|
Initial emergency room strip posted* - ED Initial Rhythm Strip Posted
|
Facility
|
OP
|
$64.00
|
|
| Hospital Charge Code |
4075881
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.25
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$43.26
|
| Rate for Payer: Quartz Medicare Advantage |
$39.94
|
| Rate for Payer: The Alliance Commercial |
$33.28
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Initial emergency room strip posted* - ED Initial Rhythm Strip Posted
|
Facility
|
IP
|
$64.00
|
|
| Hospital Charge Code |
4075881
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$39.94
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Initial - Handheld Nebulizer Charge
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
2990157
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$168.23 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.23
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| 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 |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| 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 |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$227.81
|
| 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 |
$262.86
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
Initial - Handheld Nebulizer Charge
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 94640
|
| Hospital Charge Code |
2990157
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$210.29
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
Initial Hospital Care 99221
|
Facility
|
OP
|
$691.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
4001093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$201.22 |
| Max. Negotiated Rate |
$661.15 |
| Rate for Payer: Aetna Commercial |
$646.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Aetna Managed Medicare |
$201.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$467.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$359.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$344.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$380.88
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$661.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.16
|
| Rate for Payer: Health EOS Commercial |
$639.59
|
| Rate for Payer: HFN Commercial |
$661.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$538.98
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: NAPHCARE Commercial |
$431.18
|
| Rate for Payer: Preferred Network Access Commercial |
$661.15
|
| Rate for Payer: Quartz Beloit One Network |
$352.13
|
| Rate for Payer: Quartz Commercial |
$467.12
|
| Rate for Payer: Quartz Medicare Advantage |
$431.18
|
| Rate for Payer: The Alliance Commercial |
$289.20
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$532.28
|
|
|
Initial Hospital Care 99221
|
Facility
|
IP
|
$691.00
|
|
|
Service Code
|
CPT 99221
|
| Hospital Charge Code |
4001093
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$352.13 |
| Max. Negotiated Rate |
$661.15 |
| Rate for Payer: Aetna Commercial |
$646.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$380.88
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$661.15
|
| Rate for Payer: Health EOS Commercial |
$639.59
|
| Rate for Payer: HFN Commercial |
$661.15
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: Preferred Network Access Commercial |
$661.15
|
| Rate for Payer: Quartz Beloit One Network |
$352.13
|
| Rate for Payer: Quartz Commercial |
$431.18
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$532.28
|
|
|
Initial Hospital Care 99222
|
Facility
|
IP
|
$891.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
4001094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$454.05 |
| Max. Negotiated Rate |
$852.51 |
| Rate for Payer: Aetna Commercial |
$833.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$491.12
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$852.51
|
| Rate for Payer: Health EOS Commercial |
$824.71
|
| Rate for Payer: HFN Commercial |
$852.51
|
| Rate for Payer: Multiplan Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$852.51
|
| Rate for Payer: Quartz Beloit One Network |
$454.05
|
| Rate for Payer: Quartz Commercial |
$555.98
|
| Rate for Payer: WEA Trust Commercial |
$509.65
|
| Rate for Payer: WPS Commercial |
$686.34
|
|
|
Initial Hospital Care 99222
|
Facility
|
OP
|
$891.00
|
|
|
Service Code
|
CPT 99222
|
| Hospital Charge Code |
4001094
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$259.46 |
| Max. Negotiated Rate |
$852.51 |
| Rate for Payer: Aetna Commercial |
$833.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.91
|
| Rate for Payer: Aetna Managed Medicare |
$259.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$602.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$463.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$491.12
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$852.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$518.56
|
| Rate for Payer: Health EOS Commercial |
$824.71
|
| Rate for Payer: HFN Commercial |
