|
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 |
$167.52 |
| Max. Negotiated Rate |
$847.40 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Aetna Managed Medicare |
$211.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.52
|
| Rate for Payer: Anthem Medicare Advantage |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.85
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.85
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$788.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.85
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$317.78
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$226.85
|
| Rate for Payer: Quartz Medicare Advantage |
$211.85
|
| Rate for Payer: The Alliance Commercial |
$847.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.85
|
| Rate for Payer: United Healthcare PPO |
$261.75
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: Wellcare Medicare |
$211.85
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
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 |
$171.01 |
| Max. Negotiated Rate |
$321.08 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$209.40
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
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 |
$46.21 |
| Max. Negotiated Rate |
$331.55 |
| Rate for Payer: Aetna Commercial |
$331.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$331.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.40
|
| Rate for Payer: Health EOS Commercial |
$317.59
|
| Rate for Payer: HFN Commercial |
$331.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.94
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: Preferred Network Access Commercial |
$331.55
|
| Rate for Payer: Quartz Beloit One Network |
$153.56
|
| Rate for Payer: Quartz Commercial |
$198.93
|
| Rate for Payer: The Alliance Commercial |
$174.50
|
| Rate for Payer: United Healthcare Medicaid |
$46.21
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Initial setup - CPAP/Bipap Charge
|
Facility
|
IP
|
$607.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
2990152
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$297.43 |
| Max. Negotiated Rate |
$558.44 |
| Rate for Payer: Aetna Commercial |
$546.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$522.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.71
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$558.44
|
| Rate for Payer: Health EOS Commercial |
$540.23
|
| Rate for Payer: HFN Commercial |
$558.44
|
| Rate for Payer: Multiplan Commercial |
$485.60
|
| Rate for Payer: NAPHCARE Commercial |
$364.20
|
| Rate for Payer: Preferred Network Access Commercial |
$558.44
|
| Rate for Payer: Quartz Beloit One Network |
$297.43
|
| Rate for Payer: Quartz Commercial |
$364.20
|
| Rate for Payer: WEA Trust Commercial |
$333.85
|
| Rate for Payer: WPS Commercial |
$449.60
|
|
|
Initial setup - CPAP/Bipap Charge
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
2990152
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$843.28 |
| Rate for Payer: Aetna Commercial |
$546.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$522.02
|
| Rate for Payer: Aetna Managed Medicare |
$210.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$394.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.36
|
| Rate for Payer: Anthem Medicare Advantage |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.82
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$558.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.82
|
| Rate for Payer: Health EOS Commercial |
$540.23
|
| Rate for Payer: HFN Commercial |
$558.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$210.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$210.82
|
| Rate for Payer: Multiplan Commercial |
$485.60
|
| Rate for Payer: NAPHCARE Commercial |
$316.23
|
| Rate for Payer: Preferred Network Access Commercial |
$558.44
|
| Rate for Payer: Quartz Beloit One Network |
$297.43
|
| Rate for Payer: Quartz Commercial |
$394.55
|
| Rate for Payer: Quartz Medicare Advantage |
$210.82
|
| Rate for Payer: The Alliance Commercial |
$843.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare PPO |
$455.25
|
| Rate for Payer: WEA Trust Commercial |
$333.85
|
| Rate for Payer: Wellcare Medicare |
$210.82
|
| Rate for Payer: WPS Commercial |
$449.60
|
|
|
Initial setup - Infant Cpap Charge
|
Facility
|
IP
|
$607.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3031035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$297.43 |
| Max. Negotiated Rate |
$558.44 |
| Rate for Payer: Aetna Commercial |
$546.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$522.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.71
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$558.44
|
| Rate for Payer: Health EOS Commercial |
$540.23
|
| Rate for Payer: HFN Commercial |
$558.44
|
| Rate for Payer: Multiplan Commercial |
$485.60
|
| Rate for Payer: NAPHCARE Commercial |
$364.20
|
| Rate for Payer: Preferred Network Access Commercial |
$558.44
|
| Rate for Payer: Quartz Beloit One Network |
$297.43
|
| Rate for Payer: Quartz Commercial |
$364.20
|
| Rate for Payer: WEA Trust Commercial |
$333.85
|
| Rate for Payer: WPS Commercial |
$449.60
|
|
|
Initial setup - Infant Cpap Charge
|
Facility
|
OP
|
$607.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3031035
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$843.28 |
| Rate for Payer: Aetna Commercial |
$546.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$522.02
|
| Rate for Payer: Aetna Managed Medicare |
$210.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$394.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.36
|
| Rate for Payer: Anthem Medicare Advantage |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.82
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cash Price |
$182.10
|
| Rate for Payer: Cigna Commercial |
$558.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.82
|
| Rate for Payer: Health EOS Commercial |
$540.23
|
| Rate for Payer: HFN Commercial |
$558.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$210.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$210.82
|
| Rate for Payer: Multiplan Commercial |
$485.60
|
| Rate for Payer: NAPHCARE Commercial |
$316.23
|
| Rate for Payer: Preferred Network Access Commercial |
$558.44
|
| Rate for Payer: Quartz Beloit One Network |
$297.43
|
