|
Bed/Chair Alarm (aquired from Central Services) - Devices and Equipment
|
Facility
|
IP
|
$938.00
|
|
| Hospital Charge Code |
3716168
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$897.48 |
| Rate for Payer: Aetna Commercial |
$877.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$897.48
|
| Rate for Payer: Health EOS Commercial |
$868.21
|
| Rate for Payer: HFN Commercial |
$897.48
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: Preferred Network Access Commercial |
$897.48
|
| Rate for Payer: Quartz Beloit One Network |
$478.00
|
| Rate for Payer: Quartz Commercial |
$585.31
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: WPS Commercial |
$722.54
|
|
|
Bedpan
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
3040329
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Bedpan
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
3040329
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Bedside Cystoscopy
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
3203513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
Bedside Cystoscopy
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
3203513
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
Bedside drainage bag A4357
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS A4357
|
| Hospital Charge Code |
3133592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$57.57 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$57.57
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Bedside drainage bag A4357
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS A4357
|
| Hospital Charge Code |
3133592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$39.58 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$14.39
|
| Rate for Payer: Anthem Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.39
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.39
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$21.59
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: Quartz Medicare Advantage |
$14.39
|
| Rate for Payer: The Alliance Commercial |
$39.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$25.19
|
|
|
Bedside drainage bag A4357
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS A4357
|
| Hospital Charge Code |
3133592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
BEHAVIORAL AND DEVELOPMENTAL DISORDERS
|
Facility
|
IP
|
$45,281.39
|
|
|
Service Code
|
MSDRG 886
|
| Min. Negotiated Rate |
$16,399.84 |
| Max. Negotiated Rate |
$45,281.39 |
| Rate for Payer: Aetna Managed Medicare |
$16,399.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,281.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,707.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,974.69
|
| Rate for Payer: Anthem Medicare Advantage |
$16,399.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,399.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,399.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,399.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,604.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,399.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,399.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,399.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,399.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,399.84
|
| Rate for Payer: NAPHCARE Commercial |
$24,599.76
|
| Rate for Payer: Quartz Medicare Advantage |
$16,399.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,399.84
|
| Rate for Payer: Wellcare Medicare |
$16,399.84
|
|
|
Behavioral and Qualitative Analysis of Voice - Speech Language Evaluation
|
Facility
|
IP
|
$678.00
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
3978012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$345.51 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.71
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$423.07
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
Behavioral and Qualitative Analysis of Voice - Speech Language Evaluation
|
Facility
|
OP
|
$678.00
|
|
|
Service Code
|
CPT 92524 GN
|
| Hospital Charge Code |
3978012
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$197.43 |
| Max. Negotiated Rate |
$648.71 |
| Rate for Payer: Aetna Commercial |
$634.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.40
|
| Rate for Payer: Aetna Managed Medicare |
$197.43
|
| 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 |
$373.71
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cash Price |
$203.40
|
| Rate for Payer: Cigna Commercial |
$648.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.60
|
| Rate for Payer: Health EOS Commercial |
$627.56
|
| Rate for Payer: HFN Commercial |
$648.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$564.10
|
| Rate for Payer: NAPHCARE Commercial |
$423.07
|
| Rate for Payer: Preferred Network Access Commercial |
$648.71
|
| Rate for Payer: Quartz Beloit One Network |
$345.51
|
| Rate for Payer: Quartz Commercial |
$458.33
|
| Rate for Payer: Quartz Medicare Advantage |
$423.07
|
| Rate for Payer: The Alliance Commercial |
$352.56
|
| Rate for Payer: United Healthcare PPO |
$528.84
|
| Rate for Payer: WEA Trust Commercial |
$387.82
|
| Rate for Payer: WPS Commercial |
$522.26
|
|
|
Behavioral Counseling for Obesity 15 min G0447
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
HCPCS G0447
|
| Hospital Charge Code |
5524668
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.26 |
| Max. Negotiated Rate |
$119.55 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$26.26
|
| Rate for Payer: Anthem Medicare Advantage |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.26
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$119.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.26
|
| Rate for Payer: Health EOS Commercial |
$114.51
|
| Rate for Payer: HFN Commercial |
$119.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.26