$852.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$694.98
|
| Rate for Payer: Multiplan Commercial |
$741.31
|
| Rate for Payer: NAPHCARE Commercial |
$555.98
|
| Rate for Payer: Preferred Network Access Commercial |
$852.51
|
| Rate for Payer: Quartz Beloit One Network |
$454.05
|
| Rate for Payer: Quartz Commercial |
$602.32
|
| Rate for Payer: Quartz Medicare Advantage |
$555.98
|
| Rate for Payer: The Alliance Commercial |
$460.30
|
| Rate for Payer: WEA Trust Commercial |
$509.65
|
| Rate for Payer: WPS Commercial |
$686.34
|
|
|
Initial Hospital Care 99223
|
Facility
|
IP
|
$1,093.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
4001095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$556.99 |
| Max. Negotiated Rate |
$1,045.78 |
| Rate for Payer: Aetna Commercial |
$1,023.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$977.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.46
|
| Rate for Payer: Cash Price |
$327.90
|
| Rate for Payer: Cigna Commercial |
$1,045.78
|
| Rate for Payer: Health EOS Commercial |
$1,011.68
|
| Rate for Payer: HFN Commercial |
$1,045.78
|
| Rate for Payer: Multiplan Commercial |
$909.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.78
|
| Rate for Payer: Quartz Beloit One Network |
$556.99
|
| Rate for Payer: Quartz Commercial |
$682.03
|
| Rate for Payer: WEA Trust Commercial |
$625.20
|
| Rate for Payer: WPS Commercial |
$841.94
|
|
|
Initial Hospital Care 99223
|
Facility
|
OP
|
$1,093.00
|
|
|
Service Code
|
CPT 99223
|
| Hospital Charge Code |
4001095
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.28 |
| Max. Negotiated Rate |
$1,045.78 |
| Rate for Payer: Aetna Commercial |
$1,023.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$977.58
|
| Rate for Payer: Aetna Managed Medicare |
$318.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$738.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$568.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$545.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$602.46
|
| Rate for Payer: Cash Price |
$327.90
|
| Rate for Payer: Cash Price |
$327.90
|
| Rate for Payer: Cigna Commercial |
$1,045.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$636.13
|
| Rate for Payer: Health EOS Commercial |
$1,011.68
|
| Rate for Payer: HFN Commercial |
$1,045.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$852.54
|
| Rate for Payer: Multiplan Commercial |
$909.38
|
| Rate for Payer: NAPHCARE Commercial |
$682.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,045.78
|
| Rate for Payer: Quartz Beloit One Network |
$556.99
|
| Rate for Payer: Quartz Commercial |
$738.87
|
| Rate for Payer: Quartz Medicare Advantage |
$682.03
|
| Rate for Payer: The Alliance Commercial |
$618.09
|
| Rate for Payer: WEA Trust Commercial |
$625.20
|
| Rate for Payer: WPS Commercial |
$841.94
|
|
|
Initial IV Push 96374 - Admin Initial IV Push Charge
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
3023767
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$174.22 |
| Max. Negotiated Rate |
$895.40 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Aetna Managed Medicare |
$223.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.22
|
| Rate for Payer: Anthem Medicare Advantage |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$223.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$223.85
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$223.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$223.85
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$832.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$223.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$223.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$223.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$223.85
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: NAPHCARE Commercial |
$335.77
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$235.92
|
| Rate for Payer: Quartz Medicare Advantage |
$223.85
|
| Rate for Payer: The Alliance Commercial |
$895.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$223.85
|
| Rate for Payer: United Healthcare PPO |
$272.22
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: Wellcare Medicare |
$223.85
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
Initial IV Push 96374 - Admin Initial IV Push Charge
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
3023767
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$333.92 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$217.78
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
Initial IV Push 96374 - Admin Initial IV Push Charge
|
Professional
|
Both
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
3023767
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$37.42 |
| Max. Negotiated Rate |
$344.81 |
| Rate for Payer: Aetna Commercial |
$344.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Aetna Managed Medicare |
$37.42
|
| Rate for Payer: Anthem Medicare Advantage |
$37.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.42
