|
CANNULA ZONE NAVIGATOR SYSTEM RT MID/POSTERIOR AR-7910R
|
Facility
|
OP
|
$2,114.00
|
|
| Hospital Charge Code |
6131638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.60 |
| Max. Negotiated Rate |
$2,022.68 |
| Rate for Payer: Aetna Commercial |
$1,978.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,890.76
|
| Rate for Payer: Aetna Managed Medicare |
$615.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,429.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,099.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,055.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.24
|
| Rate for Payer: Cash Price |
$634.20
|
| Rate for Payer: Cigna Commercial |
$2,022.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,230.35
|
| Rate for Payer: Health EOS Commercial |
$1,956.72
|
| Rate for Payer: HFN Commercial |
$2,022.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,648.92
|
| Rate for Payer: Multiplan Commercial |
$1,758.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,319.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,022.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.29
|
| Rate for Payer: Quartz Commercial |
$1,429.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,319.14
|
| Rate for Payer: The Alliance Commercial |
$1,099.28
|
| Rate for Payer: WEA Trust Commercial |
$1,209.21
|
| Rate for Payer: WPS Commercial |
$1,628.41
|
|
|
CANULA CO2 NASAL PEDS #2013066-005
|
Facility
|
IP
|
$277.00
|
|
| Hospital Charge Code |
2972674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$172.85
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
CANULA CO2 NASAL PEDS #2013066-005
|
Facility
|
OP
|
$277.00
|
|
| Hospital Charge Code |
2972674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$80.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.21
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.06
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$172.85
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$187.25
|
| Rate for Payer: Quartz Medicare Advantage |
$172.85
|
| Rate for Payer: The Alliance Commercial |
$144.04
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
CAP 11.0 PROTECTION FIXATOR 394.97
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
5074638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
CAP 11.0 PROTECTION FIXATOR 394.97
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
5074638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.12
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$33.70
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$33.70
|
| Rate for Payer: The Alliance Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
CAP 4.5 PROTECTION FIXATOR 394.992
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2966160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
CAP 4.5 PROTECTION FIXATOR 394.992
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2966160
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
CAP 5.0 PROTECTION FIXATOR 394.993
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
2967340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
CAP 5.0 PROTECTION FIXATOR 394.993
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
2967340
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
CAP 6.0 PROTECTION FIXATOR 394.994
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2966156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
CAP 6.0 PROTECTION FIXATOR 394.994
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2966156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
CAP 8.0 PROTECTIVE 395.781
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
2966157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.25
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$43.26
|
| Rate for Payer: Quartz Medicare Advantage |
$39.94
|
| Rate for Payer: The Alliance Commercial |
$33.28
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
CAP 8.0 PROTECTIVE 395.781
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
2966157
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$39.94
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Cap changed - Central IV Care:
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
3025901
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Cap changed - Central IV Care:
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
3025901
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
CAPD Completed Training Day
|
Facility
|
OP
|
$2,063.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
3215530
|
|
Hospital Revenue Code
|
840
|
| Min. Negotiated Rate |
$600.75 |
| Max. Negotiated Rate |
$1,973.88 |
| Rate for Payer: Aetna Commercial |
$1,930.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,845.15
|
| Rate for Payer: Aetna Managed Medicare |
$600.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,394.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,072.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,029.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,137.13
|
| Rate for Payer: Cash Price |
$618.90
|
| Rate for Payer: Cigna Commercial |
$1,973.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,200.67
|
| Rate for Payer: Health EOS Commercial |
$1,909.51
|
| Rate for Payer: HFN Commercial |
$1,973.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,609.14
|
| Rate for Payer: Multiplan Commercial |
$1,716.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,287.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,973.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,051.30
|
| Rate for Payer: Quartz Commercial |
$1,394.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,287.31
|
| Rate for Payer: The Alliance Commercial |
$1,072.76
|
| Rate for Payer: United Healthcare PPO |
