|
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 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 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 - 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 - 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
|
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 - 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 - 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 |
$4,386.95 |
| 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 |
$4,386.95
|
| 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: United Healthcare PPO |
$2,347.28
|
| 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
|
|
|
Yes - Tracheostomy Mask Charge
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
3006976
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| 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: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$48.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Yes - Training ST Generating Device Charges
|
Facility
|
IP
|
$451.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
2989781
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$229.83 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$403.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.59
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$431.52
|
| Rate for Payer: Health EOS Commercial |
$417.45
|
| Rate for Payer: HFN Commercial |
$431.52
|
| Rate for Payer: Multiplan Commercial |
$375.23
|
| Rate for Payer: Preferred Network Access Commercial |
$431.52
|
| Rate for Payer: Quartz Beloit One Network |
$229.83
|
| Rate for Payer: Quartz Commercial |
$281.42
|
| Rate for Payer: WEA Trust Commercial |
$257.97
|
| Rate for Payer: WPS Commercial |
$347.41
|
|
|
Yes - Training ST Generating Device Charges
|
Facility
|
OP
|
$451.00
|
|
|
Service Code
|
CPT 92609 GN
|
| Hospital Charge Code |
2989781
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$131.33 |
| Max. Negotiated Rate |
$431.52 |
| Rate for Payer: Quartz Medicare Advantage |
$281.42
|
| Rate for Payer: Aetna Commercial |
$422.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$403.37
|
| Rate for Payer: Aetna Managed Medicare |
$131.33
|
| 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 |
$248.59
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$431.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$262.48
|
| Rate for Payer: Health EOS Commercial |
$417.45
|
| Rate for Payer: HFN Commercial |
$431.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$375.23
|
| Rate for Payer: NAPHCARE Commercial |
$281.42
|
| Rate for Payer: Preferred Network Access Commercial |
$431.52
|
| Rate for Payer: Quartz Beloit One Network |
$229.83
|
| Rate for Payer: Quartz Commercial |
$304.88
|
| Rate for Payer: The Alliance Commercial |
$234.52
|
| Rate for Payer: United Healthcare PPO |
$351.78
|
| Rate for Payer: WEA Trust Commercial |
$257.97
|
| Rate for Payer: WPS Commercial |
$347.41
|
|
|
Yes - Ventilator Circuit Charge
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
3006978
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Yes - Ventilator Circuit Charge
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
3006978
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Yes - Venti-Mask Charge
|
Facility
|
OP
|
$77.00
|
|
| Hospital Charge Code |
3006977
|
|
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
|
|
|
Yes - Venti-Mask Charge
|
Facility
|
IP
|
$77.00
|
|
| Hospital Charge Code |
3006977
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| 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: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$48.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Yes - Video Swallow Eval Charge (Motion)
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4075915
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$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 - Video Swallow Eval Charge (Motion)
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
4075915
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$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 - Video Swallow Eval (Flexible Fiberoptic)
|
Facility
|
IP
|
$646.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
2989780
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$403.10
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
Yes - Video Swallow Eval (Flexible Fiberoptic)
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
2989780
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$188.12 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Aetna Managed Medicare |
$188.12
|
| 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 |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.97
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: NAPHCARE Commercial |
$403.10
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$436.70
|
| Rate for Payer: Quartz Medicare Advantage |
$403.10
|
| Rate for Payer: The Alliance Commercial |
$335.92
|
| Rate for Payer: United Healthcare PPO |
$503.88
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
Yes - Wound Care Non-Selective Debride Charge
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
3554169
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$292.64 |
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$105.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.77
|
| Rate for Payer: Health EOS Commercial |
$101.26
|
| Rate for Payer: HFN Commercial |
$105.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.64
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: Preferred Network Access Commercial |
$105.72
|
| Rate for Payer: Quartz Beloit One Network |
$48.96
|
| Rate for Payer: Quartz Commercial |
$63.43
|
| Rate for Payer: The Alliance Commercial |
$55.64
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
