|
CAP 6.0 PROTECTION FIXATOR 394.994
|
Facility
IP
|
$84.00
|
|
| Hospital Charge Code |
2966156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
CAP 6.0 PROTECTION FIXATOR 394.994
|
Facility
OP
|
$84.00
|
|
| Hospital Charge Code |
2966156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
CAP 8.0 PROTECTIVE 395.781
|
Facility
OP
|
$64.00
|
|
| Hospital Charge Code |
2966157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$256.00 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Aetna Managed Medicare |
$17.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.81
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.00
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$41.60
|
| Rate for Payer: Quartz Medicare Advantage |
$38.40
|
| Rate for Payer: The Alliance Commercial |
$256.00
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
CAP 8.0 PROTECTIVE 395.781
|
Facility
IP
|
$64.00
|
|
| Hospital Charge Code |
2966157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$58.88 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$38.40
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
Cap changed - Central IV Care:
|
Facility
IP
|
$111.00
|
|
| Hospital Charge Code |
3025901
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Cap changed - Central IV Care:
|
Facility
OP
|
$111.00
|
|
| Hospital Charge Code |
3025901
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.08 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$31.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.25
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.60
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
CAPD Completed Training Day
|
Facility
IP
|
$2,063.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
3215530
|
|
Hospital Revenue Code
|
840
|
| Min. Negotiated Rate |
$1,010.87 |
| Max. Negotiated Rate |
$1,897.96 |
| Rate for Payer: Aetna Commercial |
$1,856.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,093.39
|
| Rate for Payer: Cash Price |
$618.90
|
| Rate for Payer: Cigna Commercial |
$1,897.96
|
| Rate for Payer: Health EOS Commercial |
$1,836.07
|
| Rate for Payer: HFN Commercial |
$1,897.96
|
| Rate for Payer: Multiplan Commercial |
$1,650.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.87
|
| Rate for Payer: Quartz Commercial |
$1,237.80
|
| Rate for Payer: WEA Trust Commercial |
$1,134.65
|
| Rate for Payer: WPS Commercial |
$1,528.06
|
|
|
CAPD Completed Training Day
|
Facility
OP
|
$2,063.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
3215530
|
|
Hospital Revenue Code
|
840
|
| Min. Negotiated Rate |
$577.64 |
| Max. Negotiated Rate |
$1,897.96 |
| Rate for Payer: Aetna Commercial |
$1,856.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,774.18
|
| Rate for Payer: Aetna Managed Medicare |
$577.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,340.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,031.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$990.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,093.39
|
| Rate for Payer: Cash Price |
$618.90
|
| Rate for Payer: Cigna Commercial |
$1,897.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,154.45
|
| Rate for Payer: Health EOS Commercial |
$1,836.07
|
| Rate for Payer: HFN Commercial |
$1,897.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,547.25
|
| Rate for Payer: Multiplan Commercial |
$1,650.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.87
|
| Rate for Payer: Quartz Commercial |
$1,340.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,237.80
|
| Rate for Payer: United Healthcare PPO |
$1,547.25
|
| Rate for Payer: WEA Trust Commercial |
$1,134.65
|
| Rate for Payer: WPS Commercial |
$1,528.06
|
|
|
CAP DHE LCP DHHS IMPACTOR CAP
|
Facility
IP
|
$2,565.00
|
|
| Hospital Charge Code |
2966158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.85 |
| Max. Negotiated Rate |
$2,359.80 |
| Rate for Payer: Aetna Commercial |
$2,308.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,359.45
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cigna Commercial |
$2,359.80
|
| Rate for Payer: Health EOS Commercial |
$2,282.85
|
| Rate for Payer: HFN Commercial |
$2,359.80
|
| Rate for Payer: Multiplan Commercial |
$2,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,539.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,359.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.85
|
| Rate for Payer: Quartz Commercial |
$1,539.00
|
| Rate for Payer: WEA Trust Commercial |
$1,410.75
|
| Rate for Payer: WPS Commercial |
$1,899.90
|
|
|
CAP DHE LCP DHHS IMPACTOR CAP
|
Facility
OP
|
$2,565.00
|
|
| Hospital Charge Code |
2966158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$718.20 |
| Max. Negotiated Rate |
$10,260.00 |
