|
ESOPHAGOSCOPY WITH ABLATION SURGERY/HALO PROCEDURE
|
Facility
|
IP
|
$3,569.00
|
|
| Hospital Charge Code |
2975904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,818.76 |
| Max. Negotiated Rate |
$3,414.82 |
| Rate for Payer: Aetna Commercial |
$3,340.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,192.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,967.23
|
| Rate for Payer: Cash Price |
$1,070.70
|
| Rate for Payer: Cigna Commercial |
$3,414.82
|
| Rate for Payer: Health EOS Commercial |
$3,303.47
|
| Rate for Payer: HFN Commercial |
$3,414.82
|
| Rate for Payer: Multiplan Commercial |
$2,969.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,414.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,818.76
|
| Rate for Payer: Quartz Commercial |
$2,227.06
|
| Rate for Payer: WEA Trust Commercial |
$2,041.47
|
| Rate for Payer: WPS Commercial |
$2,749.20
|
|
|
ESOPHAGOSCOPY WITH ABLATION SURGERY/HALO PROCEDURE
|
Facility
|
OP
|
$3,569.00
|
|
| Hospital Charge Code |
2975904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$3,414.82 |
| Rate for Payer: Aetna Commercial |
$3,340.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,192.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,039.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,412.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,855.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,781.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,967.23
|
| Rate for Payer: Cash Price |
$1,070.70
|
| Rate for Payer: Cigna Commercial |
$3,414.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,077.16
|
| Rate for Payer: Health EOS Commercial |
$3,303.47
|
| Rate for Payer: HFN Commercial |
$3,414.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,783.82
|
| Rate for Payer: Multiplan Commercial |
$2,969.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,227.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,414.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,818.76
|
| Rate for Payer: Quartz Commercial |
$2,412.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,227.06
|
| Rate for Payer: The Alliance Commercial |
$1,855.88
|
| Rate for Payer: WEA Trust Commercial |
$2,041.47
|
| Rate for Payer: WPS Commercial |
$2,749.20
|
|
|
ESOPHAGUS ENDOSCOPY 43200
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
3014649
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$1,115.45 |
| Rate for Payer: Aetna Commercial |
$1,115.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,009.78
|
| Rate for Payer: Aetna Managed Medicare |
$76.47
|
| Rate for Payer: Anthem Medicare Advantage |
$76.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.47
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,115.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.47
|
| Rate for Payer: Health EOS Commercial |
$1,068.49
|
| Rate for Payer: HFN Commercial |
$1,115.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$300.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$300.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.47
|
| Rate for Payer: Multiplan Commercial |
$939.33
|
| Rate for Payer: NAPHCARE Commercial |
$114.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.45
|
| Rate for Payer: Quartz Beloit One Network |
$516.63
|
| Rate for Payer: Quartz Commercial |
$669.27
|
| Rate for Payer: Quartz Medicare Advantage |
$76.47
|
| Rate for Payer: The Alliance Commercial |
$325.00
|
| Rate for Payer: United Healthcare Medicaid |
$191.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.47
|
| Rate for Payer: WEA Trust Commercial |
$645.79
|
| Rate for Payer: WPS Commercial |
$344.12
|
|
|
ESOPHAGUS ENDOSCOPY, BIOPSY 43202
|
Professional
|
Both
|
$1,790.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
3014650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.55 |
| Max. Negotiated Rate |
$1,768.52 |
| Rate for Payer: Aetna Commercial |
$1,768.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Aetna Managed Medicare |
$90.55
|
| Rate for Payer: Anthem Medicare Advantage |
$90.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$90.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$90.55
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,768.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$353.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.55
|
| Rate for Payer: Health EOS Commercial |
$1,694.06
|
| Rate for Payer: HFN Commercial |
$1,768.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$90.55
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: NAPHCARE Commercial |
$135.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.52
|
| Rate for Payer: Quartz Beloit One Network |
$819.10
|
| Rate for Payer: Quartz Commercial |
$1,061.11
|
| Rate for Payer: Quartz Medicare Advantage |
$90.55
|
| Rate for Payer: The Alliance Commercial |
$384.85
|
| Rate for Payer: United Healthcare Medicaid |
$353.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.55
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$407.49
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$3,614.92
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$3,614.92 |
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
|
|
Esoph Imped Function Test >1H 91038
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
3475520
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$1,776.24 |
| Rate for Payer: Aetna Commercial |
$397.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$359.55
|
| Rate for Payer: Aetna Managed Medicare |
$444.06
|
| Rate for Payer: Anthem Medicare Advantage |
$444.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$444.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$444.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$397.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$444.06
|
| Rate for Payer: Health EOS Commercial |
$380.45
|
| Rate for Payer: HFN Commercial |
$397.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,600.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,600.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$444.06
|
| Rate for Payer: Multiplan Commercial |
$334.46
|
| Rate for Payer: NAPHCARE Commercial |
$666.09
|
| Rate for Payer: Preferred Network Access Commercial |
$397.18
|
| Rate for Payer: Quartz Beloit One Network |
