|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$52,522.18
|
|
|
Service Code
|
APR-DRG 0052
|
| Min. Negotiated Rate |
$46,653.47 |
| Max. Negotiated Rate |
$52,522.18 |
| Rate for Payer: Anthem Medicaid |
$50,292.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$50,292.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50,292.88
|
| Rate for Payer: Dean Health Medicaid |
$50,292.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$46,653.47
|
| Rate for Payer: Managed Health Services Medicaid |
$52,522.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$50,292.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$50,292.88
|
| Rate for Payer: United Healthcare Medicaid |
$50,292.88
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS WITHOUT EXTENSIVE PROCEDURE
|
Facility
|
IP
|
$78,827.11
|
|
|
Service Code
|
APR-DRG 0053
|
| Min. Negotiated Rate |
$70,019.15 |
| Max. Negotiated Rate |
$78,827.11 |
| Rate for Payer: Anthem Medicaid |
$75,481.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$75,481.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75,481.30
|
| Rate for Payer: Dean Health Medicaid |
$75,481.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$70,019.15
|
| Rate for Payer: Managed Health Services Medicaid |
$78,827.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$75,481.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$75,481.30
|
| Rate for Payer: United Healthcare Medicaid |
$75,481.30
|
|
|
TRACH QUICK DEVICE 2.0MM #120900020
|
Facility
|
OP
|
$2,070.00
|
|
| Hospital Charge Code |
2970262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$602.78 |
| Max. Negotiated Rate |
$1,980.58 |
| Rate for Payer: Aetna Commercial |
$1,937.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,851.41
|
| Rate for Payer: Aetna Managed Medicare |
$602.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,399.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,076.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,033.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,140.98
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,980.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,204.74
|
| Rate for Payer: Health EOS Commercial |
$1,915.99
|
| Rate for Payer: HFN Commercial |
$1,980.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,614.60
|
| Rate for Payer: Multiplan Commercial |
$1,722.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,291.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,980.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,054.87
|
| Rate for Payer: Quartz Commercial |
$1,399.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,291.68
|
| Rate for Payer: The Alliance Commercial |
$1,076.40
|
| Rate for Payer: WEA Trust Commercial |
$1,184.04
|
| Rate for Payer: WPS Commercial |
$1,594.52
|
|
|
TRACH QUICK DEVICE 2.0MM #120900020
|
Facility
|
IP
|
$2,070.00
|
|
| Hospital Charge Code |
2970262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,054.87 |
| Max. Negotiated Rate |
$1,980.58 |
| Rate for Payer: Aetna Commercial |
$1,937.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,851.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,140.98
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,980.58
|
| Rate for Payer: Health EOS Commercial |
$1,915.99
|
| Rate for Payer: HFN Commercial |
$1,980.58
|
| Rate for Payer: Multiplan Commercial |
$1,722.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,980.58
|
| Rate for Payer: Quartz Beloit One Network |
$1,054.87
|
| Rate for Payer: Quartz Commercial |
$1,291.68
|
| Rate for Payer: WEA Trust Commercial |
$1,184.04
|
| Rate for Payer: WPS Commercial |
$1,594.52
|
|
|
TRACH QUICK DEVICE 4.0MM #120900040
|
Facility
|
OP
|
$2,065.00
|
|
| Hospital Charge Code |
2970179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$601.33 |
| Max. Negotiated Rate |
$1,975.79 |
| Rate for Payer: Aetna Commercial |
$1,932.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,846.94
|
| Rate for Payer: Aetna Managed Medicare |
$601.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,395.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,073.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,030.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,138.23
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,975.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,201.83
|
| Rate for Payer: Health EOS Commercial |
$1,911.36
|
| Rate for Payer: HFN Commercial |
$1,975.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,610.70
|
| Rate for Payer: Multiplan Commercial |
$1,718.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,288.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,975.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,052.32
|
| Rate for Payer: Quartz Commercial |
$1,395.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,288.56
|
| Rate for Payer: The Alliance Commercial |
$1,073.80
|
| Rate for Payer: WEA Trust Commercial |
$1,181.18
|