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$39.39
|
| Rate for Payer: Preferred Network Access Commercial |
$119.55
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$71.73
|
| Rate for Payer: Quartz Medicare Advantage |
$26.26
|
| Rate for Payer: The Alliance Commercial |
$72.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.26
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$45.95
|
|
|
BEHAVIORAL HEALTH RESIDENTIAL TREATMENT
|
Facility
|
OP
|
$86.48
|
|
|
Service Code
|
EAPG 00333
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Anthem Medicaid |
$83.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$83.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.15
|
| Rate for Payer: Dean Health Medicaid |
$83.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$83.15
|
| Rate for Payer: Managed Health Services Medicaid |
$86.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$83.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$83.15
|
| Rate for Payer: United Healthcare Medicaid |
$83.15
|
|
|
BEHAVIORAL HEATLH ASSESSMENT
|
Facility
|
OP
|
$134.96
|
|
|
Service Code
|
EAPG 00323
|
| Min. Negotiated Rate |
$129.77 |
| Max. Negotiated Rate |
$134.96 |
| Rate for Payer: Anthem Medicaid |
$129.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$129.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.77
|
| Rate for Payer: Dean Health Medicaid |
$129.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$129.77
|
| Rate for Payer: Managed Health Services Medicaid |
$134.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$129.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$129.77
|
| Rate for Payer: United Healthcare Medicaid |
$129.77
|
|
|
BELT FETAL MONITOR DISP 2 SET
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2963339
|
|
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
|
|
|
BELT FETAL MONITOR DISP 2 SET
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
HCPCS A9279
|
| Hospital Charge Code |
2963339
|
|
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
|
|
|
BELT GAIT TRANSFER 54 NEUTRAL #C655701
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
HCPCS E0700
|
| Hospital Charge Code |
2970161
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
BELT GAIT TRANSFER 54 NEUTRAL #C655701
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
HCPCS E0700
|
| Hospital Charge Code |
2970161
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$42.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.66
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$91.73
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$91.73
|
| Rate for Payer: The Alliance Commercial |
$53.51
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
BELT RECHARGER LARGE INTERSTIM FP9000L
|
Facility
|
IP
|
$799.00
|
|
| Hospital Charge Code |
5603556
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$407.17 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$498.58
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
BELT RECHARGER LARGE INTERSTIM FP9000L
|
Facility
|
OP
|
$799.00
|
|
| Hospital Charge Code |
5603556
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Aetna Managed Medicare |
$232.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.02
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.22
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$540.12
|
| Rate for Payer: Quartz Medicare Advantage |
$498.58
|
| Rate for Payer: The Alliance Commercial |
$415.48
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
BELT RECHARGER MEDIUM INTERSTIM FP9000M
|
Facility
|
OP
|
$799.00
|
|
| Hospital Charge Code |
5603698
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Aetna Managed Medicare |
$232.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.02
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.22
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$540.12
|
| Rate for Payer: Quartz Medicare Advantage |
$498.58
|
| Rate for Payer: The Alliance Commercial |
$415.48
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
BELT RECHARGER MEDIUM INTERSTIM FP9000M
|
Facility
|
IP
|
$799.00
|
|
| Hospital Charge Code |
5603698
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$407.17 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$498.58
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
BELT RECHARGER SMALL INTERSTIM FP9000S
|
Facility
|
IP
|
$799.00
|
|
| Hospital Charge Code |
5603699
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$407.17 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$498.58
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
BELT RECHARGER SMALL INTERSTIM FP9000S
|
Facility
|
OP
|
$799.00
|
|
| Hospital Charge Code |
5603699
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Aetna Managed Medicare |
$232.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.02
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.22
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$540.12
|
| Rate for Payer: Quartz Medicare Advantage |
$498.58
|
| Rate for Payer: The Alliance Commercial |
$415.48
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
Benadryl 25 mg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J1200
|
| Hospital Charge Code |
2958849
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.74 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$0.74
|
| Rate for Payer: Anthem Medicare Advantage |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.74
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.74
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.74
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$1.11
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$0.74
|
| Rate for Payer: The Alliance Commercial |
$2.03
|
| Rate for Payer: United Healthcare Medicaid |
$0.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.74
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$1.29
|
|
