|
STOCKING MEDIUM REGULAR THIGH 3416LF
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2963622
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING MEDIUM SHORT THIGH 3310LF
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2963623
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING MEDIUM SHORT THIGH 3310LF
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
2963623
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING SMALL LONG THIGH 3222LF
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
2963624
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING SMALL LONG THIGH 3222LF
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2963624
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING SMALL REGULAR THIGH 3130LF
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2963625
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING SMALL REGULAR THIGH 3130LF
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
2963625
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING SMALL SHORT THIGH 3071LF
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
2963626
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING SMALL SHORT THIGH 3071LF
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2963626
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING THIGH LARGE SHORT 3634LF
|
Facility
|
OP
|
$218.00
|
|
| Hospital Charge Code |
2969234
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.48 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$63.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.88
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.04
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$136.03
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$136.03
|
| Rate for Payer: The Alliance Commercial |
$113.36
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
STOCKING THIGH LARGE SHORT 3634LF
|
Facility
|
IP
|
$218.00
|
|
| Hospital Charge Code |
2969234
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
STOCKING XLARGE LONG KNEE 7802
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2963627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING XLARGE LONG KNEE 7802
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
2963627
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING XX-LARGE LONG 3185
|
Facility
|
OP
|
$210.00
|
|
| Hospital Charge Code |
2963428
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$61.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.80
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$131.04
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$131.04
|
| Rate for Payer: The Alliance Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOCKING XX-LARGE LONG 3185
|
Facility
|
IP
|
$210.00
|
|
| Hospital Charge Code |
2963428
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC
|
Facility
|
IP
|
$69,384.64
|
|
|
Service Code
|
MSDRG 327
|
| Min. Negotiated Rate |
$19,224.95 |
| Max. Negotiated Rate |
$69,384.64 |
| Rate for Payer: Aetna Managed Medicare |
$19,224.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53,330.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40,877.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,836.19
|
| Rate for Payer: Anthem Medicare Advantage |
$19,224.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,224.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,224.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,224.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,111.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,224.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,647.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,224.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,224.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,224.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,224.95
|
| Rate for Payer: NAPHCARE Commercial |
$28,837.43
|
| Rate for Payer: Quartz Medicare Advantage |
$19,224.95
|
| Rate for Payer: The Alliance Commercial |
$69,384.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,224.95
|
| Rate for Payer: United Healthcare PPO |
$39,429.55
|
| Rate for Payer: Wellcare Medicare |
$19,224.95
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$140,765.04
|
|
|
Service Code
|
MSDRG 326
|
| Min. Negotiated Rate |
$38,701.27 |
| Max. Negotiated Rate |
$140,765.04 |
| Rate for Payer: Aetna Managed Medicare |
$38,701.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108,821.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83,410.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79,245.40
|
| Rate for Payer: Anthem Medicare Advantage |
$38,701.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38,701.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38,701.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38,701.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87,969.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38,701.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103,002.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38,701.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38,701.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38,701.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38,701.27
|
| Rate for Payer: NAPHCARE Commercial |
$58,051.91
|
| Rate for Payer: Quartz Medicare Advantage |
$38,701.27
|
| Rate for Payer: The Alliance Commercial |
$140,765.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,701.27
|
| Rate for Payer: United Healthcare PPO |
$80,188.47
|
| Rate for Payer: Wellcare Medicare |
$38,701.27
|
|
|
STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$44,497.44
|
|
|
Service Code
|
MSDRG 328
|
| Min. Negotiated Rate |
$12,777.51 |
| Max. Negotiated Rate |
$44,497.44 |
| Rate for Payer: Aetna Managed Medicare |
$12,777.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,960.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,797.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,459.14
|
| Rate for Payer: Anthem Medicare Advantage |
$12,777.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,777.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,777.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,777.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,261.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,777.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,393.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,777.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,777.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,777.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,777.51
|
| Rate for Payer: NAPHCARE Commercial |
$19,166.27
|
| Rate for Payer: Quartz Medicare Advantage |
$12,777.51
|
| Rate for Payer: The Alliance Commercial |
$44,497.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,777.51
|
| Rate for Payer: United Healthcare PPO |
$25,218.55
|
| Rate for Payer: Wellcare Medicare |
$12,777.51
|
|
|
STOMAHESIVE WAFER 4X4
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
2963916
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$24.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$53.04
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$53.04
|
| Rate for Payer: The Alliance Commercial |
$44.20
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
STOMAHESIVE WAFER 4X4
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
2963916
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
STOMAHESIVE WAFER 8X8
|
Facility
|
IP
|
$216.00
|
|
| Hospital Charge Code |
2963712
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$134.78
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
STOMAHESIVE WAFER 8X8
|
Facility
|
OP
|
$216.00
|
|
| Hospital Charge Code |
2963712
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$62.90 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Aetna Managed Medicare |
$62.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.71
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.48
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: NAPHCARE Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: Quartz Medicare Advantage |
$134.78
|
| Rate for Payer: The Alliance Commercial |
$112.32
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
STOMAL URETERAL STENT CHANGE
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960391
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
STOMAL URETERAL STENT CHANGE
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960391
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Stone Analysis
|
Professional
|
Both
|
$222.00
|
|
|
Service Code
|
CPT 82355
|
| Hospital Charge Code |
3241498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.04 |
| Max. Negotiated Rate |
$219.34 |
| Rate for Payer: Aetna Commercial |
$219.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.04
|
| Rate for Payer: Anthem Medicare Advantage |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.04
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$219.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.04
|
| Rate for Payer: Health EOS Commercial |
$210.10
|
| Rate for Payer: HFN Commercial |
$219.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.04
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: NAPHCARE Commercial |
$18.06
|
| Rate for Payer: Preferred Network Access Commercial |
$219.34
|
| Rate for Payer: Quartz Beloit One Network |
$101.59
|
| Rate for Payer: Quartz Commercial |
$131.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.04
|
| Rate for Payer: The Alliance Commercial |
$47.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.04
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: WPS Commercial |
$52.99
|
|
