|
Yes - Speaking Trach Valve Charge
|
Facility
|
IP
|
$231.00
|
|
| Hospital Charge Code |
2990200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Yes - Speaking Trach Valve Charge
|
Facility
|
OP
|
$231.00
|
|
| Hospital Charge Code |
2990200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$67.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$144.14
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| Rate for Payer: Quartz Medicare Advantage |
$144.14
|
| Rate for Payer: The Alliance Commercial |
$120.12
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Yes - Speech Eval Fitting Voice Prosth Charges
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
CPT 92597 GN
|
| Hospital Charge Code |
2989782
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$120.85 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Aetna Managed Medicare |
$120.85
|
| 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 |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.53
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: NAPHCARE Commercial |
$258.96
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$280.54
|
| Rate for Payer: Quartz Medicare Advantage |
$258.96
|
| Rate for Payer: The Alliance Commercial |
$215.80
|
| Rate for Payer: United Healthcare PPO |
$323.70
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
Yes - Speech Eval Fitting Voice Prosth Charges
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
CPT 92597 GN
|
| Hospital Charge Code |
2989782
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$211.48 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
Yes - Speech Language Therapy Charge
|
Facility
|
IP
|
$574.00
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
3007311
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$292.51 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$358.18
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
Yes - Speech Language Therapy Charge
|
Facility
|
OP
|
$574.00
|
|
|
Service Code
|
CPT 92507 GN
|
| Hospital Charge Code |
3007311
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Aetna Managed Medicare |
$167.15
|
| 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 |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.07
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: NAPHCARE Commercial |
$358.18
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$388.02
|
| Rate for Payer: Quartz Medicare Advantage |
$358.18
|
| Rate for Payer: The Alliance Commercial |
$298.48
|
| Rate for Payer: United Healthcare PPO |
$447.72
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
Yes - Speech Multi-View Video VP Eval Charges
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
CPT 70371 GN
|
| Hospital Charge Code |
2987973
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
Yes - Speech Multi-View Video VP Eval Charges
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 70371 GN
|
| Hospital Charge Code |
2987973
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| 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 |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.68
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: United Healthcare PPO |
$429.78
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
Yes - Speech Non-Instrum Swallow Eval Charges
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
2987972
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$508.06 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.69
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$331.34
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
Yes - Speech Non-Instrum Swallow Eval Charges
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 92610 GN
|
| Hospital Charge Code |
2987972
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$154.63 |
| Max. Negotiated Rate |
$508.06 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Aetna Managed Medicare |
$154.63
|
| 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 |
$292.69
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.04
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: NAPHCARE Commercial |
$331.34
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$358.96
|
| Rate for Payer: Quartz Medicare Advantage |
$331.34
|
| Rate for Payer: The Alliance Commercial |
$276.12
|
| Rate for Payer: United Healthcare PPO |
$414.18
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
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 |
$254.29 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$311.38
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
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 |
$145.31 |
| Max. Negotiated Rate |
$477.44 |
| Rate for Payer: Aetna Commercial |
$467.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.31
|
| Rate for Payer: Aetna Managed Medicare |
$145.31
|
| 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 |
$275.05
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cash Price |
$149.70
|
| Rate for Payer: Cigna Commercial |
$477.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.42
|
| Rate for Payer: Health EOS Commercial |
$461.87
|
| Rate for Payer: HFN Commercial |
$477.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$415.17
|
| Rate for Payer: NAPHCARE Commercial |
$311.38
|
| Rate for Payer: Preferred Network Access Commercial |
$477.44
|
| Rate for Payer: Quartz Beloit One Network |
$254.29
|
| Rate for Payer: Quartz Commercial |
$337.32
|
