|
Cytomegalovirus, Rapid Cx
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
6180573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$20.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.77
|
| Rate for Payer: Anthem Medicare Advantage |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.34
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.34
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$30.51
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$20.34
|
| Rate for Payer: The Alliance Commercial |
$81.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.34
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: Wellcare Medicare |
$20.34
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Cytopathology, concentration technique, smears and interpretation (e.g., Saccomanno technique)
|
Facility
|
OP
|
$157.25
|
|
|
Service Code
|
CPT 88108
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
|
|
Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequacy for diagnosis, first evaluation episode, each site
|
Facility
|
OP
|
$717.18
|
|
|
Service Code
|
CPT 88172
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
|
|
Cytopathology, evaluation of fine needle aspirate; interpretation and report
|
Facility
|
OP
|
$219.36
|
|
|
Service Code
|
CPT 88173
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$219.36 |
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
|
|
Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with interpretation
|
Facility
|
OP
|
$157.25
|
|
|
Service Code
|
CPT 88104
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
|
|
Dacogen 1 mg Charge
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
2958910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.26
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.88
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$91.10
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$98.70
|
| Rate for Payer: Quartz Medicare Advantage |
$91.10
|
| Rate for Payer: The Alliance Commercial |
$4.41
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$4.27
|
|
|
Dacogen 1 mg Charge
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
2958910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.68 |
| Max. Negotiated Rate |
$144.25 |
| Rate for Payer: Aetna Commercial |
$144.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.10
|
| Rate for Payer: Anthem Medicare Advantage |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.10
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$144.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.71
|
| Rate for Payer: Health EOS Commercial |
$138.17
|
| Rate for Payer: HFN Commercial |
$144.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.10
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$1.65
|
| Rate for Payer: Preferred Network Access Commercial |
$144.25
|
| Rate for Payer: Quartz Beloit One Network |
$66.81
|
| Rate for Payer: Quartz Commercial |
$86.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1.10
|
| Rate for Payer: The Alliance Commercial |
$3.03
|
| Rate for Payer: United Healthcare Medicaid |
$0.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.10
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$4.27
|
|
|
Dacogen 1 mg Charge
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
2958910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$91.10
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
DACROCYSTORHINOSTOMY (DCR)
|
Facility
|
OP
|
$6,808.00
|
|
| Hospital Charge Code |
2959989
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,982.49 |
| Max. Negotiated Rate |
$6,513.89 |
| Rate for Payer: Aetna Commercial |
$6,372.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,089.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,982.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,602.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,540.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,398.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,752.57
|
| Rate for Payer: Cash Price |
$2,042.40
|
| Rate for Payer: Cigna Commercial |
$6,513.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,962.26
|
| Rate for Payer: Health EOS Commercial |
$6,301.48
|
| Rate for Payer: HFN Commercial |
$6,513.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,310.24
|
| Rate for Payer: Multiplan Commercial |
$5,664.26
|
| Rate for Payer: NAPHCARE Commercial |
$4,248.19
|
| Rate for Payer: Preferred Network Access Commercial |
$6,513.89
|
| Rate for Payer: Quartz Beloit One Network |
$3,469.36
|
| Rate for Payer: Quartz Commercial |
$4,602.21
|
| Rate for Payer: Quartz Medicare Advantage |
$4,248.19
|
| Rate for Payer: The Alliance Commercial |
$3,540.16
|
| Rate for Payer: WEA Trust Commercial |
$3,894.18
|
| Rate for Payer: WPS Commercial |
$5,244.20
|
|
|
DACROCYSTORHINOSTOMY (DCR)
|
Facility
|
IP
|
$6,808.00
|
|
| Hospital Charge Code |
2959989
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,469.36 |
| Max. Negotiated Rate |
$6,513.89 |
| Rate for Payer: Aetna Commercial |
$6,372.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,089.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,752.57
|
| Rate for Payer: Cash Price |
$2,042.40
|
| Rate for Payer: Cigna Commercial |
$6,513.89
|
| Rate for Payer: Health EOS Commercial |
$6,301.48
|
| Rate for Payer: HFN Commercial |
$6,513.89
|
| Rate for Payer: Multiplan Commercial |
$5,664.26
|
| Rate for Payer: Preferred Network Access Commercial |
$6,513.89
|
| Rate for Payer: Quartz Beloit One Network |
$3,469.36
|
| Rate for Payer: Quartz Commercial |
$4,248.19
|
| Rate for Payer: WEA Trust Commercial |
$3,894.18
|
| Rate for Payer: WPS Commercial |
$5,244.20
|
|
|
Daily - Therapeutic Gases Charge
|
Facility
|
IP
|
$612.00
|
|
| Hospital Charge Code |
3004207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$311.88 |
| Max. Negotiated Rate |
$585.56 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$547.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$337.33
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$585.56
|