$1,609.14
|
| Rate for Payer: WEA Trust Commercial |
$1,180.04
|
| Rate for Payer: WPS Commercial |
$1,589.13
|
|
|
CAPD Completed Training Day
|
Facility
|
IP
|
$2,063.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
3215530
|
|
Hospital Revenue Code
|
840
|
| Min. Negotiated Rate |
$1,051.30 |
| Max. Negotiated Rate |
$1,973.88 |
| Rate for Payer: Aetna Commercial |
$1,930.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,845.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,137.13
|
| Rate for Payer: Cash Price |
$618.90
|
| Rate for Payer: Cigna Commercial |
$1,973.88
|
| Rate for Payer: Health EOS Commercial |
$1,909.51
|
| Rate for Payer: HFN Commercial |
$1,973.88
|
| Rate for Payer: Multiplan Commercial |
$1,716.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,973.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,051.30
|
| Rate for Payer: Quartz Commercial |
$1,287.31
|
| Rate for Payer: WEA Trust Commercial |
$1,180.04
|
| Rate for Payer: WPS Commercial |
$1,589.13
|
|
|
CAP DHE LCP DHHS IMPACTOR CAP
|
Facility
|
IP
|
$2,565.00
|
|
| Hospital Charge Code |
2966158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,307.12 |
| Max. Negotiated Rate |
$2,454.19 |
| Rate for Payer: Aetna Commercial |
$2,400.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,294.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,413.83
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cigna Commercial |
$2,454.19
|
| Rate for Payer: Health EOS Commercial |
$2,374.16
|
| Rate for Payer: HFN Commercial |
$2,454.19
|
| Rate for Payer: Multiplan Commercial |
$2,134.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,454.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,307.12
|
| Rate for Payer: Quartz Commercial |
$1,600.56
|
| Rate for Payer: WEA Trust Commercial |
$1,467.18
|
| Rate for Payer: WPS Commercial |
$1,975.82
|
|
|
CAP DHE LCP DHHS IMPACTOR CAP
|
Facility
|
OP
|
$2,565.00
|
|
| Hospital Charge Code |
2966158
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$746.93 |
| Max. Negotiated Rate |
$2,454.19 |
| Rate for Payer: Aetna Commercial |
$2,400.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,294.14
|
| Rate for Payer: Aetna Managed Medicare |
$746.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,733.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,333.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,280.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,413.83
|
| Rate for Payer: Cash Price |
$769.50
|
| Rate for Payer: Cigna Commercial |
$2,454.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,492.83
|
| Rate for Payer: Health EOS Commercial |
$2,374.16
|
| Rate for Payer: HFN Commercial |
$2,454.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,000.70
|
| Rate for Payer: Multiplan Commercial |
$2,134.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,600.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,454.19
|
| Rate for Payer: Quartz Beloit One Network |
$1,307.12
|
| Rate for Payer: Quartz Commercial |
$1,733.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,600.56
|
| Rate for Payer: The Alliance Commercial |
$1,333.80
|
| Rate for Payer: WEA Trust Commercial |
$1,467.18
|
| Rate for Payer: WPS Commercial |
$1,975.82
|
|
|
CAPD Inpatient
|
Facility
|
OP
|
$1,343.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005582
|
|
Hospital Revenue Code
|
803
|
| Min. Negotiated Rate |
$439.12 |
| Max. Negotiated Rate |
$1,756.48 |
| Rate for Payer: Aetna Commercial |
$1,257.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,201.18
|
| Rate for Payer: Aetna Managed Medicare |
$439.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$907.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$698.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$670.43
|
| Rate for Payer: Anthem Medicare Advantage |
$439.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$439.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$439.12
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,284.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$439.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$781.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$439.12
|
| Rate for Payer: Health EOS Commercial |
$1,243.08
|
| Rate for Payer: HFN Commercial |
$1,284.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,633.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$439.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$439.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$439.12
|
| Rate for Payer: Multiplan Commercial |
$1,117.38
|
| Rate for Payer: NAPHCARE Commercial |
$658.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.98
|
| Rate for Payer: Quartz Beloit One Network |
$684.39
|
| Rate for Payer: Quartz Commercial |
$907.87
|
| Rate for Payer: Quartz Medicare Advantage |
$439.12
|
| Rate for Payer: The Alliance Commercial |
$1,756.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.12
|
| Rate for Payer: WEA Trust Commercial |
$768.20
|
| Rate for Payer: Wellcare Medicare |
$439.12
|
| Rate for Payer: WPS Commercial |
$1,034.51
|
|
|
CAPD Inpatient
|
Facility
|
IP
|
$1,343.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005582
|
|
Hospital Revenue Code
|
803
|
| Min. Negotiated Rate |
$684.39 |
| Max. Negotiated Rate |
$1,284.98 |
| Rate for Payer: Aetna Commercial |
$1,257.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,201.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.26
|
| Rate for Payer: Cash Price |
$402.90
|
| Rate for Payer: Cigna Commercial |
$1,284.98
|
| Rate for Payer: Health EOS Commercial |
$1,243.08
|
| Rate for Payer: HFN Commercial |
$1,284.98
|
| Rate for Payer: Multiplan Commercial |
$1,117.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,284.98
