|
IV Infusion for Ther-Concurrent - 96368
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
5516708
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| 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: 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: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.00
|
| 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 |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$213.60
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
IV Infusion for Ther-Concurrent - 96368
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
5516708
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
|
IV Infusion For Ther-Concurrnt
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
3040220
|
|
Hospital Revenue Code
|
260
|
| 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
|
|
|
IV Infusion For Ther-Concurrnt
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 96368
|
| Hospital Charge Code |
3040220
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| 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: 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: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.00
|
| 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 |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$213.60
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
IV Infusion For Ther-Subsequnt
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
3040221
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.24
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| 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 |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| 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 |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| 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 |
$291.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
IV Infusion For Ther-Subsequnt
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
3040221
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
IV Infusion Hydration 1 hr
|
Facility
|
IP
|
$508.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
3970748
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$248.92 |
| Max. Negotiated Rate |
$467.36 |
| Rate for Payer: Aetna Commercial |
$457.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.24
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$467.36
|
| Rate for Payer: Health EOS Commercial |
$452.12
|
| Rate for Payer: HFN Commercial |
$467.36
|
| Rate for Payer: Multiplan Commercial |
$406.40
|
| Rate for Payer: NAPHCARE Commercial |
$304.80
|
| Rate for Payer: Preferred Network Access Commercial |
$467.36
|
| Rate for Payer: Quartz Beloit One Network |
$248.92
|
| Rate for Payer: Quartz Commercial |
$304.80
|
| Rate for Payer: WEA Trust Commercial |
$279.40
|
| Rate for Payer: WPS Commercial |
$376.28
|
|
|
IV Infusion Hydration 1 hr
|
Facility
|
OP
|
$508.00
|
|
|
Service Code
|
CPT 96360
|
| Hospital Charge Code |
3970748
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$211.85 |
| Max. Negotiated Rate |
$847.40 |
| Rate for Payer: Aetna Commercial |
$457.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.88
|
| Rate for Payer: Aetna Managed Medicare |
$211.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$243.84
|
| Rate for Payer: Anthem Medicare Advantage |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.24
|
| 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 |
$152.40
|
| Rate for Payer: Cash Price |
$152.40
|
| Rate for Payer: Cigna Commercial |
$467.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.85
|
| Rate for Payer: Health EOS Commercial |
$452.12
|
| Rate for Payer: HFN Commercial |
$467.36
|
| 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 |
$406.40
|
| Rate for Payer: NAPHCARE Commercial |
$317.78
|
| Rate for Payer: Preferred Network Access Commercial |
$467.36
|
| Rate for Payer: Quartz Beloit One Network |
$248.92
|
| Rate for Payer: Quartz Commercial |
$330.20
|
| 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 |
$381.00
|
| Rate for Payer: WEA Trust Commercial |
$279.40
|
| Rate for Payer: Wellcare Medicare |
$211.85
|
| Rate for Payer: WPS Commercial |
$376.28
|
|
|
IV Infusion Hydration Addl hr
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
3970749
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$187.80 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$46.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Anthem Medicare Advantage |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.95
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.95
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$70.42
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$46.95
|
| Rate for Payer: The Alliance Commercial |
$187.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare PPO |
$141.75
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: Wellcare Medicare |
$46.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
IV Infusion Hydration Addl hr
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
3970749
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
IV Infusion Hydration Addl HR
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
4532709
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$187.80 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$46.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Anthem Medicare Advantage |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.95
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.95
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$70.42
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$46.95
|
| Rate for Payer: The Alliance Commercial |
$187.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare PPO |
$141.75
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: Wellcare Medicare |
$46.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
IV Infusion Hydration Addl HR
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
4532709
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
IV Infusion Therapy Ea Addl Hr
|
Facility
|
IP
|
$264.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
3040218
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$129.36 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.92
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$158.40
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
IV Infusion Therapy Ea Addl Hr
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
3040218
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Aetna Managed Medicare |
$46.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$171.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.72
|
| Rate for Payer: Anthem Medicare Advantage |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.95
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.95
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$70.42
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$46.95
|
| Rate for Payer: The Alliance Commercial |
$187.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare PPO |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: Wellcare Medicare |
$46.95
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
IV Infuson For Hydration Add Hr
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
3040217
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
IV Infuson For Hydration Add Hr
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 96361
|
| Hospital Charge Code |
3040217
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$46.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.48
|
| Rate for Payer: Anthem Medicare Advantage |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.95
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.95
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$70.42
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$46.95
|
| Rate for Payer: The Alliance Commercial |
$187.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare PPO |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: Wellcare Medicare |
$46.95
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
IV PUMP
|
Facility
|
OP
|
$579.00
|
|
| Hospital Charge Code |
3075868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$162.12 |
| Max. Negotiated Rate |
$2,316.00 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Aetna Managed Medicare |
$162.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$376.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$277.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.01
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.25
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$376.35
|
| Rate for Payer: Quartz Medicare Advantage |
$347.40
|
| Rate for Payer: The Alliance Commercial |
$2,316.00
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
IV PUMP
|
Facility
|
IP
|
$579.00
|
|
| Hospital Charge Code |
3075868
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$283.71 |
| Max. Negotiated Rate |
$532.68 |
| Rate for Payer: Aetna Commercial |
$521.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.87
|
| Rate for Payer: Cash Price |
$173.70
|
| Rate for Payer: Cigna Commercial |
$532.68
|
| Rate for Payer: Health EOS Commercial |
$515.31
|
| Rate for Payer: HFN Commercial |
$532.68
|
| Rate for Payer: Multiplan Commercial |
$463.20
|
| Rate for Payer: NAPHCARE Commercial |
$347.40
|
| Rate for Payer: Preferred Network Access Commercial |
$532.68
|
| Rate for Payer: Quartz Beloit One Network |
$283.71
|
| Rate for Payer: Quartz Commercial |
$347.40
|
| Rate for Payer: WEA Trust Commercial |
$318.45
|
| Rate for Payer: WPS Commercial |
$428.87
|
|
|
IV Pumps
|
Facility
|
OP
|
$620.00
|
|
| Hospital Charge Code |
2983452
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$2,480.00 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$173.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| Rate for Payer: Quartz Medicare Advantage |
$372.00
|
| Rate for Payer: The Alliance Commercial |
$2,480.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
IV Pumps
|
Facility
|
IP
|
$620.00
|
|
| Hospital Charge Code |
2983452
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
IV securement device - Peripheral IV Equipment:
|
Facility
|
IP
|
$139.00
|
|
| Hospital Charge Code |
3092876
|
|
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
|
|
|
IV securement device - Peripheral IV Equipment:
|
Facility
|
OP
|
$139.00
|
|
| Hospital Charge Code |
3092876
|
|
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
|
|
|
I.V. Start Kit
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
3040292
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.40
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
I.V. Start Kit
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
3040292
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$2.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.04
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.40
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
IV START KIT DYNDV1539B
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2962923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$22.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.75
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$48.60
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