| Rate for Payer: Quartz Commercial |
$394.55
|
| Rate for Payer: Quartz Medicare Advantage |
$210.82
|
| Rate for Payer: The Alliance Commercial |
$843.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare PPO |
$455.25
|
| Rate for Payer: WEA Trust Commercial |
$333.85
|
| Rate for Payer: Wellcare Medicare |
$210.82
|
| Rate for Payer: WPS Commercial |
$449.60
|
|
|
Initial setup - Vapotherm Charge
|
Facility
|
OP
|
$561.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3023869
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$843.28 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Aetna Managed Medicare |
$210.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.28
|
| Rate for Payer: Anthem Medicare Advantage |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.82
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.82
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$210.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$210.82
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$316.23
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$364.65
|
| Rate for Payer: Quartz Medicare Advantage |
$210.82
|
| Rate for Payer: The Alliance Commercial |
$843.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare PPO |
$420.75
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: Wellcare Medicare |
$210.82
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
Initial setup - Vapotherm Charge
|
Facility
|
IP
|
$561.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3023869
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$274.89 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
Initial setup - Ventilator Charge
|
Facility
|
OP
|
$1,801.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
2990154
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$619.40 |
| Max. Negotiated Rate |
$2,477.60 |
| Rate for Payer: Aetna Commercial |
$1,620.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,548.86
|
| Rate for Payer: Aetna Managed Medicare |
$619.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,170.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$900.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$864.48
|
| Rate for Payer: Anthem Medicare Advantage |
$619.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$954.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$619.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$619.40
|
| Rate for Payer: Cash Price |
$540.30
|
| Rate for Payer: Cash Price |
$540.30
|
| Rate for Payer: Cigna Commercial |
$1,656.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$619.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,007.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$619.40
|
| Rate for Payer: Health EOS Commercial |
$1,602.89
|
| Rate for Payer: HFN Commercial |
$1,656.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,304.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$619.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$619.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$619.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$619.40
|
| Rate for Payer: Multiplan Commercial |
$1,440.80
|
| Rate for Payer: NAPHCARE Commercial |
$929.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,656.92
|
| Rate for Payer: Quartz Beloit One Network |
$882.49
|
| Rate for Payer: Quartz Commercial |
$1,170.65
|
| Rate for Payer: Quartz Medicare Advantage |
$619.40
|
| Rate for Payer: The Alliance Commercial |
$2,477.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.40
|
| Rate for Payer: United Healthcare PPO |
$1,350.75
|
| Rate for Payer: WEA Trust Commercial |
$990.55
|
| Rate for Payer: Wellcare Medicare |
$619.40
|
| Rate for Payer: WPS Commercial |
$1,334.00
|
|
|
Initial setup - Ventilator Charge
|
Facility
|
IP
|
$1,801.00
|
|
|
Service Code
|
CPT 94002
|
| Hospital Charge Code |
2990154
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$882.49 |
| Max. Negotiated Rate |
$1,656.92 |
| Rate for Payer: Aetna Commercial |
$1,620.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,548.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$954.53
|
| Rate for Payer: Cash Price |
$540.30
|
| Rate for Payer: Cigna Commercial |
$1,656.92
|
| Rate for Payer: Health EOS Commercial |
$1,602.89
|
| Rate for Payer: HFN Commercial |
$1,656.92
|
| Rate for Payer: Multiplan Commercial |
$1,440.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,080.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,656.92
|
| Rate for Payer: Quartz Beloit One Network |
$882.49
|
| Rate for Payer: Quartz Commercial |
$1,080.60
|
| Rate for Payer: WEA Trust Commercial |
$990.55
|
| Rate for Payer: WPS Commercial |
$1,334.00
|
|
|
Initial tubing - PCA Pump Related Activity
|
Facility
|
OP
|
$139.00
|
|
| Hospital Charge Code |
3031391
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$38.92 |
| Max. Negotiated Rate |
$556.00 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$38.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.25
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$83.40
|
| Rate for Payer: The Alliance Commercial |
$556.00
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Initial tubing - PCA Pump Related Activity
|
Facility
|
IP
|
$139.00
|
|
| Hospital Charge Code |
3031391
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
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 |
$69.63 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
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 |
$28.86 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Aetna Commercial |
$338.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| 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 |
$338.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.60
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$338.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.99
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.20
|
| Rate for Payer: Quartz Beloit One Network |
$156.64
|
| Rate for Payer: Quartz Commercial |
$202.92
|
| Rate for Payer: The Alliance Commercial |
$178.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.86
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Inj 2nd Admin H Antineoplastic 96402-59 - Admin Chemo SubQ/IM H Anti #2
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 96402 59
|
| Hospital Charge Code |
6183065