$183.96
|
| Rate for Payer: Quartz Commercial |
$238.31
|
| Rate for Payer: Quartz Medicare Advantage |
$444.06
|
| Rate for Payer: The Alliance Commercial |
$1,110.15
|
| Rate for Payer: United Healthcare Medicaid |
$116.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.06
|
| Rate for Payer: WEA Trust Commercial |
$229.94
|
| Rate for Payer: WPS Commercial |
$1,776.24
|
|
|
Esoph Imped Function Test >1H 9103826
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
CPT 91038 26
|
| Hospital Charge Code |
5472751
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$397.18 |
| Rate for Payer: Aetna Commercial |
$397.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$359.55
|
| Rate for Payer: Aetna Managed Medicare |
$59.82
|
| Rate for Payer: Anthem Medicare Advantage |
$59.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.82
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$397.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.82
|
| Rate for Payer: Health EOS Commercial |
$380.45
|
| Rate for Payer: HFN Commercial |
$397.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.82
|
| Rate for Payer: Multiplan Commercial |
$334.46
|
| Rate for Payer: NAPHCARE Commercial |
$89.73
|
| Rate for Payer: Preferred Network Access Commercial |
$397.18
|
| Rate for Payer: Quartz Beloit One Network |
$183.96
|
| Rate for Payer: Quartz Commercial |
$238.31
|
| Rate for Payer: Quartz Medicare Advantage |
$59.82
|
| Rate for Payer: The Alliance Commercial |
$149.55
|
| Rate for Payer: United Healthcare Medicaid |
$54.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.82
|
| Rate for Payer: WEA Trust Commercial |
$229.94
|
| Rate for Payer: WPS Commercial |
$239.28
|
|
|
ESOPH IMPED FUNCTION TEST 91037
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
3015324
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$745.97 |
| Rate for Payer: Aetna Commercial |
$542.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.03
|
| Rate for Payer: Aetna Managed Medicare |
$186.49
|
| Rate for Payer: Anthem Medicare Advantage |
$186.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$186.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$186.49
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna Commercial |
$542.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.49
|
| Rate for Payer: Health EOS Commercial |
$519.57
|
| Rate for Payer: HFN Commercial |
$542.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$186.49
|
| Rate for Payer: Multiplan Commercial |
$456.77
|
| Rate for Payer: NAPHCARE Commercial |
$279.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.41
|
| Rate for Payer: Quartz Beloit One Network |
$251.22
|
| Rate for Payer: Quartz Commercial |
$325.45
|
| Rate for Payer: Quartz Medicare Advantage |
$186.49
|
| Rate for Payer: The Alliance Commercial |
$466.23
|
| Rate for Payer: United Healthcare Medicaid |
$135.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.49
|
| Rate for Payer: WEA Trust Commercial |
$314.03
|
| Rate for Payer: WPS Commercial |
$745.97
|
|
|
ESOPH IMPED FUNCTION TEST 9103726
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
CPT 91037 26
|
| Hospital Charge Code |
5472737
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.69 |
| Max. Negotiated Rate |
$542.41 |
| Rate for Payer: Aetna Commercial |
$542.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.03
|
| Rate for Payer: Aetna Managed Medicare |
$51.50
|
| Rate for Payer: Anthem Medicare Advantage |
$51.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.50
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna Commercial |
$542.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.50
|
| Rate for Payer: Health EOS Commercial |
$519.57
|
| Rate for Payer: HFN Commercial |
$542.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$176.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$176.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.50
|
| Rate for Payer: Multiplan Commercial |
$456.77
|
| Rate for Payer: NAPHCARE Commercial |
$77.25
|
| Rate for Payer: Preferred Network Access Commercial |
$542.41
|
| Rate for Payer: Quartz Beloit One Network |
$251.22
|
| Rate for Payer: Quartz Commercial |
$325.45
|
| Rate for Payer: Quartz Medicare Advantage |
$51.50
|
| Rate for Payer: The Alliance Commercial |
$128.75
|
| Rate for Payer: United Healthcare Medicaid |
$47.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.50
|
| Rate for Payer: WEA Trust Commercial |
$314.03
|
| Rate for Payer: WPS Commercial |
$206.00
|
|
|
ESRD CASE MANAGEMENT
|
Facility
|
OP
|
$117.08
|
|
|
Service Code
|
EAPG 00261
|
| Min. Negotiated Rate |
$112.58 |
| Max. Negotiated Rate |
$117.08 |
| Rate for Payer: Anthem Medicaid |
$112.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$112.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.58
|
| Rate for Payer: Dean Health Medicaid |
$112.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$112.58
|
| Rate for Payer: Managed Health Services Medicaid |
$117.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$112.58
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$112.58
|
| Rate for Payer: United Healthcare Medicaid |
$112.58
|
|
|
ESTABLISH ACCESS TO ARTERY 36140
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
3014509
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.70 |
| Max. Negotiated Rate |
$2,414.67 |
| Rate for Payer: Aetna Commercial |
$2,414.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,185.91
|
| Rate for Payer: Aetna Managed Medicare |
$72.70
|
| Rate for Payer: Anthem Medicare Advantage |
$72.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.70
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cigna Commercial |
$2,414.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.70
|
| Rate for Payer: Health EOS Commercial |
$2,313.00
|
| Rate for Payer: HFN Commercial |
$2,414.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$298.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$298.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.70
|
| Rate for Payer: Multiplan Commercial |
$2,033.41
|
| Rate for Payer: NAPHCARE Commercial |
$109.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.37
|
| Rate for Payer: Quartz Commercial |
$1,448.80
|
| Rate for Payer: Quartz Medicare Advantage |