| Rate for Payer: Quartz Medicare Advantage |
$311.38
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: United Healthcare PPO |
$389.22
|
| Rate for Payer: WEA Trust Commercial |
$285.43
|
| Rate for Payer: WPS Commercial |
$384.38
|
|
|
Yes - Sputum Collection Charge
|
Facility
|
OP
|
$98.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
2990181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.92
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| 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 |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| 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 |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$66.25
|
| 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 |
$76.44
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
Yes - Sputum Collection Charge
|
Facility
|
IP
|
$98.00
|
|
|
Service Code
|
CPT 94799
|
| Hospital Charge Code |
2990181
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.94 |
| Max. Negotiated Rate |
$93.77 |
| Rate for Payer: Aetna Commercial |
$91.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.02
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.77
|
| Rate for Payer: Health EOS Commercial |
$90.71
|
| Rate for Payer: HFN Commercial |
$93.77
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: Preferred Network Access Commercial |
$93.77
|
| Rate for Payer: Quartz Beloit One Network |
$49.94
|
| Rate for Payer: Quartz Commercial |
$61.15
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$75.49
|
|
|
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 |
$193.14 |
| Max. Negotiated Rate |
$362.63 |
| Rate for Payer: Aetna Commercial |
$354.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.90
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$362.63
|
| Rate for Payer: Health EOS Commercial |
$350.80
|
| Rate for Payer: HFN Commercial |
$362.63
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: Preferred Network Access Commercial |
$362.63
|
| Rate for Payer: Quartz Beloit One Network |
$193.14
|
| Rate for Payer: Quartz Commercial |
$236.50
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: WPS Commercial |
$291.94
|
|
|
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 |
$189.20 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$354.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.98
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$256.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$197.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$189.20
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$230.45
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cash Price |
$113.70
|
| Rate for Payer: Cigna Commercial |
$362.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$350.80
|
| Rate for Payer: HFN Commercial |
$362.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$230.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$230.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$230.45
|
| Rate for Payer: Multiplan Commercial |
$315.33
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$362.63
|
| Rate for Payer: Quartz Beloit One Network |
$193.14
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: Quartz Medicare Advantage |
$230.45
|
| Rate for Payer: The Alliance Commercial |
$921.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.45
|
| Rate for Payer: United Healthcare PPO |
$295.62
|
| Rate for Payer: WEA Trust Commercial |
$216.79
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$291.94
|
|
|
Yes - Standardized Cognitive Performance Test
|
Facility
|
OP
|
$885.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
4163486
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Aetna Managed Medicare |
$257.71
|
| 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 |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$515.07
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: NAPHCARE Commercial |
$552.24
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$598.26
|
| Rate for Payer: Quartz Medicare Advantage |
$552.24
|
| Rate for Payer: The Alliance Commercial |
$416.29
|
| Rate for Payer: United Healthcare PPO |
$690.30
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
Yes - Standardized Cognitive Performance Test
|
Facility
|
IP
|
$885.00
|
|
|
Service Code
|
CPT 96125
|
| Hospital Charge Code |
4163486
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$451.00 |
| Max. Negotiated Rate |
$846.77 |
| Rate for Payer: Aetna Commercial |
$828.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$487.81
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$846.77
|
| Rate for Payer: Health EOS Commercial |
$819.16
|
| Rate for Payer: HFN Commercial |
$846.77
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: Preferred Network Access Commercial |
$846.77
|
| Rate for Payer: Quartz Beloit One Network |
$451.00
|
| Rate for Payer: Quartz Commercial |
$552.24
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$681.72
|
|
|
Yes - Swallow Evaluation Charge
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4075916
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$712.82 |
| Rate for Payer: Aetna Commercial |
$697.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$410.64
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$712.82
|
| Rate for Payer: Health EOS Commercial |
$689.57
|
| Rate for Payer: HFN Commercial |
$712.82
|
| Rate for Payer: Multiplan Commercial |
$619.84
