|
TRACHEOSTOMY TUBE SHILEY SZ 8
|
Facility
|
IP
|
$1,135.00
|
|
| Hospital Charge Code |
2965406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$556.15 |
| Max. Negotiated Rate |
$1,044.20 |
| Rate for Payer: Aetna Commercial |
$1,021.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.55
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,044.20
|
| Rate for Payer: Health EOS Commercial |
$1,010.15
|
| Rate for Payer: HFN Commercial |
$1,044.20
|
| Rate for Payer: Multiplan Commercial |
$908.00
|
| Rate for Payer: NAPHCARE Commercial |
$681.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.20
|
| Rate for Payer: Quartz Beloit One Network |
$556.15
|
| Rate for Payer: Quartz Commercial |
$681.00
|
| Rate for Payer: WEA Trust Commercial |
$624.25
|
| Rate for Payer: WPS Commercial |
$840.69
|
|
|
TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES
|
Facility
|
IP
|
$391,134.00
|
|
|
Service Code
|
MSDRG 004
|
| Min. Negotiated Rate |
$140,695.69 |
| Max. Negotiated Rate |
$391,134.00 |
| Rate for Payer: Aetna Managed Medicare |
$140,695.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308,406.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$236,390.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224,586.60
|
| Rate for Payer: Anthem Medicare Advantage |
$140,695.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140,695.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140,695.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140,695.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$249,311.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140,695.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286,650.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140,695.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140,695.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140,695.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140,695.69
|
| Rate for Payer: NAPHCARE Commercial |
$211,043.54
|
| Rate for Payer: Quartz Medicare Advantage |
$140,695.69
|
| Rate for Payer: The Alliance Commercial |
$391,134.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140,695.69
|
| Rate for Payer: United Healthcare PPO |
$223,160.70
|
| Rate for Payer: Wellcare Medicare |
$140,695.69
|
|
|
TRACH QUICK DEVICE 2.0MM #120900020
|
Facility
|
OP
|
$2,070.00
|
|
| Hospital Charge Code |
2970262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$579.60 |
| Max. Negotiated Rate |
$8,280.00 |
| Rate for Payer: Aetna Commercial |
$1,863.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,780.20
|
| Rate for Payer: Aetna Managed Medicare |
$579.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,345.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,035.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$993.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,097.10
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,904.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,158.37
|
| Rate for Payer: Health EOS Commercial |
$1,842.30
|
| Rate for Payer: HFN Commercial |
$1,904.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,552.50
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,242.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,904.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,014.30
|
| Rate for Payer: Quartz Commercial |
$1,345.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,242.00
|
| Rate for Payer: The Alliance Commercial |
$8,280.00
|
| Rate for Payer: WEA Trust Commercial |
$1,138.50
|
| Rate for Payer: WPS Commercial |
$1,533.25
|
|
|
TRACH QUICK DEVICE 2.0MM #120900020
|
Facility
|
IP
|
$2,070.00
|
|
| Hospital Charge Code |
2970262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,014.30 |
| Max. Negotiated Rate |
$1,904.40 |
| Rate for Payer: Aetna Commercial |
$1,863.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,780.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,097.10
|
| Rate for Payer: Cash Price |
$621.00
|
| Rate for Payer: Cigna Commercial |
$1,904.40
|
| Rate for Payer: Health EOS Commercial |
$1,842.30
|
| Rate for Payer: HFN Commercial |
$1,904.40
|
| Rate for Payer: Multiplan Commercial |
$1,656.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,242.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,904.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,014.30
|
| Rate for Payer: Quartz Commercial |
$1,242.00
|
| Rate for Payer: WEA Trust Commercial |
$1,138.50
|
| Rate for Payer: WPS Commercial |
$1,533.25
|
|
|
TRACH QUICK DEVICE 4.0MM #120900040
|
Facility
|
IP
|
$2,065.00
|
|
| Hospital Charge Code |
2970179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,011.85 |
| Max. Negotiated Rate |
$1,899.80 |
| Rate for Payer: Aetna Commercial |
$1,858.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,775.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,094.45
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,899.80
|
| Rate for Payer: Health EOS Commercial |
$1,837.85
|
| Rate for Payer: HFN Commercial |
$1,899.80
|
| Rate for Payer: Multiplan Commercial |
$1,652.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,239.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,899.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,011.85
|
| Rate for Payer: Quartz Commercial |
$1,239.00
|
| Rate for Payer: WEA Trust Commercial |
$1,135.75
|
| Rate for Payer: WPS Commercial |
$1,529.55
|
|
|
TRACH QUICK DEVICE 4.0MM #120900040
|
Facility
|
OP
|
$2,065.00
|
|
| Hospital Charge Code |
2970179
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.20 |
| Max. Negotiated Rate |
$8,260.00 |
| Rate for Payer: Aetna Commercial |
$1,858.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,775.90
|
| Rate for Payer: Aetna Managed Medicare |
$578.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,342.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,032.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$991.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,094.45
