |
2989850
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$54.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$116.06
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$116.06
|
| Rate for Payer: The Alliance Commercial |
$96.72
|
| Rate for Payer: United Healthcare PPO |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Yes - Pulse Oximetry with Exercise Charge
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
3610753
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.02
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$68.02
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$68.02
|
| Rate for Payer: The Alliance Commercial |
$16.39
|
| Rate for Payer: United Healthcare PPO |
$85.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Yes - Pulse Oximetry with Exercise Charge
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
3610753
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Yes - Respiratory Mechanics Charge
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
2990198
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Yes - Respiratory Mechanics Charge
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
2990198
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$59.90 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.90
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Yes - Respirguard Nebulizer Charge
|
Facility
|
OP
|
$437.00
|
|
| Hospital Charge Code |
3006970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$127.25 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$127.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$295.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$227.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$218.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.33
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.86
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$272.69
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$295.41
|
| Rate for Payer: Quartz Medicare Advantage |
$272.69
|
| Rate for Payer: The Alliance Commercial |
$227.24
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
Yes - Respirguard Nebulizer Charge
|
Facility
|
IP
|
$437.00
|
|
| Hospital Charge Code |
3006970
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$222.70 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$272.69
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
Yes - Resuscitation Bag/Mask Adult Charge
|
Facility
|
IP
|
$287.00
|
|
| Hospital Charge Code |
3006971
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$146.26 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$179.09
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
Yes - Resuscitation Bag/Mask Adult Charge
|
Facility
|
OP
|
$287.00
|
|
| Hospital Charge Code |
3006971
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Aetna Managed Medicare |
$83.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$194.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$149.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$143.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.03
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.86
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: NAPHCARE Commercial |
$179.09
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$194.01
|
| Rate for Payer: Quartz Medicare Advantage |
$179.09
|
| Rate for Payer: The Alliance Commercial |
$149.24
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
Yes - Resuscitation Bag/Mask Infant Charge
|
Facility
|
OP
|
$287.00
|
|
| Hospital Charge Code |
3006973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Aetna Managed Medicare |
$83.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$194.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$149.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$143.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.03
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.86
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: NAPHCARE Commercial |
$179.09
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$194.01
|
| Rate for Payer: Quartz Medicare Advantage |
$179.09
|
| Rate for Payer: The Alliance Commercial |
$149.24
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
Yes - Resuscitation Bag/Mask Infant Charge
|
Facility
|
IP
|
$287.00
|
|
| Hospital Charge Code |
3006973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$146.26 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$179.09
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
Yes - Resuscitation Bag/Mask Peds Charge
|
Facility
|
IP
|
$287.00
|
|
| Hospital Charge Code |
3006972
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$146.26 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$179.09
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
Yes - Resuscitation Bag/Mask Peds Charge
|
Facility
|
OP
|
$287.00
|
|
| Hospital Charge Code |
3006972
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$83.57 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Aetna Managed Medicare |
$83.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$194.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$149.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$143.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.03
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$223.86
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: NAPHCARE Commercial |
$179.09
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$194.01
|
| Rate for Payer: Quartz Medicare Advantage |
$179.09
|
| Rate for Payer: The Alliance Commercial |
$149.24
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
Yes - Resuscitation- Complex Charge
|
Facility
|
OP
|
$2,522.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
3006933
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$2,413.05 |
| Rate for Payer: Aetna Commercial |
$2,360.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,255.68
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,704.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,311.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,258.98
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cigna Commercial |
$2,413.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,467.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$2,334.36
|
| Rate for Payer: HFN Commercial |
$2,413.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$2,098.30
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,413.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.21
|
| Rate for Payer: Quartz Commercial |
$1,704.87
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$1,967.16
|
| Rate for Payer: WEA Trust Commercial |
$1,442.58
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$1,942.70
|
|
|
Yes - Resuscitation- Complex Charge
|
Facility
|
IP
|
$2,522.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
3006933
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$1,285.21 |
| Max. Negotiated Rate |
$2,413.05 |
| Rate for Payer: Aetna Commercial |
$2,360.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,390.13
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cigna Commercial |
$2,413.05
|
| Rate for Payer: Health EOS Commercial |
$2,334.36
|
| Rate for Payer: HFN Commercial |
$2,413.05
|
| Rate for Payer: Multiplan Commercial |
$2,098.30
|
| Rate for Payer: Preferred Network Access Commercial |
$2,413.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.21
|
| Rate for Payer: Quartz Commercial |
$1,573.73
|
| Rate for Payer: WEA Trust Commercial |
$1,442.58
|
| Rate for Payer: WPS Commercial |
$1,942.70
|
|
|
Yes - Resuscitation- Simple Charge
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
3006932
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$149.76 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$202.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$149.76
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
Yes - Resuscitation- Simple Charge
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
3006932
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
Yes - RT Airway Maintinence Charge
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
2990194
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$57.91 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.91
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