|
| Rate for Payer: Quartz Beloit One Network |
$684.39
|
| Rate for Payer: Quartz Commercial |
$838.03
|
| Rate for Payer: WEA Trust Commercial |
$768.20
|
| Rate for Payer: WPS Commercial |
$1,034.51
|
|
|
CAPD Method I
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005580
|
|
Hospital Revenue Code
|
841
|
| Min. Negotiated Rate |
$432.65 |
| Max. Negotiated Rate |
$1,756.48 |
| Rate for Payer: Aetna Commercial |
$794.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.35
|
| Rate for Payer: Aetna Managed Medicare |
$439.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$726.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$596.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.80
|
| Rate for Payer: Anthem Medicare Advantage |
$439.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$439.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$439.12
|
| 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 |
$812.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$439.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$494.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$439.12
|
| Rate for Payer: Health EOS Commercial |
$785.83
|
| Rate for Payer: HFN Commercial |
$812.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,633.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$439.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$439.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$439.12
|
| Rate for Payer: Multiplan Commercial |
$706.37
|
| Rate for Payer: NAPHCARE Commercial |
$658.68
|
| Rate for Payer: Preferred Network Access Commercial |
$812.32
|
| Rate for Payer: Quartz Beloit One Network |
$432.65
|
| Rate for Payer: Quartz Commercial |
$573.92
|
| Rate for Payer: Quartz Medicare Advantage |
$439.12
|
| Rate for Payer: The Alliance Commercial |
$1,756.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.12
|
| Rate for Payer: United Healthcare PPO |
$662.22
|
| Rate for Payer: WEA Trust Commercial |
$485.63
|
| Rate for Payer: Wellcare Medicare |
$439.12
|
| Rate for Payer: WPS Commercial |
$653.98
|
|
|
CAPD Method I
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005580
|
|
Hospital Revenue Code
|
841
|
| Min. Negotiated Rate |
$432.65 |
| Max. Negotiated Rate |
$812.32 |
| Rate for Payer: Aetna Commercial |
$794.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$759.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$467.97
|
| Rate for Payer: Cash Price |
$254.70
|
| Rate for Payer: Cigna Commercial |
$812.32
|
| Rate for Payer: Health EOS Commercial |
$785.83
|
| Rate for Payer: HFN Commercial |
$812.32
|
| Rate for Payer: Multiplan Commercial |
$706.37
|
| Rate for Payer: Preferred Network Access Commercial |
$812.32
|
| Rate for Payer: Quartz Beloit One Network |
$432.65
|
| Rate for Payer: Quartz Commercial |
$529.78
|
| Rate for Payer: WEA Trust Commercial |
$485.63
|
| Rate for Payer: WPS Commercial |
$653.98
|
|
|
Capd Support Method 2
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3603558
|
|
Hospital Revenue Code
|
845
|
| Min. Negotiated Rate |
$439.12 |
| Max. Negotiated Rate |
$4,811.75 |
| Rate for Payer: Aetna Commercial |
$4,707.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.94
|
| Rate for Payer: Aetna Managed Medicare |
$439.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,399.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,615.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,510.48
|
| Rate for Payer: Anthem Medicare Advantage |
$439.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$439.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$439.12
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,811.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$439.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,926.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$439.12
|
| Rate for Payer: Health EOS Commercial |
$4,654.84
|
| Rate for Payer: HFN Commercial |
$4,811.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,633.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$439.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$439.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$439.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$439.12
|
| Rate for Payer: Multiplan Commercial |
$4,184.13
|
| Rate for Payer: NAPHCARE Commercial |
$658.68
|
| Rate for Payer: Preferred Network Access Commercial |
$4,811.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.78
|
| Rate for Payer: Quartz Commercial |
$3,399.60
|
| Rate for Payer: Quartz Medicare Advantage |
$439.12
|
| Rate for Payer: The Alliance Commercial |
$1,756.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$439.12
|
| Rate for Payer: United Healthcare PPO |
$3,922.62
|
| Rate for Payer: WEA Trust Commercial |
$2,876.59
|
| Rate for Payer: Wellcare Medicare |
$439.12
|
| Rate for Payer: WPS Commercial |
$3,873.84
|
|
|
Capd Support Method 2
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3603558
|
|
Hospital Revenue Code
|
845
|
| Min. Negotiated Rate |
$2,562.78 |
| Max. Negotiated Rate |
$4,811.75 |
| Rate for Payer: Aetna Commercial |
$4,707.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,497.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,771.98
|
| Rate for Payer: Cash Price |
$1,508.70
|
| Rate for Payer: Cigna Commercial |
$4,811.75
|
| Rate for Payer: Health EOS Commercial |
$4,654.84
|
| Rate for Payer: HFN Commercial |
$4,811.75
|
| Rate for Payer: Multiplan Commercial |
$4,184.13
|
| Rate for Payer: Preferred Network Access Commercial |
$4,811.75
|
| Rate for Payer: Quartz Beloit One Network |
$2,562.78
|
| Rate for Payer: Quartz Commercial |
$3,138.10
|
| Rate for Payer: WEA Trust Commercial |
$2,876.59
|
| Rate for Payer: WPS Commercial |
$3,873.84
|
|