|
| Rate for Payer: Cash Price |
$619.50
|
| Rate for Payer: Cigna Commercial |
$1,899.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,155.57
|
| Rate for Payer: Health EOS Commercial |
$1,837.85
|
| Rate for Payer: HFN Commercial |
$1,899.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,548.75
|
| Rate for Payer: Multiplan Commercial |
$1,652.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,239.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,899.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,011.85
|
| Rate for Payer: Quartz Commercial |
$1,342.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,239.00
|
| Rate for Payer: The Alliance Commercial |
$8,260.00
|
| Rate for Payer: WEA Trust Commercial |
$1,135.75
|
| Rate for Payer: WPS Commercial |
$1,529.55
|
|
|
TRACH TUBE 3.0MM PEDIATRIC
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE 3.0MM PEDIATRIC
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963752
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE 3.5MM PEDIATRIC
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE 3.5MM PEDIATRIC
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963751
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE 4.0MM PEDIATRIC
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE 4.0MM PEDIATRIC
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963750
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE BIVONA 7.0MM 75FHXL70
|
Facility
|
OP
|
$1,716.00
|
|
| Hospital Charge Code |
4058137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$6,864.00 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Aetna Managed Medicare |
$480.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,115.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$823.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$960.27
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,115.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,029.60
|
| Rate for Payer: The Alliance Commercial |
$6,864.00
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 7.0MM 75FHXL70
|
Facility
|
IP
|
$1,716.00
|
|
| Hospital Charge Code |
4058137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.84 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,029.60
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 8.0MM 75FHXL80
|
Facility
|
OP
|
$1,716.00
|
|
| Hospital Charge Code |
4004564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$6,864.00 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Aetna Managed Medicare |
$480.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,115.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$823.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$960.27
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,115.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,029.60
|
| Rate for Payer: The Alliance Commercial |
$6,864.00
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 8.0MM 75FHXL80
|
Facility
|
IP
|
$1,716.00
|
|
| Hospital Charge Code |
4004564
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.84 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,029.60
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 9.0MM 75FHXL90
|
Facility
|
IP
|
$1,716.00
|
|
| Hospital Charge Code |
4004565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.84 |
| Max. Negotiated Rate |
$1,578.72 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,029.60
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE BIVONA 9.0MM 75FHXL90
|
Facility
|
OP
|
$1,716.00
|
|
| Hospital Charge Code |
4004565
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.48 |
| Max. Negotiated Rate |
$6,864.00 |
| Rate for Payer: Aetna Commercial |
$1,544.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,475.76
|
| Rate for Payer: Aetna Managed Medicare |
$480.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,115.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$858.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$823.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$909.48
|
| Rate for Payer: Cash Price |
$514.80
|
| Rate for Payer: Cigna Commercial |
$1,578.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$960.27
|
| Rate for Payer: Health EOS Commercial |
$1,527.24
|
| Rate for Payer: HFN Commercial |
$1,578.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.00
|
| Rate for Payer: Multiplan Commercial |
$1,372.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,578.72
|
| Rate for Payer: Quartz Beloit One Network |
$840.84
|
| Rate for Payer: Quartz Commercial |
$1,115.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,029.60
|
| Rate for Payer: The Alliance Commercial |
$6,864.00
|
| Rate for Payer: WEA Trust Commercial |
$943.80
|
| Rate for Payer: WPS Commercial |
$1,271.04
|
|
|
TRACH TUBE CUFFED FEN 6.0MM
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 6.0MM
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963686
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 8.0MM 513080
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2969235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 8.0MM 513080
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2969235
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 9.0MM
|
Facility
|
OP
|
$493.00
|
|
| Hospital Charge Code |
2963685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.04 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$138.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$320.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$246.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$369.75
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$295.80
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE CUFFED FEN 9.0MM
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
TRACH TUBE FLEX CUFFED SZ 10
|
Facility
|
IP
|
$493.00
|
|
| Hospital Charge Code |
2963698
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
