|
CAVILON NO STING BARRIER SPRAY #3346
|
Facility
|
OP
|
$240.00
|
|
| Hospital Charge Code |
2969698
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$69.89 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$69.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$162.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.68
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.20
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$149.76
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: Quartz Medicare Advantage |
$149.76
|
| Rate for Payer: The Alliance Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
CAVUS FOOT RECONSTRUCTION
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2959920
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
CAVUS FOOT RECONSTRUCTION
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2959920
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
CCatheterization (Simple)
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
3005555
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$107.83 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.83
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
CCatheterization (Simple)
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 51701
|
| Hospital Charge Code |
3005555
|
|
Hospital Revenue Code
|
940
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$134.78
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
CCC Arterial Line Pressure Monitoring - CCC Monitoring Charges
|
Facility
|
IP
|
$354.00
|
|
| Hospital Charge Code |
3715551
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$220.90
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
CCC Arterial Line Pressure Monitoring - CCC Monitoring Charges
|
Facility
|
OP
|
$354.00
|
|
| Hospital Charge Code |
3715551
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Aetna Managed Medicare |
$103.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.03
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.12
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: NAPHCARE Commercial |
$220.90
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$239.30
|
| Rate for Payer: Quartz Medicare Advantage |
$220.90
|
| Rate for Payer: The Alliance Commercial |
$184.08
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
CCC Central Venous Pressure Monitoring - CCC Monitoring Charges
|
Facility
|
OP
|
$306.00
|
|
| Hospital Charge Code |
3715546
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$89.11 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Aetna Managed Medicare |
$89.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.09
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$238.68
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: NAPHCARE Commercial |
$190.94
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$206.86
|
| Rate for Payer: Quartz Medicare Advantage |
$190.94
|
| Rate for Payer: The Alliance Commercial |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
CCC Central Venous Pressure Monitoring - CCC Monitoring Charges
|
Facility
|
IP
|
$306.00
|
|
| Hospital Charge Code |
3715546
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$155.94 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$190.94
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
CCC Observation Per Hour
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040434
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
CCC Observation Per Hour
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040434
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$39.60 |
| Max. Negotiated Rate |
$7,271.68 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$39.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,271.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,271.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,958.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.08
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$84.86
|
| Rate for Payer: The Alliance Commercial |
$70.72
|
| Rate for Payer: United Healthcare PPO |
$2,701.92
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
CCC Pulmonary Capillary Wedge Pressure Monitoring - CCC Monitoring Charges
|
Facility
|
OP
|
$354.00
|
|
| Hospital Charge Code |
3715550
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.08 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Aetna Managed Medicare |
$103.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$184.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.03
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$276.12
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: NAPHCARE Commercial |
$220.90
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$239.30
|
| Rate for Payer: Quartz Medicare Advantage |
$220.90
|
| Rate for Payer: The Alliance Commercial |
$184.08
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
CCC Pulmonary Capillary Wedge Pressure Monitoring - CCC Monitoring Charges
|
Facility
|
IP
|
$354.00
|
|
| Hospital Charge Code |
3715550
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$220.90
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
CCPD Completed Training Day
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
3215531
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
CCPD Completed Training Day
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 90989
|
| Hospital Charge Code |
3215531
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: United Healthcare PPO |
$1,485.12
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
CCPD Inpatient
|
Facility
|
IP
|
$1,455.00
|
|
| Hospital Charge Code |
3603560
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$741.47 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$907.92
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
CCPD Inpatient
|
Facility
|
OP
|
$1,455.00
|
|
| Hospital Charge Code |
3603560
|
|
Hospital Revenue Code
|
804
|
| Min. Negotiated Rate |
$423.70 |
| Max. Negotiated Rate |
$1,392.14 |
| Rate for Payer: Aetna Commercial |
$1,361.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,301.35
|
| Rate for Payer: Aetna Managed Medicare |
$423.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$983.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$756.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$726.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$802.00
|
| Rate for Payer: Cash Price |
$436.50
|
| Rate for Payer: Cigna Commercial |
$1,392.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$846.81
|
| Rate for Payer: Health EOS Commercial |
$1,346.75
|
| Rate for Payer: HFN Commercial |
$1,392.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.90
|
| Rate for Payer: Multiplan Commercial |
$1,210.56
|
| Rate for Payer: NAPHCARE Commercial |
$907.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,392.14
|
| Rate for Payer: Quartz Beloit One Network |
$741.47
|
| Rate for Payer: Quartz Commercial |
$983.58
|
| Rate for Payer: Quartz Medicare Advantage |
$907.92
|
| Rate for Payer: The Alliance Commercial |
$756.60
|
| Rate for Payer: WEA Trust Commercial |
$832.26
|
| Rate for Payer: WPS Commercial |
$1,120.79
|
|
|
CCPD Method I
|
Facility
|
IP
|
$849.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005581
|
|
Hospital Revenue Code
|
851
|
| 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
|
|
|
CCPD Method I
|
Facility
|
OP
|
$849.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3005581
|
|
Hospital Revenue Code
|
851
|
| 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
|
|
|
CCPD Support Method 2
|
Facility
|
OP
|
$5,029.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3603559
|
|
Hospital Revenue Code
|
855
|
| 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
|
|
|
CCPD Support Method 2
|
Facility
|
IP
|
$5,029.00
|
|
|
Service Code
|
CPT 90945
|
| Hospital Charge Code |
3603559
|
|
Hospital Revenue Code
|
855
|
| 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
|
|
|
CCPD Training per Day
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
CPT 90993
|
| Hospital Charge Code |
3005583
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
CCPD Training per Day
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
CPT 90993
|
| Hospital Charge Code |
3005583
|
|
Hospital Revenue Code
|
850
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: United Healthcare PPO |
$1,485.12
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
CD19, CD20 to Mayo
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4620679
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$39.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.14
|
| Rate for Payer: Anthem Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.24
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.24
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$58.86
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| Rate for Payer: Quartz Medicare Advantage |
$39.24
|
| Rate for Payer: The Alliance Commercial |
$156.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.24
|
| Rate for Payer: United Healthcare PPO |
$452.40
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: Wellcare Medicare |
$39.24
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
CD19, CD20 to Mayo
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4620679
|
|
Hospital Revenue Code
|
305
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