| Rate for Payer: Health EOS Commercial |
$566.47
|
| Rate for Payer: HFN Commercial |
$585.56
|
| Rate for Payer: Multiplan Commercial |
$509.18
|
| Rate for Payer: Preferred Network Access Commercial |
$585.56
|
| Rate for Payer: Quartz Beloit One Network |
$311.88
|
| Rate for Payer: Quartz Commercial |
$381.89
|
| Rate for Payer: WEA Trust Commercial |
$350.06
|
| Rate for Payer: WPS Commercial |
$471.42
|
|
|
Daily - Therapeutic Gases Charge
|
Facility
|
OP
|
$612.00
|
|
| Hospital Charge Code |
3004207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$178.21 |
| Max. Negotiated Rate |
$585.56 |
| Rate for Payer: Aetna Commercial |
$572.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$547.37
|
| Rate for Payer: Aetna Managed Medicare |
$178.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$413.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$318.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$305.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$337.33
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$585.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$356.18
|
| Rate for Payer: Health EOS Commercial |
$566.47
|
| Rate for Payer: HFN Commercial |
$585.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$477.36
|
| Rate for Payer: Multiplan Commercial |
$509.18
|
| Rate for Payer: NAPHCARE Commercial |
$381.89
|
| Rate for Payer: Preferred Network Access Commercial |
$585.56
|
| Rate for Payer: Quartz Beloit One Network |
$311.88
|
| Rate for Payer: Quartz Commercial |
$413.71
|
| Rate for Payer: Quartz Medicare Advantage |
$381.89
|
| Rate for Payer: The Alliance Commercial |
$318.24
|
| Rate for Payer: WEA Trust Commercial |
$350.06
|
| Rate for Payer: WPS Commercial |
$471.42
|
|
|
Daily use - CPAP/Bipap Charge
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
2990153
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$230.45 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$265.08
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$230.45
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$230.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$230.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$230.45
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$358.96
|
| Rate for Payer: Quartz Medicare Advantage |
$230.45
|
| Rate for Payer: The Alliance Commercial |
$921.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.45
|
| Rate for Payer: United Healthcare PPO |
$414.18
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
Daily use - CPAP/Bipap Charge
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
2990153
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$270.60 |
| Max. Negotiated Rate |
$508.06 |
| Rate for Payer: Aetna Commercial |
$497.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.69
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$508.06
|
| Rate for Payer: Health EOS Commercial |
$491.49
|
| Rate for Payer: HFN Commercial |
$508.06
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: Preferred Network Access Commercial |
$508.06
|
| Rate for Payer: Quartz Beloit One Network |
$270.60
|
| Rate for Payer: Quartz Commercial |
$331.34
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
Daily use - Infant Cpap Charge
|
Facility
|
OP
|
$575.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3031036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$230.45 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$287.04
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$230.45
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$230.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$230.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$230.45
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$388.70
|
| Rate for Payer: Quartz Medicare Advantage |
$230.45
|
| Rate for Payer: The Alliance Commercial |
$921.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.45
|
| Rate for Payer: United Healthcare PPO |
$448.50
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$442.92
|
|
|
Daily use - Infant Cpap Charge
|
Facility
|
IP
|
$575.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3031036
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$293.02 |
| Max. Negotiated Rate |
$550.16 |
| Rate for Payer: Aetna Commercial |
$538.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$514.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.94
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$550.16
|
| Rate for Payer: Health EOS Commercial |
$532.22
|
| Rate for Payer: HFN Commercial |
$550.16
|
| Rate for Payer: Multiplan Commercial |
$478.40
|
| Rate for Payer: Preferred Network Access Commercial |
$550.16
|
| Rate for Payer: Quartz Beloit One Network |
$293.02
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$328.90
|
| Rate for Payer: WPS Commercial |
$442.92
|
|
|
Daily use - Vapotherm Charge
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3006979
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$285.89 |
| Max. Negotiated Rate |
$536.76 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.22
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$536.76
|
| Rate for Payer: Health EOS Commercial |
$519.26
|
| Rate for Payer: HFN Commercial |
$536.76
|
| Rate for Payer: Multiplan Commercial |
$466.75
|
| Rate for Payer: Preferred Network Access Commercial |
$536.76
|
| Rate for Payer: Quartz Beloit One Network |
$285.89
|
| Rate for Payer: Quartz Commercial |
$350.06
|
| Rate for Payer: WEA Trust Commercial |
$320.89
|
| Rate for Payer: WPS Commercial |
$432.14
|
|
|
Daily use - Vapotherm Charge
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3006979
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$230.45 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$525.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.76
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$379.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.05
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$230.45
