|
Yes - Balloon Tamponade Catheter Charge
|
Facility
|
IP
|
$490.00
|
|
| Hospital Charge Code |
2990204
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$249.70 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$305.76
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
Yes - Balloon Tamponade Catheter Charge
|
Facility
|
OP
|
$490.00
|
|
| Hospital Charge Code |
2990204
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$468.83 |
| Rate for Payer: Aetna Commercial |
$458.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Aetna Managed Medicare |
$142.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$331.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.09
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$468.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.18
|
| Rate for Payer: Health EOS Commercial |
$453.54
|
| Rate for Payer: HFN Commercial |
$468.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$382.20
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: NAPHCARE Commercial |
$305.76
|
| Rate for Payer: Preferred Network Access Commercial |
$468.83
|
| Rate for Payer: Quartz Beloit One Network |
$249.70
|
| Rate for Payer: Quartz Commercial |
$331.24
|
| Rate for Payer: Quartz Medicare Advantage |
$305.76
|
| Rate for Payer: The Alliance Commercial |
$254.80
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
Yes - Bipap/CPAP Circuit Charge
|
Facility
|
IP
|
$128.00
|
|
| Hospital Charge Code |
3006942
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$79.87
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Yes - Bipap/CPAP Circuit Charge
|
Facility
|
OP
|
$128.00
|
|
| Hospital Charge Code |
3006942
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.50
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.84
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$86.53
|
| Rate for Payer: Quartz Medicare Advantage |
$79.87
|
| Rate for Payer: The Alliance Commercial |
$66.56
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Yes - BiPAP/CPAP Full Face Mask Charge
|
Facility
|
OP
|
$277.00
|
|
| Hospital Charge Code |
3006944
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$80.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.21
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.06
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$172.85
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$187.25
|
| Rate for Payer: Quartz Medicare Advantage |
$172.85
|
| Rate for Payer: The Alliance Commercial |
$144.04
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
Yes - BiPAP/CPAP Full Face Mask Charge
|
Facility
|
IP
|
$277.00
|
|
| Hospital Charge Code |
3006944
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$172.85
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
Yes - Bipap/CPAP Nasal Mask Charge
|
Facility
|
IP
|
$277.00
|
|
| Hospital Charge Code |
3006943
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$172.85
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
Yes - Bipap/CPAP Nasal Mask Charge
|
Facility
|
OP
|
$277.00
|
|
| Hospital Charge Code |
3006943
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$80.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.21
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.06
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$172.85
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$187.25
|
| Rate for Payer: Quartz Medicare Advantage |
$172.85
|
| Rate for Payer: The Alliance Commercial |
$144.04
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
Yes - Box of Saline Vials Charge
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
3006946
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Yes - Box of Saline Vials Charge
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
3006946
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.02
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| Rate for Payer: Quartz Medicare Advantage |
$36.82
|
| Rate for Payer: The Alliance Commercial |
$30.68
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Yes - Bronchoscopy Ventilator Adapter Charge
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
3006945
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$14.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.20
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Yes - Bronchoscopy Ventilator Adapter Charge
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
3006945
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Yes (CBI bag changed)* - CBI Bag Changed
|
Facility
|
OP
|
$129.00
|
|
| Hospital Charge Code |
4075877
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.62
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$80.50
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| Rate for Payer: Quartz Medicare Advantage |
$80.50
|
| Rate for Payer: The Alliance Commercial |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Yes (CBI bag changed)* - CBI Bag Changed
|
Facility
|
IP
|
$129.00
|
|
| Hospital Charge Code |
4075877
|
|
Hospital Revenue Code
|
258
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Yes - Continuous Nebulizer, subsequent Charge
|
Facility
|
IP
|
$2,210.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
3006934
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$1,126.22 |
| Max. Negotiated Rate |
$2,114.53 |
| Rate for Payer: Aetna Commercial |
$2,068.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,218.15
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$2,114.53
|
| Rate for Payer: Health EOS Commercial |
$2,045.58
|
| Rate for Payer: HFN Commercial |
$2,114.53
|
| Rate for Payer: Multiplan Commercial |
$1,838.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,114.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.22