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$344.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.42
|
| Rate for Payer: Health EOS Commercial |
$330.29
|
| Rate for Payer: HFN Commercial |
$344.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$144.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.42
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: NAPHCARE Commercial |
$56.13
|
| Rate for Payer: Preferred Network Access Commercial |
$344.81
|
| Rate for Payer: Quartz Beloit One Network |
$159.70
|
| Rate for Payer: Quartz Commercial |
$206.89
|
| Rate for Payer: Quartz Medicare Advantage |
$37.42
|
| Rate for Payer: The Alliance Commercial |
$93.55
|
| Rate for Payer: United Healthcare Medicaid |
$48.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.42
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$149.68
|
|
|
Initial setup - CPAP/Bipap Charge
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
2990152
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$230.45 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$568.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.90
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$410.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$315.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$303.01
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.58
|
| 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 |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$580.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$353.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$561.84
|
| Rate for Payer: HFN Commercial |
$580.78
|
| 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 |
$505.02
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$580.78
|
| Rate for Payer: Quartz Beloit One Network |
$309.33
|
| Rate for Payer: Quartz Commercial |
$410.33
|
| 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 |
$473.46
|
| Rate for Payer: WEA Trust Commercial |
$347.20
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$467.57
|
|
|
Initial setup - CPAP/Bipap Charge
|
Facility
|
IP
|
$607.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
2990152
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$309.33 |
| Max. Negotiated Rate |
$580.78 |
| Rate for Payer: Aetna Commercial |
$568.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.58
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$580.78
|
| Rate for Payer: Health EOS Commercial |
$561.84
|
| Rate for Payer: HFN Commercial |
$580.78
|
| Rate for Payer: Multiplan Commercial |
$505.02
|
| Rate for Payer: Preferred Network Access Commercial |
$580.78
|
| Rate for Payer: Quartz Beloit One Network |
$309.33
|
| Rate for Payer: Quartz Commercial |
$378.77
|
| Rate for Payer: WEA Trust Commercial |
$347.20
|
| Rate for Payer: WPS Commercial |
$467.57
|
|
|
Initial setup - Infant Cpap Charge
|
Facility
|
IP
|
$607.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3031035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$309.33 |
| Max. Negotiated Rate |
$580.78 |
| Rate for Payer: Aetna Commercial |
$568.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.58
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$580.78
|
| Rate for Payer: Health EOS Commercial |
$561.84
|
| Rate for Payer: HFN Commercial |
$580.78
|
| Rate for Payer: Multiplan Commercial |
$505.02
|
| Rate for Payer: Preferred Network Access Commercial |
$580.78
|
| Rate for Payer: Quartz Beloit One Network |
$309.33
|
| Rate for Payer: Quartz Commercial |
$378.77
|
| Rate for Payer: WEA Trust Commercial |
$347.20
|
| Rate for Payer: WPS Commercial |
$467.57
|
|
|
Initial setup - Infant Cpap Charge
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3031035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$230.45 |
| Max. Negotiated Rate |
$921.81 |
| Rate for Payer: Aetna Commercial |
$568.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.90
|
| Rate for Payer: Aetna Managed Medicare |
$230.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$410.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$315.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$303.01
|
| Rate for Payer: Anthem Medicare Advantage |
$230.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.58
|
| 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 |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$580.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$230.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$353.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$230.45
|
| Rate for Payer: Health EOS Commercial |
$561.84
|
| Rate for Payer: HFN Commercial |
$580.78
|
| 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 |
$505.02
|
| Rate for Payer: NAPHCARE Commercial |
$345.68
|
| Rate for Payer: Preferred Network Access Commercial |
$580.78
|
| Rate for Payer: Quartz Beloit One Network |
$309.33
|
| Rate for Payer: Quartz Commercial |
$410.33
|
| 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 |
$473.46
|
| Rate for Payer: WEA Trust Commercial |
