|
PACK LITHOTOMY PERI-GYNE IV 88541
|
Facility
|
IP
|
$246.00
|
|
| Hospital Charge Code |
2962813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.36 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.60
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$235.37
|
| Rate for Payer: Health EOS Commercial |
$227.70
|
| Rate for Payer: HFN Commercial |
$235.37
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$235.37
|
| Rate for Payer: Quartz Beloit One Network |
$125.36
|
| Rate for Payer: Quartz Commercial |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$189.49
|
|
|
PACK MAJOR SET UP DNYJ30559F 2957
|
Facility
|
IP
|
$918.00
|
|
| Hospital Charge Code |
2975360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$467.81 |
| Max. Negotiated Rate |
$878.34 |
| Rate for Payer: Aetna Commercial |
$859.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.00
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$878.34
|
| Rate for Payer: Health EOS Commercial |
$849.70
|
| Rate for Payer: HFN Commercial |
$878.34
|
| Rate for Payer: Multiplan Commercial |
$763.78
|
| Rate for Payer: Preferred Network Access Commercial |
$878.34
|
| Rate for Payer: Quartz Beloit One Network |
$467.81
|
| Rate for Payer: Quartz Commercial |
$572.83
|
| Rate for Payer: WEA Trust Commercial |
$525.10
|
| Rate for Payer: WPS Commercial |
$707.14
|
|
|
PACK MAJOR SET UP DNYJ30559F 2957
|
Facility
|
OP
|
$918.00
|
|
| Hospital Charge Code |
2975360
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$267.32 |
| Max. Negotiated Rate |
$878.34 |
| Rate for Payer: Aetna Commercial |
$859.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$821.06
|
| Rate for Payer: Aetna Managed Medicare |
$267.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$620.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$477.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$458.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$506.00
|
| Rate for Payer: Cash Price |
$275.40
|
| Rate for Payer: Cigna Commercial |
$878.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$534.28
|
| Rate for Payer: Health EOS Commercial |
$849.70
|
| Rate for Payer: HFN Commercial |
$878.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.04
|
| Rate for Payer: Multiplan Commercial |
$763.78
|
| Rate for Payer: NAPHCARE Commercial |
$572.83
|
| Rate for Payer: Preferred Network Access Commercial |
$878.34
|
| Rate for Payer: Quartz Beloit One Network |
$467.81
|
| Rate for Payer: Quartz Commercial |
$620.57
|
| Rate for Payer: Quartz Medicare Advantage |
$572.83
|
| Rate for Payer: The Alliance Commercial |
$477.36
|
| Rate for Payer: WEA Trust Commercial |
$525.10
|
| Rate for Payer: WPS Commercial |
$707.14
|
|
|
PACK MAJOR VASCULAR CUSTOM DYNJ30564I
|
Facility
|
IP
|
$1,821.00
|
|
| Hospital Charge Code |
2963036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$927.98 |
| Max. Negotiated Rate |
$1,742.33 |
| Rate for Payer: Aetna Commercial |
$1,704.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,628.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,003.74
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna Commercial |
$1,742.33
|
| Rate for Payer: Health EOS Commercial |
$1,685.52
|
| Rate for Payer: HFN Commercial |
$1,742.33
|
| Rate for Payer: Multiplan Commercial |
$1,515.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,742.33
|
| Rate for Payer: Quartz Beloit One Network |
$927.98
|
| Rate for Payer: Quartz Commercial |
$1,136.30
|
| Rate for Payer: WEA Trust Commercial |
$1,041.61
|
| Rate for Payer: WPS Commercial |
$1,402.72
|
|
|
PACK MAJOR VASCULAR CUSTOM DYNJ30564I
|
Facility
|
OP
|
$1,821.00
|
|
| Hospital Charge Code |
2963036
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.28 |
| Max. Negotiated Rate |
$1,742.33 |
| Rate for Payer: Aetna Commercial |
$1,704.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,628.70
|
| Rate for Payer: Aetna Managed Medicare |
$530.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,231.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$946.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$909.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,003.74
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna Commercial |
$1,742.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,059.82
|
| Rate for Payer: Health EOS Commercial |
$1,685.52
|
| Rate for Payer: HFN Commercial |
$1,742.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,420.38
|
| Rate for Payer: Multiplan Commercial |
$1,515.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,136.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,742.33
|
| Rate for Payer: Quartz Beloit One Network |
$927.98
|
| Rate for Payer: Quartz Commercial |