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$536.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$519.26
|
| Rate for Payer: HFN Commercial |
$536.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$230.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$230.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$230.45
|
| Rate for Payer: Multiplan Commercial |
$466.75
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$536.76
|
| Rate for Payer: Quartz Beloit One Network |
$285.89
|
| Rate for Payer: Quartz Commercial |
$379.24
|
| Rate for Payer: Quartz Medicare Advantage |
$230.45
|
| Rate for Payer: The Alliance Commercial |
$921.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$230.45
|
| Rate for Payer: United Healthcare PPO |
$437.58
|
| Rate for Payer: WEA Trust Commercial |
$320.89
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$432.14
|
|
|
Daily use - Ventilator Charge
|
Facility
|
IP
|
$1,526.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
2990155
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$777.65 |
| Max. Negotiated Rate |
$1,460.08 |
| Rate for Payer: Aetna Commercial |
$1,428.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,364.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$841.13
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$1,460.08
|
| Rate for Payer: Health EOS Commercial |
$1,412.47
|
| Rate for Payer: HFN Commercial |
$1,460.08
|
| Rate for Payer: Multiplan Commercial |
$1,269.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$777.65
|
| Rate for Payer: Quartz Commercial |
$952.22
|
| Rate for Payer: WEA Trust Commercial |
$872.87
|
| Rate for Payer: WPS Commercial |
$1,175.48
|
|
|
Daily use - Ventilator Charge
|
Facility
|
OP
|
$1,526.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
2990155
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$650.16 |
| Max. Negotiated Rate |
$2,600.62 |
| Rate for Payer: Aetna Commercial |
$1,428.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,364.85
|
| Rate for Payer: Aetna Managed Medicare |
$650.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,031.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$793.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$761.78
|
| Rate for Payer: Anthem Medicare Advantage |
$650.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$841.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$650.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$650.16
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$1,460.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$650.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$888.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$650.16
|
| Rate for Payer: Health EOS Commercial |
$1,412.47
|
| Rate for Payer: HFN Commercial |
$1,460.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,418.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$650.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$650.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$650.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$650.16
|
| Rate for Payer: Multiplan Commercial |
$1,269.63
|
| Rate for Payer: NAPHCARE Commercial |
$975.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,460.08
|
| Rate for Payer: Quartz Beloit One Network |
$777.65
|
| Rate for Payer: Quartz Commercial |
$1,031.58
|
| Rate for Payer: Quartz Medicare Advantage |
$650.16
|
| Rate for Payer: The Alliance Commercial |
$2,600.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$650.16
|
| Rate for Payer: United Healthcare PPO |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$872.87
|
| Rate for Payer: Wellcare Medicare |
$650.16
|
| Rate for Payer: WPS Commercial |
$1,175.48
|
|
|
Daily VAC Rental - PT Equipment Issued Rehab
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2989876
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$182.21
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
Daily VAC Rental - PT Equipment Issued Rehab
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2989876
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$85.03 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$85.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$197.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.94
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.76
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$197.39
|
| Rate for Payer: Quartz Medicare Advantage |
$182.21
|
| Rate for Payer: The Alliance Commercial |
$151.84
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
Daily VAC Rental - PT Equipment Issued Rehab
|
Professional
|
Both
|
$292.00
|
|
| Hospital Charge Code |
2989876
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$133.62 |
| Max. Negotiated Rate |
$288.50 |
| Rate for Payer: Aetna Commercial |
$288.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$288.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.21
|
| Rate for Payer: Health EOS Commercial |
$276.35
|
| Rate for Payer: HFN Commercial |
$288.50
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: Preferred Network Access Commercial |
$288.50
|
| Rate for Payer: Quartz Beloit One Network |
$133.62
|
| Rate for Payer: Quartz Commercial |
$173.10
|
| Rate for Payer: The Alliance Commercial |
$151.84
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
D Antigen Typing
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
5374643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
D Antigen Typing
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
5374643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$100.78 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$3.11
|
| Rate for Payer: Anthem Medicare Advantage |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.11
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.11
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$4.66
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$3.11
|
| Rate for Payer: The Alliance Commercial |
$12.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.11
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$13.68
|
|