$347.20
|
| Rate for Payer: Wellcare Medicare |
$230.45
|
| Rate for Payer: WPS Commercial |
$467.57
|
|
|
Initial setup - Vapotherm Charge
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3023869
|
|
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
|
|
|
Initial setup - Vapotherm Charge
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3023869
|
|
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
|
|
|
Initial setup - Ventilator Charge
|
Facility
|
IP
|
$1,801.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
2990154
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$917.79 |
| Max. Negotiated Rate |
$1,723.20 |
| Rate for Payer: Aetna Commercial |
$1,685.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,610.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$992.71
|
| Rate for Payer: Cash Price |
$540.30
|
| Rate for Payer: Cigna Commercial |
$1,723.20
|
| Rate for Payer: Health EOS Commercial |
$1,667.01
|
| Rate for Payer: HFN Commercial |
$1,723.20
|
| Rate for Payer: Multiplan Commercial |
$1,498.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,723.20
|
| Rate for Payer: Quartz Beloit One Network |
$917.79
|
| Rate for Payer: Quartz Commercial |
$1,123.82
|
| Rate for Payer: WEA Trust Commercial |
$1,030.17
|
| Rate for Payer: WPS Commercial |
$1,387.31
|
|
|
Initial setup - Ventilator Charge
|
Facility
|
OP
|
$1,801.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
2990154
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$650.16 |
| Max. Negotiated Rate |
$2,600.62 |
| Rate for Payer: Aetna Commercial |
$1,685.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,610.81
|
| Rate for Payer: Aetna Managed Medicare |
$650.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,217.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$936.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$899.06
|
| Rate for Payer: Anthem Medicare Advantage |
$650.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$992.71
|
| 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 |
$540.30
|
| Rate for Payer: Cash Price |
$540.30
|
| Rate for Payer: Cigna Commercial |
$1,723.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$650.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,048.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$650.16
|
| Rate for Payer: Health EOS Commercial |
$1,667.01
|
| Rate for Payer: HFN Commercial |
$1,723.20
|
| 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 |
$1,498.43
|
| Rate for Payer: NAPHCARE Commercial |
$975.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,723.20
|
| Rate for Payer: Quartz Beloit One Network |
$917.79
|
| Rate for Payer: Quartz Commercial |
$1,217.48
|
| 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 |
$1,404.78
|
| Rate for Payer: WEA Trust Commercial |
$1,030.17
|
| Rate for Payer: Wellcare Medicare |
$650.16
|
| Rate for Payer: WPS Commercial |
$1,387.31
|
|
|
Initial tubing - PCA Pump Related Activity
|
Facility
|
OP
|
$139.00
|
|
| Hospital Charge Code |
3031391
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$40.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.42
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$86.74
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$86.74
|
| Rate for Payer: The Alliance Commercial |
$72.28
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Initial tubing - PCA Pump Related Activity
|
Facility
|
IP
|
$139.00
|
|
| Hospital Charge Code |
3031391
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Inj 2nd Admin H Antineoplastic 96402-59 - Admin Chemo SubQ/IM H Anti #2
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 96402 59
|
| Hospital Charge Code |
6183065
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$103.67 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$103.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$277.68
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$222.14
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$222.14
|
| Rate for Payer: The Alliance Commercial |
$185.12
|
| Rate for Payer: United Healthcare PPO |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Inj 2nd Admin H Antineoplastic 96402-59 - Admin Chemo SubQ/IM H Anti #2
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 96402 59
|
| Hospital Charge Code |
6183065
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$30.01 |
| Max. Negotiated Rate |
$351.73 |
| Rate for Payer: Aetna Commercial |
$351.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$351.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.14
|
| Rate for Payer: Health EOS Commercial |
$336.92
|
| Rate for Payer: HFN Commercial |
$351.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.39
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$351.73
|
| Rate for Payer: Quartz Beloit One Network |
$162.91
|
| Rate for Payer: Quartz Commercial |
$211.04
|
| Rate for Payer: The Alliance Commercial |
$185.12
|
| Rate for Payer: United Healthcare Medicaid |
$30.01
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