| Rate for Payer: Aetna Commercial |
$2,308.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,205.90
|
| Rate for Payer: Aetna Managed Medicare |
$718.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,667.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,282.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,231.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,359.45
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cigna Commercial |
$2,359.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,435.37
|
| Rate for Payer: Health EOS Commercial |
$2,282.85
|
| Rate for Payer: HFN Commercial |
$2,359.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,923.75
|
| Rate for Payer: Multiplan Commercial |
$2,052.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,539.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,359.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.85
|
| Rate for Payer: Quartz Commercial |
$1,667.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,539.00
|
| Rate for Payer: The Alliance Commercial |
$10,260.00
|
| Rate for Payer: WEA Trust Commercial |
$1,410.75
|
| Rate for Payer: WPS Commercial |
$1,899.90
|
|
|
CAPD Inpatient
|
Facility
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005582
|
|
Hospital Revenue Code
|
803
|
| Min. Negotiated Rate |
$658.07 |
| Max. Negotiated Rate |
$1,235.56 |
| Rate for Payer: Aetna Commercial |
$1,208.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.79
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,235.56
|
| Rate for Payer: Health EOS Commercial |
$1,195.27
|
| Rate for Payer: HFN Commercial |
$1,235.56
|
| Rate for Payer: Multiplan Commercial |
$1,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$805.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.56
|
| Rate for Payer: Quartz Beloit One Network |
$658.07
|
| Rate for Payer: Quartz Commercial |
$805.80
|
| Rate for Payer: WEA Trust Commercial |
$738.65
|
| Rate for Payer: WPS Commercial |
$994.76
|
|
|
CAPD Inpatient
|
Facility
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005582
|
|
Hospital Revenue Code
|
803
|
| Min. Negotiated Rate |
$437.77 |
| Max. Negotiated Rate |
$1,628.50 |
| Rate for Payer: Aetna Commercial |
$1,208.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.98
|
| Rate for Payer: Aetna Managed Medicare |
$437.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$872.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$671.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$644.64
|
| Rate for Payer: Anthem Medicare Advantage |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$437.77
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,235.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$437.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$437.77
|
| Rate for Payer: Health EOS Commercial |
$1,195.27
|
| Rate for Payer: HFN Commercial |
$1,235.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,628.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$437.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$437.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$437.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$437.77
|
| Rate for Payer: Multiplan Commercial |
$1,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$656.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,235.56
|
| Rate for Payer: Quartz Beloit One Network |
$658.07
|
| Rate for Payer: Quartz Commercial |
$872.95
|
| Rate for Payer: Quartz Medicare Advantage |
$437.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.77
|
| Rate for Payer: WEA Trust Commercial |
$738.65
|
| Rate for Payer: Wellcare Medicare |
$437.77
|
| Rate for Payer: WPS Commercial |
$994.76
|
|
|
CAPD Method I
|
Facility
IP
|
$849.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005580
|
|
Hospital Revenue Code
|
841
|
| Min. Negotiated Rate |
$416.01 |
| Max. Negotiated Rate |
$781.08 |
| Rate for Payer: Aetna Commercial |
$764.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.97
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$781.08
|
| Rate for Payer: Health EOS Commercial |
$755.61
|
| Rate for Payer: HFN Commercial |
$781.08
|
| Rate for Payer: Multiplan Commercial |
$679.20
|
| Rate for Payer: NAPHCARE Commercial |
$509.40
|
| Rate for Payer: Preferred Network Access Commercial |
$781.08
|
| Rate for Payer: Quartz Beloit One Network |
$416.01
|
| Rate for Payer: Quartz Commercial |
$509.40
|
| Rate for Payer: WEA Trust Commercial |
$466.95
|
| Rate for Payer: WPS Commercial |
$628.85
|
|
|
CAPD Method I
|
Facility
OP
|
$849.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005580
|
|
Hospital Revenue Code
|
841
|
| Min. Negotiated Rate |
$416.01 |
| Max. Negotiated Rate |
$1,628.50 |