$1,231.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,136.30
|
| Rate for Payer: The Alliance Commercial |
$946.92
|
| Rate for Payer: WEA Trust Commercial |
$1,041.61
|
| Rate for Payer: WPS Commercial |
$1,402.72
|
|
|
PACK MINOR CUSTOM DYNJ30560F
|
Facility
|
IP
|
$470.00
|
|
| Hospital Charge Code |
2963110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.51 |
| Max. Negotiated Rate |
$449.70 |
| Rate for Payer: Aetna Commercial |
$439.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.06
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$449.70
|
| Rate for Payer: Health EOS Commercial |
$435.03
|
| Rate for Payer: HFN Commercial |
$449.70
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: Preferred Network Access Commercial |
$449.70
|
| Rate for Payer: Quartz Beloit One Network |
$239.51
|
| Rate for Payer: Quartz Commercial |
$293.28
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$362.04
|
|
|
PACK MINOR CUSTOM DYNJ30560F
|
Facility
|
OP
|
$470.00
|
|
| Hospital Charge Code |
2963110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.86 |
| Max. Negotiated Rate |
$449.70 |
| Rate for Payer: Aetna Commercial |
$439.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$136.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.06
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$449.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.54
|
| Rate for Payer: Health EOS Commercial |
$435.03
|
| Rate for Payer: HFN Commercial |
$449.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$366.60
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$293.28
|
| Rate for Payer: Preferred Network Access Commercial |
$449.70
|
| Rate for Payer: Quartz Beloit One Network |
$239.51
|
| Rate for Payer: Quartz Commercial |
$317.72
|
| Rate for Payer: Quartz Medicare Advantage |
$293.28
|
| Rate for Payer: The Alliance Commercial |
$244.40
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$362.04
|
|
|
PACK PHACO ADD #DP4310
|
Facility
|
IP
|
$978.00
|
|
| Hospital Charge Code |
2962989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.39 |
| Max. Negotiated Rate |
$935.75 |
| Rate for Payer: Aetna Commercial |
$915.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$874.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$539.07
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cigna Commercial |
$935.75
|
| Rate for Payer: Health EOS Commercial |
$905.24
|
| Rate for Payer: HFN Commercial |
$935.75
|
| Rate for Payer: Multiplan Commercial |
$813.70
|
| Rate for Payer: Preferred Network Access Commercial |
$935.75
|
| Rate for Payer: Quartz Beloit One Network |
$498.39
|
| Rate for Payer: Quartz Commercial |
$610.27
|
| Rate for Payer: WEA Trust Commercial |
$559.42
|
| Rate for Payer: WPS Commercial |
$753.35
|
|
|
PACK PHACO ADD #DP4310
|
Facility
|
OP
|
$978.00
|
|
| Hospital Charge Code |
2962989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$284.79 |
| Max. Negotiated Rate |
$935.75 |
| Rate for Payer: Aetna Commercial |
$915.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$874.72
|
| Rate for Payer: Aetna Managed Medicare |
$284.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$661.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$488.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$539.07
|
| Rate for Payer: Cash Price |
$293.40
|
| Rate for Payer: Cigna Commercial |
$935.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$569.20
|
| Rate for Payer: Health EOS Commercial |
$905.24
|
| Rate for Payer: HFN Commercial |
$935.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.84
|
| Rate for Payer: Multiplan Commercial |
$813.70
|
| Rate for Payer: NAPHCARE Commercial |
$610.27
|
| Rate for Payer: Preferred Network Access Commercial |
$935.75
|
| Rate for Payer: Quartz Beloit One Network |
$498.39
|
| Rate for Payer: Quartz Commercial |
$661.13
|
| Rate for Payer: Quartz Medicare Advantage |
$610.27
|
| Rate for Payer: The Alliance Commercial |
$508.56
|
| Rate for Payer: WEA Trust Commercial |
$559.42
|
| Rate for Payer: WPS Commercial |
$753.35
|
|
|
PACK SMALL ADULT PUMP X-COATED FX 77039
|
Facility
|
IP
|
$6,658.00
|
|
| Hospital Charge Code |
2962890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,392.92 |
| Max. Negotiated Rate |
$6,370.37 |
| Rate for Payer: Aetna Commercial |
$6,231.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,954.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,669.89
|
| Rate for Payer: Cash Price |
$1,997.40
|
| Rate for Payer: Cigna Commercial |
$6,370.37
|
| Rate for Payer: Health EOS Commercial |
$6,162.64
|
| Rate for Payer: HFN Commercial |
$6,370.37
|
| Rate for Payer: Multiplan Commercial |
$5,539.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,370.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,392.92