|
| Rate for Payer: Preferred Network Access Commercial |
$712.82
|
| Rate for Payer: Quartz Beloit One Network |
$379.65
|
| Rate for Payer: Quartz Commercial |
$464.88
|
| Rate for Payer: WEA Trust Commercial |
$426.14
|
| Rate for Payer: WPS Commercial |
$573.87
|
|
|
Yes - Swallow Evaluation Charge
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4075916
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$210.08 |
| Max. Negotiated Rate |
$712.82 |
| Rate for Payer: Aetna Commercial |
$697.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.33
|
| Rate for Payer: Aetna Managed Medicare |
$216.94
|
| 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 |
$410.64
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$712.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$433.59
|
| Rate for Payer: Health EOS Commercial |
$689.57
|
| Rate for Payer: HFN Commercial |
$712.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$619.84
|
| Rate for Payer: NAPHCARE Commercial |
$464.88
|
| Rate for Payer: Preferred Network Access Commercial |
$712.82
|
| Rate for Payer: Quartz Beloit One Network |
$379.65
|
| Rate for Payer: Quartz Commercial |
$503.62
|
| Rate for Payer: Quartz Medicare Advantage |
$464.88
|
| Rate for Payer: The Alliance Commercial |
$387.40
|
| Rate for Payer: United Healthcare PPO |
$581.10
|
| Rate for Payer: WEA Trust Commercial |
$426.14
|
| Rate for Payer: WPS Commercial |
$573.87
|
|
|
Yes - Tent Canopy Charge
|
Facility
|
IP
|
$157.00
|
|
| Hospital Charge Code |
3006975
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$97.97
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
Yes - Tent Canopy Charge
|
Facility
|
OP
|
$157.00
|
|
| Hospital Charge Code |
3006975
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$45.72 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Aetna Managed Medicare |
$45.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.37
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.46
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: NAPHCARE Commercial |
$97.97
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$106.13
|
| Rate for Payer: Quartz Medicare Advantage |
$97.97
|
| Rate for Payer: The Alliance Commercial |
$81.64
|
| Rate for Payer: United Healthcare PPO |
$122.46
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
Yes - Thoracentesis Charge
|
Facility
|
IP
|
$731.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
3006938
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.52 |
| Max. Negotiated Rate |
$699.42 |
| Rate for Payer: Aetna Commercial |
$684.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.93
|
| Rate for Payer: Cash Price |
$219.30
|
| Rate for Payer: Cigna Commercial |
$699.42
|
| Rate for Payer: Health EOS Commercial |
$676.61
|
| Rate for Payer: HFN Commercial |
$699.42
|
| Rate for Payer: Multiplan Commercial |
$608.19
|
| Rate for Payer: Preferred Network Access Commercial |
$699.42
|
| Rate for Payer: Quartz Beloit One Network |
$372.52
|
| Rate for Payer: Quartz Commercial |
$456.14
|
| Rate for Payer: WEA Trust Commercial |
$418.13
|
| Rate for Payer: WPS Commercial |
$563.09
|
|
|
Yes - Thoracentesis Charge
|
Facility
|
OP
|
$731.00
|
|
|
Service Code
|
CPT 32554
|
| Hospital Charge Code |
3006938
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$372.52 |
| Max. Negotiated Rate |
$3,030.56 |
| Rate for Payer: Aetna Commercial |
$684.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$653.81
|
| Rate for Payer: Aetna Managed Medicare |
$660.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$402.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$660.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$660.17
|
| 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 |
$699.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$660.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$425.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$660.17
|
| Rate for Payer: Health EOS Commercial |
$676.61
|
| Rate for Payer: HFN Commercial |
$699.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,455.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$660.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$660.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$660.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$660.17
|
| Rate for Payer: Multiplan Commercial |
$608.19
|
| Rate for Payer: NAPHCARE Commercial |
$990.26
|
| Rate for Payer: Preferred Network Access Commercial |
$699.42
|
| Rate for Payer: Quartz Beloit One Network |
$372.52
|
| Rate for Payer: Quartz Commercial |
$494.16
|
| Rate for Payer: Quartz Medicare Advantage |
$660.17
|
| Rate for Payer: The Alliance Commercial |
$2,640.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$660.17
|
| Rate for Payer: WEA Trust Commercial |
$418.13
|
| Rate for Payer: Wellcare Medicare |
$660.17
|
| Rate for Payer: WPS Commercial |
$563.09
|
|
|
Yes - Tracheostomy Mask Charge
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
3006976
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$22.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.81
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.06
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$48.05
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$52.05
|
| Rate for Payer: Quartz Medicare Advantage |
$48.05
|
| Rate for Payer: The Alliance Commercial |
$40.04
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
