|
STOCKING MEDIUM REGULAR THIGH 3416LF
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
2963622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING MEDIUM REGULAR THIGH 3416LF
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
2963622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING MEDIUM SHORT THIGH 3310LF
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
2963623
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING MEDIUM SHORT THIGH 3310LF
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
2963623
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING SMALL LONG THIGH 3222LF
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
2963624
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING SMALL LONG THIGH 3222LF
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
2963624
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING SMALL REGULAR THIGH 3130LF
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
2963625
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING SMALL REGULAR THIGH 3130LF
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
2963625
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING SMALL SHORT THIGH 3071LF
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
2963626
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING SMALL SHORT THIGH 3071LF
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
2963626
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING THIGH LARGE SHORT 3634LF
|
Facility
IP
|
$218.00
|
|
| Hospital Charge Code |
2969234
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$130.80
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
STOCKING THIGH LARGE SHORT 3634LF
|
Facility
OP
|
$218.00
|
|
| Hospital Charge Code |
2969234
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.04 |
| Max. Negotiated Rate |
$872.00 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Aetna Managed Medicare |
$61.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.99
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.50
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$141.70
|
| Rate for Payer: Quartz Medicare Advantage |
$130.80
|
| Rate for Payer: The Alliance Commercial |
$872.00
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
STOCKING XLARGE LONG KNEE 7802
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
2963627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING XLARGE LONG KNEE 7802
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
2963627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING XX-LARGE LONG 3185
|
Facility
OP
|
$210.00
|
|
| Hospital Charge Code |
2963428
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$840.00 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$58.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.50
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$126.00
|
| Rate for Payer: The Alliance Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOCKING XX-LARGE LONG 3185
|
Facility
IP
|
$210.00
|
|
| Hospital Charge Code |
2963428
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
IP
|
$66,716.00
|
|
|
Service Code
|
MS-DRG 327
|
| Min. Negotiated Rate |
$23,998.63 |
| Max. Negotiated Rate |
$66,716.00 |
| Rate for Payer: Aetna Managed Medicare |
$23,998.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52,450.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40,202.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,195.00
|
| Rate for Payer: Anthem Medicare Advantage |
$23,998.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,998.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,998.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,998.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42,399.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,998.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48,699.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,998.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,998.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,998.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,998.63
|
| Rate for Payer: NAPHCARE Commercial |
$35,997.94
|
| Rate for Payer: Quartz Medicare Advantage |
$23,998.63
|
| Rate for Payer: The Alliance Commercial |
$66,716.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,998.63
|
| Rate for Payer: United Healthcare PPO |
$37,913.03
|
| Rate for Payer: Wellcare Medicare |
$23,998.63
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
IP
|
$135,351.00
|
|
|
Service Code
|
MS-DRG 326
|
| Min. Negotiated Rate |
$48,687.24 |
| Max. Negotiated Rate |
$135,351.00 |
| Rate for Payer: Aetna Managed Medicare |
$48,687.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106,578.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81,691.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77,612.24
|
| Rate for Payer: Anthem Medicare Advantage |
$48,687.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48,687.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48,687.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$48,687.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86,156.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$48,687.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99,040.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48,687.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48,687.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$48,687.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$48,687.24
|
| Rate for Payer: NAPHCARE Commercial |
$73,030.86
|
| Rate for Payer: Quartz Medicare Advantage |
$48,687.24
|
| Rate for Payer: The Alliance Commercial |
$135,351.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48,687.24
|
| Rate for Payer: United Healthcare PPO |
$77,104.30
|
| Rate for Payer: Wellcare Medicare |
$48,687.24
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$42,786.00
|
|
|
Service Code
|
MS-DRG 328
|
| Min. Negotiated Rate |
$15,390.72 |
| Max. Negotiated Rate |
$42,786.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,390.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,568.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,729.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,444.80
|
| Rate for Payer: Anthem Medicare Advantage |
$15,390.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,390.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,390.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,390.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,135.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,390.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,147.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,390.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,390.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,390.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,390.72
|
| Rate for Payer: NAPHCARE Commercial |
$23,086.08
|
| Rate for Payer: Quartz Medicare Advantage |
$15,390.72
|
| Rate for Payer: The Alliance Commercial |
$42,786.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,390.72
|
| Rate for Payer: United Healthcare PPO |
$24,248.61
|
| Rate for Payer: Wellcare Medicare |
$15,390.72
|
|
|
STOMAHESIVE WAFER 4X4
|
Facility
IP
|
$85.00
|
|
| Hospital Charge Code |
2963916
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
STOMAHESIVE WAFER 4X4
|
Facility
OP
|
$85.00
|
|
| Hospital Charge Code |
2963916
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$23.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$51.00
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
STOMAHESIVE WAFER 8X8
|
Facility
IP
|
$216.00
|
|
| Hospital Charge Code |
2963712
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$194.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$198.72
|
| Rate for Payer: Health EOS Commercial |
$192.24
|
| Rate for Payer: HFN Commercial |
$198.72
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: NAPHCARE Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$198.72
|
| Rate for Payer: Quartz Beloit One Network |
$105.84
|
| Rate for Payer: Quartz Commercial |
$129.60
|
| Rate for Payer: WEA Trust Commercial |
$118.80
|
| Rate for Payer: WPS Commercial |
$159.99
|
|
|
STOMAHESIVE WAFER 8X8
|
Facility
OP
|
$216.00
|
|
| Hospital Charge Code |
2963712
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.48 |
| Max. Negotiated Rate |
$864.00 |
| Rate for Payer: Aetna Commercial |
$194.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.76
|
| Rate for Payer: Aetna Managed Medicare |
$60.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$140.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$198.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.87
|
| Rate for Payer: Health EOS Commercial |
$192.24
|
| Rate for Payer: HFN Commercial |
$198.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$162.00
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: NAPHCARE Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$198.72
|
| Rate for Payer: Quartz Beloit One Network |
$105.84
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: Quartz Medicare Advantage |
$129.60
|
| Rate for Payer: The Alliance Commercial |
$864.00
|
| Rate for Payer: WEA Trust Commercial |
$118.80
|
| Rate for Payer: WPS Commercial |
$159.99
|
|
|
STOMAL URETERAL STENT CHANGE
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960391
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
STOMAL URETERAL STENT CHANGE
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960391
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