|
| Rate for Payer: Quartz Commercial |
$4,154.59
|
| Rate for Payer: WEA Trust Commercial |
$3,808.38
|
| Rate for Payer: WPS Commercial |
$5,128.66
|
|
|
PACK SMALL ADULT PUMP X-COATED FX 77039
|
Facility
|
OP
|
$6,658.00
|
|
| Hospital Charge Code |
2962890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,938.81 |
| Max. Negotiated Rate |
$6,370.37 |
| Rate for Payer: Aetna Commercial |
$6,231.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,954.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,938.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,500.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,462.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,323.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,669.89
|
| Rate for Payer: Cash Price |
$1,997.40
|
| Rate for Payer: Cigna Commercial |
$6,370.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,874.96
|
| Rate for Payer: Health EOS Commercial |
$6,162.64
|
| Rate for Payer: HFN Commercial |
$6,370.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,193.24
|
| Rate for Payer: Multiplan Commercial |
$5,539.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,154.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,370.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,392.92
|
| Rate for Payer: Quartz Commercial |
$4,500.81
|
| Rate for Payer: Quartz Medicare Advantage |
$4,154.59
|
| Rate for Payer: The Alliance Commercial |
$3,462.16
|
| Rate for Payer: WEA Trust Commercial |
$3,808.38
|
| Rate for Payer: WPS Commercial |
$5,128.66
|
|
|
PACK STANDARD VASCULAR ACCESS NP AMS15117
|
Facility
|
OP
|
$616.00
|
|
| Hospital Charge Code |
6206996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.38 |
| Max. Negotiated Rate |
$589.39 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Aetna Managed Medicare |
$179.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$416.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$320.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.51
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$480.48
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: NAPHCARE Commercial |
$384.38
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$416.42
|
| Rate for Payer: Quartz Medicare Advantage |
$384.38
|
| Rate for Payer: The Alliance Commercial |
$320.32
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
PACK STANDARD VASCULAR ACCESS NP AMS15117
|
Facility
|
IP
|
$616.00
|
|
| Hospital Charge Code |
6206996
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.91 |
| Max. Negotiated Rate |
$589.39 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$384.38
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
PACK VITRECTOMY ANTERIOR INFINITI 8065750157
|
Facility
|
OP
|
$2,729.00
|
|
| Hospital Charge Code |
2962876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$794.68 |
| Max. Negotiated Rate |
$2,611.11 |
| Rate for Payer: Aetna Commercial |
$2,554.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,440.82
|
| Rate for Payer: Aetna Managed Medicare |
$794.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,844.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,419.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,362.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,504.22
|
| Rate for Payer: Cash Price |
$818.70
|
| Rate for Payer: Cigna Commercial |
$2,611.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,588.28
|
| Rate for Payer: Health EOS Commercial |
$2,525.96
|
| Rate for Payer: HFN Commercial |
$2,611.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,128.62
|
| Rate for Payer: Multiplan Commercial |
$2,270.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,702.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,611.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,390.70
|
| Rate for Payer: Quartz Commercial |
$1,844.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,702.90
|
| Rate for Payer: The Alliance Commercial |
$1,419.08
|
| Rate for Payer: WEA Trust Commercial |
$1,560.99
|
| Rate for Payer: WPS Commercial |
$2,102.15
|
|
|
PACK VITRECTOMY ANTERIOR INFINITI 8065750157
|
Facility
|
IP
|
$2,729.00
|
|
| Hospital Charge Code |
2962876
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,390.70 |
| Max. Negotiated Rate |
$2,611.11 |
| Rate for Payer: Aetna Commercial |
$2,554.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,440.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,504.22
|
| Rate for Payer: Cash Price |
$818.70
|
| Rate for Payer: Cigna Commercial |
$2,611.11
|
| Rate for Payer: Health EOS Commercial |
$2,525.96
|
| Rate for Payer: HFN Commercial |
$2,611.11
|
| Rate for Payer: Multiplan Commercial |