| Rate for Payer: WPS Commercial |
$1,590.67
|
|
|
TRACH QUICK DEVICE 4.0MM #120900040
|
Facility
|
IP
|
$2,065.00
|
|
| Hospital Charge Code |
2970179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,052.32 |
| Max. Negotiated Rate |
$1,975.79 |
| Rate for Payer: Aetna Commercial |
$1,932.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,846.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,138.23
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,975.79
|
| Rate for Payer: Health EOS Commercial |
$1,911.36
|
| Rate for Payer: HFN Commercial |
$1,975.79
|
| Rate for Payer: Multiplan Commercial |
$1,718.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,975.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,052.32
|
| Rate for Payer: Quartz Commercial |
$1,288.56
|
| Rate for Payer: WEA Trust Commercial |
$1,181.18
|
| Rate for Payer: WPS Commercial |
$1,590.67
|
|
|
TRACH TUBE 3.0MM PEDIATRIC
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$143.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$307.63
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$307.63
|
| Rate for Payer: The Alliance Commercial |
$256.36
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE 3.0MM PEDIATRIC
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE 3.5MM PEDIATRIC
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE 3.5MM PEDIATRIC
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$143.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$307.63
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$307.63
|
| Rate for Payer: The Alliance Commercial |
$256.36
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE 4.0MM PEDIATRIC
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$143.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$307.63
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$307.63
|
| Rate for Payer: The Alliance Commercial |
$256.36
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE 4.0MM PEDIATRIC
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE BIVONA 7.0MM 75FHXL70
|
Facility
|
IP
|
$1,716.00
|
|
| Hospital Charge Code |
4058137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$874.47 |
| Max. Negotiated Rate |
$1,641.87 |
| Rate for Payer: Aetna Commercial |
$1,606.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,534.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$945.86
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,641.87
|
| Rate for Payer: Health EOS Commercial |
$1,588.33
|
| Rate for Payer: HFN Commercial |
$1,641.87
|
| Rate for Payer: Multiplan Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,641.87
|
| Rate for Payer: Quartz Beloit One Network |
$874.47
|
| Rate for Payer: Quartz Commercial |
$1,070.78
|
| Rate for Payer: WEA Trust Commercial |
$981.55
|
| Rate for Payer: WPS Commercial |
$1,321.83
|
|
|
TRACH TUBE BIVONA 7.0MM 75FHXL70
|
Facility
|
OP
|
$1,716.00
|
|
| Hospital Charge Code |
4058137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.70 |
| Max. Negotiated Rate |
$1,641.87 |
| Rate for Payer: Aetna Commercial |
$1,606.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,534.79
|
| Rate for Payer: Aetna Managed Medicare |
$499.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,160.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$892.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$856.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$945.86
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,641.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$998.71
|
| Rate for Payer: Health EOS Commercial |
$1,588.33
|
| Rate for Payer: HFN Commercial |
$1,641.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,338.48
|
| Rate for Payer: Multiplan Commercial |
$1,427.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,070.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,641.87
|
| Rate for Payer: Quartz Beloit One Network |
$874.47
|
| Rate for Payer: Quartz Commercial |
$1,160.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,070.78
|
| Rate for Payer: The Alliance Commercial |
$892.32
|
| Rate for Payer: WEA Trust Commercial |
$981.55
|
| Rate for Payer: WPS Commercial |
$1,321.83
|
|
|
TRACH TUBE BIVONA 8.0MM 75FHXL80
|
Facility
|
OP
|
$1,716.00
|
|
| Hospital Charge Code |
4004564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.70 |
| Max. Negotiated Rate |
$1,641.87 |
| Rate for Payer: Aetna Commercial |
$1,606.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,534.79
|
| Rate for Payer: Aetna Managed Medicare |
$499.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,160.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$892.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$856.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$945.86
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,641.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$998.71
|
| Rate for Payer: Health EOS Commercial |
$1,588.33
|
| Rate for Payer: HFN Commercial |