| Rate for Payer: Aetna Commercial |
$764.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.14
|
| Rate for Payer: Aetna Managed Medicare |
$437.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$699.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$545.00
|
| Rate for Payer: Anthem Medicare Advantage |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$437.77
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$781.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$437.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$437.77
|
| Rate for Payer: Health EOS Commercial |
$755.61
|
| Rate for Payer: HFN Commercial |
$781.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,628.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$437.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$437.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$437.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$437.77
|
| Rate for Payer: Multiplan Commercial |
$679.20
|
| Rate for Payer: NAPHCARE Commercial |
$656.66
|
| Rate for Payer: Preferred Network Access Commercial |
$781.08
|
| Rate for Payer: Quartz Beloit One Network |
$416.01
|
| Rate for Payer: Quartz Commercial |
$551.85
|
| Rate for Payer: Quartz Medicare Advantage |
$437.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.77
|
| Rate for Payer: United Healthcare PPO |
$636.75
|
| Rate for Payer: WEA Trust Commercial |
$466.95
|
| Rate for Payer: Wellcare Medicare |
$437.77
|
| Rate for Payer: WPS Commercial |
$628.85
|
|
|
Capd Support Method 2
|
Facility
OP
|
$5,029.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3603558
|
|
Hospital Revenue Code
|
845
|
| Min. Negotiated Rate |
$437.77 |
| Max. Negotiated Rate |
$4,626.68 |
| Rate for Payer: Aetna Commercial |
$4,526.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,324.94
|
| Rate for Payer: Aetna Managed Medicare |
$437.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,268.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,514.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,413.92
|
| Rate for Payer: Anthem Medicare Advantage |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$437.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$437.77
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,626.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$437.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,814.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$437.77
|
| Rate for Payer: Health EOS Commercial |
$4,475.81
|
| Rate for Payer: HFN Commercial |
$4,626.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,628.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$437.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$437.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$437.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$437.77
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: NAPHCARE Commercial |
$656.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.21
|
| Rate for Payer: Quartz Commercial |
$3,268.85
|
| Rate for Payer: Quartz Medicare Advantage |
$437.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$437.77
|
| Rate for Payer: United Healthcare PPO |
$3,771.75
|
| Rate for Payer: WEA Trust Commercial |
$2,765.95
|
| Rate for Payer: Wellcare Medicare |
$437.77
|
| Rate for Payer: WPS Commercial |
$3,724.98
|
|
|
Capd Support Method 2
|
Facility
IP
|
$5,029.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3603558
|
|
Hospital Revenue Code
|
845
|
| Min. Negotiated Rate |
$2,464.21 |
| Max. Negotiated Rate |
$4,626.68 |
| Rate for Payer: Aetna Commercial |
$4,526.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,665.37
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,626.68
|
| Rate for Payer: Health EOS Commercial |
$4,475.81
|
| Rate for Payer: HFN Commercial |
$4,626.68
|
| Rate for Payer: Multiplan Commercial |
$4,023.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,017.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,626.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,464.21
|
| Rate for Payer: Quartz Commercial |
$3,017.40
|
| Rate for Payer: WEA Trust Commercial |
$2,765.95
|
| Rate for Payer: WPS Commercial |
$3,724.98
|
|
|
CAPD Training Per Day
|
Facility
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 90993
|
| Hospital Charge Code |
3605556
|
|
Hospital Revenue Code
|
840
|
| Min. Negotiated Rate |
$533.12 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,637.44
|
| Rate for Payer: Aetna Managed Medicare |
$533.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,237.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$952.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$913.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,065.48