$2,270.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,611.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,390.70
|
| Rate for Payer: Quartz Commercial |
$1,702.90
|
| Rate for Payer: WEA Trust Commercial |
$1,560.99
|
| Rate for Payer: WPS Commercial |
$2,102.15
|
|
|
Paclitaxel Injection J9267
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
4498591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.10 |
| Max. Negotiated Rate |
$11.86 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$0.10
|
| Rate for Payer: Anthem Medicare Advantage |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.10
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.11
|
| Rate for Payer: Health EOS Commercial |
$11.36
|
| Rate for Payer: HFN Commercial |
$11.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.10
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$0.16
|
| Rate for Payer: Preferred Network Access Commercial |
$11.86
|
| Rate for Payer: Quartz Beloit One Network |
$5.49
|
| Rate for Payer: Quartz Commercial |
$7.11
|
| Rate for Payer: Quartz Medicare Advantage |
$0.10
|
| Rate for Payer: The Alliance Commercial |
$0.29
|
| Rate for Payer: United Healthcare Medicaid |
$0.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.10
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$0.28
|
|
|
Paclitaxel Injection J9267
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
4498591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Paclitaxel Injection J9267
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS J9267
|
| Hospital Charge Code |
4498591
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.15 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.15
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$0.42
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$0.28
|
|
|
PAD ALIGNMENT IMMOBILIZER
|
Facility
|
OP
|
$148.00
|
|
| Hospital Charge Code |
2963998
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.10 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$43.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.14
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.44
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$100.05
|
| Rate for Payer: Quartz Medicare Advantage |
$92.35
|
| Rate for Payer: The Alliance Commercial |
$76.96
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
PAD ALIGNMENT IMMOBILIZER
|
Facility
|
IP
|
$148.00
|
|
| Hospital Charge Code |
2963998
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
PAD ALVARADO DISPOSABLE LINER 00-1320-015-10
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
6232148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$82.37
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
PAD ALVARADO DISPOSABLE LINER 00-1320-015-10
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
6232148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$38.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.82
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.96
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$82.37
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$89.23
|
| Rate for Payer: Quartz Medicare Advantage |
$82.37
|
| Rate for Payer: The Alliance Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
PAD ARMBOARD 2 X 7.5 X 20 M10-323
|
Facility
|
OP
|
$178.00
|
|
| Hospital Charge Code |
2965828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.83 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$51.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.60
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.84
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$111.07
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$120.33
|
| Rate for Payer: Quartz Medicare Advantage |
$111.07
|
| Rate for Payer: The Alliance Commercial |
$92.56
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
PAD ARMBOARD 2 X 7.5 X 20 M10-323
|
Facility
|
IP
|
$178.00
|
|
| Hospital Charge Code |
2965828
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$170.31 |
| Rate for Payer: Aetna Commercial |
$166.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.11
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$170.31
|
| Rate for Payer: Health EOS Commercial |
$164.76
|
| Rate for Payer: HFN Commercial |
$170.31
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: Preferred Network Access Commercial |
$170.31
|
| Rate for Payer: Quartz Beloit One Network |
$90.71
|
| Rate for Payer: Quartz Commercial |
$111.07
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$137.11
|
|
|
PAD BODY XL PREVALON AIRTAP 7250
|
Facility
|
IP
|
$354.00
|
|
| Hospital Charge Code |
5414959
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$220.90
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