$1,641.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,338.48
|
| Rate for Payer: Multiplan Commercial |
$1,427.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,070.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,641.87
|
| Rate for Payer: Quartz Beloit One Network |
$874.47
|
| Rate for Payer: Quartz Commercial |
$1,160.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,070.78
|
| Rate for Payer: The Alliance Commercial |
$892.32
|
| Rate for Payer: WEA Trust Commercial |
$981.55
|
| Rate for Payer: WPS Commercial |
$1,321.83
|
|
|
TRACH TUBE BIVONA 8.0MM 75FHXL80
|
Facility
|
IP
|
$1,716.00
|
|
| Hospital Charge Code |
4004564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$874.47 |
| Max. Negotiated Rate |
$1,641.87 |
| Rate for Payer: Aetna Commercial |
$1,606.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,534.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$945.86
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,641.87
|
| Rate for Payer: Health EOS Commercial |
$1,588.33
|
| Rate for Payer: HFN Commercial |
$1,641.87
|
| Rate for Payer: Multiplan Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,641.87
|
| Rate for Payer: Quartz Beloit One Network |
$874.47
|
| Rate for Payer: Quartz Commercial |
$1,070.78
|
| Rate for Payer: WEA Trust Commercial |
$981.55
|
| Rate for Payer: WPS Commercial |
$1,321.83
|
|
|
TRACH TUBE BIVONA 9.0MM 75FHXL90
|
Facility
|
IP
|
$1,716.00
|
|
| Hospital Charge Code |
4004565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$874.47 |
| Max. Negotiated Rate |
$1,641.87 |
| Rate for Payer: Aetna Commercial |
$1,606.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,534.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$945.86
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,641.87
|
| Rate for Payer: Health EOS Commercial |
$1,588.33
|
| Rate for Payer: HFN Commercial |
$1,641.87
|
| Rate for Payer: Multiplan Commercial |
$1,427.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,641.87
|
| Rate for Payer: Quartz Beloit One Network |
$874.47
|
| Rate for Payer: Quartz Commercial |
$1,070.78
|
| Rate for Payer: WEA Trust Commercial |
$981.55
|
| Rate for Payer: WPS Commercial |
$1,321.83
|
|
|
TRACH TUBE BIVONA 9.0MM 75FHXL90
|
Facility
|
OP
|
$1,716.00
|
|
| Hospital Charge Code |
4004565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.70 |
| Max. Negotiated Rate |
$1,641.87 |
| Rate for Payer: Aetna Commercial |
$1,606.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,534.79
|
| Rate for Payer: Aetna Managed Medicare |
$499.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,160.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$892.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$856.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$945.86
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,641.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$998.71
|
| Rate for Payer: Health EOS Commercial |
$1,588.33
|
| Rate for Payer: HFN Commercial |
$1,641.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,338.48
|
| Rate for Payer: Multiplan Commercial |
$1,427.71
|
| Rate for Payer: NAPHCARE Commercial |
$1,070.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,641.87
|
| Rate for Payer: Quartz Beloit One Network |
$874.47
|
| Rate for Payer: Quartz Commercial |
$1,160.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,070.78
|
| Rate for Payer: The Alliance Commercial |
$892.32
|
| Rate for Payer: WEA Trust Commercial |
$981.55
|
| Rate for Payer: WPS Commercial |
$1,321.83
|
|
|
TRACH TUBE CUFFED FEN 6.0MM
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$143.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$307.63
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$307.63
|
| Rate for Payer: The Alliance Commercial |
$256.36
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE CUFFED FEN 6.0MM
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE CUFFED FEN 8.0MM 513080
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2969235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE CUFFED FEN 8.0MM 513080
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2969235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$143.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$307.63
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$307.63
|
| Rate for Payer: The Alliance Commercial |
$256.36
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE CUFFED FEN 9.0MM
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.56 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$143.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.54
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$307.63
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$307.63
|
| Rate for Payer: The Alliance Commercial |
$256.36
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE CUFFED FEN 9.0MM
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
TRACH TUBE FLEX CUFFED SZ 10
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