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Inj Admin Alteplase/Cathflow 36593 - Admin Alteplase/Cathflow
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
3023770
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$334.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.56
|
| Rate for Payer: Anthem Medicare Advantage |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.74
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.74
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.74
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$502.11
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$334.74
|
| Rate for Payer: The Alliance Commercial |
$1,338.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.74
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: Wellcare Medicare |
$334.74
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
Inj Admin Alteplase/Cathflow 36593 - Admin Alteplase/Cathflow
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
3023770
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
Inj Admin Alteplase/Cathflow 36593 - Admin Alteplase/Cathflow
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
3023770
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.85 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Aetna Commercial |
$139.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$139.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.20
|
| Rate for Payer: Health EOS Commercial |
$133.77
|
| Rate for Payer: HFN Commercial |
$139.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.78
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$139.65
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$83.79
|
| Rate for Payer: The Alliance Commercial |
$73.50
|
| Rate for Payer: United Healthcare Medicaid |
$23.85
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
Inj Admin Hormonal Antineoplastic 96402 - Admin Chemo SubQ/IM Hormonal Antineoplastic
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 96402 59
|
| Hospital Charge Code |
3165610
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Inj Admin Hormonal Antineoplastic 96402 - Admin Chemo SubQ/IM Hormonal Antineoplastic
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 96402 59
|
| Hospital Charge Code |
3165610
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$28.86 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Aetna Commercial |
$338.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| 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 |
$338.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.60
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$338.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.99
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.20
|
| Rate for Payer: Quartz Beloit One Network |
$156.64
|
| Rate for Payer: Quartz Commercial |
$202.92
|
| Rate for Payer: The Alliance Commercial |
$178.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.86
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Inj Admin Hormonal Antineoplastic 96402 - Admin Chemo SubQ/IM Hormonal Antineoplastic
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 96402 59
|
| Hospital Charge Code |
3165610
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Inj Admin Intravitreal 67028 - Admin Intravitreal Injection Charge
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
3023771
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.72 |
| Max. Negotiated Rate |
$663.10 |
| Rate for Payer: Aetna Commercial |
$663.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.28
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$663.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.80
|
| Rate for Payer: Health EOS Commercial |
$635.18
|
| Rate for Payer: HFN Commercial |
$663.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.18
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Preferred Network Access Commercial |
$663.10
|
| Rate for Payer: Quartz Beloit One Network |
$307.12
|
| Rate for Payer: Quartz Commercial |
$397.86
|
| Rate for Payer: The Alliance Commercial |
$349.00
|
| Rate for Payer: United Healthcare Medicaid |
$170.72
|
| Rate for Payer: WEA Trust Commercial |
$383.90
|
| Rate for Payer: WPS Commercial |
$517.01
|
|
|
Inj Admin Non-hormonal Antineoplastic 96401 - Admin Chemo SubQ/IM Non-hormonal Antineoplastic
|
Facility
|
OP
|
$441.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
3437512
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$405.72 |
| Rate for Payer: Aetna Commercial |
$396.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$379.26
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$286.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$220.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.68
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna Commercial |
$405.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$392.49
|
| Rate for Payer: HFN Commercial |
$405.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$405.72
|
| Rate for Payer: Quartz Beloit One Network |
$216.09
|
| Rate for Payer: Quartz Commercial |
$286.65
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$330.75
|
| Rate for Payer: WEA Trust Commercial |
$242.55
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$326.65
|
|
|
Inj Admin Non-hormonal Antineoplastic 96401 - Admin Chemo SubQ/IM Non-hormonal Antineoplastic
|
Professional
|
Both
|
$441.00
|
|
|
Service Code
|
CPT 96401
|
| Hospital Charge Code |
3437512
|
|
Hospital Revenue Code
|
331
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$418.95 |
| Rate for Payer: Aetna Commercial |
$418.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$379.26
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cash Price |
$132.30
|
| Rate for Payer: Cigna Commercial |
$418.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.60
|
| Rate for Payer: Health EOS Commercial |
$401.31
|
| Rate for Payer: HFN Commercial |
$418.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.35
|
| Rate for Payer: Multiplan Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$418.95
|
| Rate for Payer: Quartz Beloit One Network |
$194.04
|
| Rate for Payer: Quartz Commercial |
$251.37
|
| Rate for Payer: The Alliance Commercial |
$220.50
|
| Rate for Payer: United Healthcare Medicaid |
$53.36
|
| Rate for Payer: WEA Trust Commercial |
$242.55
|
| Rate for Payer: WPS Commercial |
$326.65
|
|