|
| Rate for Payer: Quartz Commercial |
$1,379.04
|
| Rate for Payer: WEA Trust Commercial |
$1,264.12
|
| Rate for Payer: WPS Commercial |
$1,702.36
|
|
|
Yes - Continuous Nebulizer, subsequent Charge
|
Facility
|
OP
|
$2,210.00
|
|
|
Service Code
|
CPT 94645
|
| Hospital Charge Code |
3006934
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$65.64 |
| Max. Negotiated Rate |
$2,114.53 |
| Rate for Payer: Aetna Commercial |
$2,068.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,976.62
|
| Rate for Payer: Aetna Managed Medicare |
$643.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,493.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,149.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,103.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,218.15
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cash Price |
$663.00
|
| Rate for Payer: Cigna Commercial |
$2,114.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,286.22
|
| Rate for Payer: Health EOS Commercial |
$2,045.58
|
| Rate for Payer: HFN Commercial |
$2,114.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,723.80
|
| Rate for Payer: Multiplan Commercial |
$1,838.72
|
| Rate for Payer: NAPHCARE Commercial |
$1,379.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,114.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,126.22
|
| Rate for Payer: Quartz Commercial |
$1,493.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,379.04
|
| Rate for Payer: The Alliance Commercial |
$65.64
|
| Rate for Payer: United Healthcare PPO |
$1,723.80
|
| Rate for Payer: WEA Trust Commercial |
$1,264.12
|
| Rate for Payer: WPS Commercial |
$1,702.36
|
|
|
Yes - Continuous Oximeter Monitor Charge
|
Facility
|
OP
|
$1,115.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
3023868
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$1,066.83 |
| Rate for Payer: Aetna Commercial |
$1,043.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$997.26
|
| Rate for Payer: Aetna Managed Medicare |
$324.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$753.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$579.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$556.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.59
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,066.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.93
|
| Rate for Payer: Health EOS Commercial |
$1,032.04
|
| Rate for Payer: HFN Commercial |
$1,066.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$869.70
|
| Rate for Payer: Multiplan Commercial |
$927.68
|
| Rate for Payer: NAPHCARE Commercial |
$695.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,066.83
|
| Rate for Payer: Quartz Beloit One Network |
$568.20
|
| Rate for Payer: Quartz Commercial |
$753.74
|
| Rate for Payer: Quartz Medicare Advantage |
$695.76
|
| Rate for Payer: The Alliance Commercial |
$16.39
|
| Rate for Payer: United Healthcare PPO |
$869.70
|
| Rate for Payer: WEA Trust Commercial |
$637.78
|
| Rate for Payer: WPS Commercial |
$858.88
|
|
|
Yes - Continuous Oximeter Monitor Charge
|
Facility
|
IP
|
$1,115.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
3023868
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$568.20 |
| Max. Negotiated Rate |
$1,066.83 |
| Rate for Payer: Aetna Commercial |
$1,043.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$997.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.59
|
| Rate for Payer: Cash Price |
$334.50
|
| Rate for Payer: Cigna Commercial |
$1,066.83
|
| Rate for Payer: Health EOS Commercial |
$1,032.04
|
| Rate for Payer: HFN Commercial |
$1,066.83
|
| Rate for Payer: Multiplan Commercial |
$927.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,066.83
|
| Rate for Payer: Quartz Beloit One Network |
$568.20
|
| Rate for Payer: Quartz Commercial |
$695.76
|
| Rate for Payer: WEA Trust Commercial |
$637.78
|
| Rate for Payer: WPS Commercial |
$858.88
|
|
|
Yes - Corrugated Tubing Charge
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
3006949
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Yes - Corrugated Tubing Charge
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
3006949
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.60
|
| Rate for Payer: The Alliance Commercial |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Yes - CPAP Nasal Mask Charge
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
3004216
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Yes - CPAP Nasal Mask Charge
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
3004216
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: United Healthcare PPO |
$207.48
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Yes - CPT Palm Percussor Charge
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
2990206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$14.56
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Yes - CPT Palm Percussor Charge
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
2990206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Yes - CPT Vest Charge
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 94669
|
| Hospital Charge Code |
3006947
|
|
Hospital Revenue Code
|
419
|
| Min. Negotiated Rate |
$77.88 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.88
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| 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 |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| 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 |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$105.46
|
| 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 |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