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,428.00
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,237.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,142.40
|
| Rate for Payer: United Healthcare PPO |
$1,428.00
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
CAPD Training Per Day
|
Facility
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 90993
|
| Hospital Charge Code |
3605556
|
|
Hospital Revenue Code
|
840
|
| Min. Negotiated Rate |
$932.96 |
| Max. Negotiated Rate |
$1,751.68 |
| Rate for Payer: Aetna Commercial |
$1,713.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,009.12
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,751.68
|
| Rate for Payer: Health EOS Commercial |
$1,694.56
|
| Rate for Payer: HFN Commercial |
$1,751.68
|
| Rate for Payer: Multiplan Commercial |
$1,523.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,751.68
|
| Rate for Payer: Quartz Beloit One Network |
$932.96
|
| Rate for Payer: Quartz Commercial |
$1,142.40
|
| Rate for Payer: WEA Trust Commercial |
$1,047.20
|
| Rate for Payer: WPS Commercial |
$1,410.29
|
|
|
CAP HALO MEDIUM CP-002A
|
Facility
IP
|
$620.00
|
|
| Hospital Charge Code |
2973371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
CAP HALO MEDIUM CP-002A
|
Facility
OP
|
$620.00
|
|
| Hospital Charge Code |
2973371
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$2,480.00 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$173.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| Rate for Payer: Quartz Medicare Advantage |
$372.00
|
| Rate for Payer: The Alliance Commercial |
$2,480.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
CAP HALO SMALL CP-001A
|
Facility
IP
|
$596.00
|
|
| Hospital Charge Code |
2973370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.04 |
| Max. Negotiated Rate |
$548.32 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$357.60
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
CAP HALO SMALL CP-001A
|
Facility
OP
|
$596.00
|
|
| Hospital Charge Code |
2973370
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.88 |
| Max. Negotiated Rate |
$2,384.00 |
| Rate for Payer: Aetna Commercial |
$536.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.56
|
| Rate for Payer: Aetna Managed Medicare |
$166.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.88
|
| Rate for Payer: Cash Price |
$178.80
|
| Rate for Payer: Cigna Commercial |
$548.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.52
|
| Rate for Payer: Health EOS Commercial |
$530.44
|
| Rate for Payer: HFN Commercial |
$548.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.00
|
| Rate for Payer: Multiplan Commercial |
$476.80
|
| Rate for Payer: NAPHCARE Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$548.32
|
| Rate for Payer: Quartz Beloit One Network |
$292.04
|
| Rate for Payer: Quartz Commercial |
$387.40
|
| Rate for Payer: Quartz Medicare Advantage |
$357.60
|
| Rate for Payer: The Alliance Commercial |
$2,384.00
|
| Rate for Payer: WEA Trust Commercial |
$327.80
|
| Rate for Payer: WPS Commercial |
$441.46
|
|
|
CAP MINI 5C4466P
|
Facility
OP
|
$24.00
|
|
| Hospital Charge Code |
2971443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.72 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Aetna Managed Medicare |
$6.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.43
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.40
|
| Rate for Payer: The Alliance Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
CAP MINI 5C4466P
|
Facility
IP
|
$24.00
|
|
| Hospital Charge Code |
2971443
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
CAP PROTECTIVE 1.8
|
Facility
OP
|
$650.00
|
|
| Hospital Charge Code |
2966159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.00 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Aetna Managed Medicare |
$182.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$422.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$325.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$312.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$344.50
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$598.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$363.74
|
| Rate for Payer: Health EOS Commercial |
$578.50
|
| Rate for Payer: HFN Commercial |
$598.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.50
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: NAPHCARE Commercial |
$390.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.00
|
| Rate for Payer: Quartz Beloit One Network |
$318.50
|
| Rate for Payer: Quartz Commercial |
$422.50
|
| Rate for Payer: Quartz Medicare Advantage |
$390.00
|
| Rate for Payer: The Alliance Commercial |
$2,600.00
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