$72.70
|
| Rate for Payer: The Alliance Commercial |
$308.96
|
| Rate for Payer: United Healthcare Medicaid |
$73.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.70
|
| Rate for Payer: WEA Trust Commercial |
$1,397.97
|
| Rate for Payer: WPS Commercial |
$327.13
|
|
|
Establish Access To Artery 3614022
|
Professional
|
Both
|
$2,932.00
|
|
|
Service Code
|
CPT 36140 22
|
| Hospital Charge Code |
5492669
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.83 |
| Max. Negotiated Rate |
$2,896.82 |
| Rate for Payer: Aetna Commercial |
$2,896.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,622.38
|
| Rate for Payer: Cash Price |
$879.60
|
| Rate for Payer: Cash Price |
$879.60
|
| Rate for Payer: Cash Price |
$879.60
|
| Rate for Payer: Cigna Commercial |
$2,896.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,829.57
|
| Rate for Payer: Health EOS Commercial |
$2,774.84
|
| Rate for Payer: HFN Commercial |
$2,896.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$298.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$298.25
|
| Rate for Payer: Multiplan Commercial |
$2,439.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,896.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,341.68
|
| Rate for Payer: Quartz Commercial |
$1,738.09
|
| Rate for Payer: The Alliance Commercial |
$1,524.64
|
| Rate for Payer: United Healthcare Medicaid |
$73.83
|
| Rate for Payer: WEA Trust Commercial |
$1,677.10
|
| Rate for Payer: WPS Commercial |
$2,258.52
|
|
|
Established major dressing charge
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3165538
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Established major dressing charge
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3165538
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$122.47
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Established minor dressing charge
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3165537
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
Established minor dressing charge
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3165537
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
Established Patient Home Visit 40 Minutes
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
1122862
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$102.39 |
| Max. Negotiated Rate |
$461.40 |
| Rate for Payer: Aetna Commercial |
$461.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.68
|
| Rate for Payer: Aetna Managed Medicare |
$131.73
|
| Rate for Payer: Anthem Medicare Advantage |
$131.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$131.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$131.73
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$461.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.73
|
| Rate for Payer: Health EOS Commercial |
$441.97
|
| Rate for Payer: HFN Commercial |
$461.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$451.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$451.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$131.73
|
| Rate for Payer: Multiplan Commercial |
$388.54
|
| Rate for Payer: NAPHCARE Commercial |
$197.59
|
| Rate for Payer: Preferred Network Access Commercial |
$461.40
|
| Rate for Payer: Quartz Beloit One Network |
$213.70
|
| Rate for Payer: Quartz Commercial |
$276.84
|
| Rate for Payer: Quartz Medicare Advantage |
$131.73
|
| Rate for Payer: The Alliance Commercial |
$316.14
|
| Rate for Payer: United Healthcare Medicaid |
$102.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.73
|
| Rate for Payer: WEA Trust Commercial |
$267.12
|
| Rate for Payer: WPS Commercial |
$362.25
|
|
|
Established Pt Consult Level 2
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
3040420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$139.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$170.98
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Established Pt Consult Level 2
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
3040420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$79.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.72
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$170.98
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$170.98
|
| Rate for Payer: The Alliance Commercial |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Established Pt Consult Level 3
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3040421
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Established Pt Consult Level 3
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3040421
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$459.39 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$101.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$218.40
|
| Rate for Payer: The Alliance Commercial |
$459.39
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Established Pt Consult Level 4
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
3040422
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$206.90 |
| Max. Negotiated Rate |
$388.46 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$253.34
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Established Pt Consult Level 4
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
3040422
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$388.46 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Aetna Managed Medicare |
$118.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$274.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$211.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.29
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$316.68
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: NAPHCARE Commercial |
$253.34
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$274.46
|
| Rate for Payer: Quartz Medicare Advantage |
$253.34
|
| Rate for Payer: The Alliance Commercial |
$211.12
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Est Office Visit Routine
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
3040417
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
Est Office Visit Routine
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
3040417
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$228.43
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
