|
TRAY THAL QUICK 12F CHEST TUBE G05464
|
Facility
|
OP
|
$2,311.00
|
|
| Hospital Charge Code |
6202989
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$672.96 |
| Max. Negotiated Rate |
$2,211.16 |
| Rate for Payer: Aetna Commercial |
$2,163.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,066.96
|
| Rate for Payer: Aetna Managed Medicare |
$672.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,562.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,201.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,153.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,273.82
|
| Rate for Payer: Cash Price |
$693.30
|
| Rate for Payer: Cigna Commercial |
$2,211.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,345.00
|
| Rate for Payer: Health EOS Commercial |
$2,139.06
|
| Rate for Payer: HFN Commercial |
$2,211.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,802.58
|
| Rate for Payer: Multiplan Commercial |
$1,922.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,442.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,211.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,177.69
|
| Rate for Payer: Quartz Commercial |
$1,562.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,442.06
|
| Rate for Payer: The Alliance Commercial |
$1,201.72
|
| Rate for Payer: WEA Trust Commercial |
$1,321.89
|
| Rate for Payer: WPS Commercial |
$1,780.16
|
|
|
TRAY THAL QUICK 32F CHEST TUBE G07242
|
Facility
|
IP
|
$2,084.00
|
|
| Hospital Charge Code |
6202991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,062.01 |
| Max. Negotiated Rate |
$1,993.97 |
| Rate for Payer: Aetna Commercial |
$1,950.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,863.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,148.70
|
| Rate for Payer: Cash Price |
$625.20
|
| Rate for Payer: Cigna Commercial |
$1,993.97
|
| Rate for Payer: Health EOS Commercial |
$1,928.95
|
| Rate for Payer: HFN Commercial |
$1,993.97
|
| Rate for Payer: Multiplan Commercial |
$1,733.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,993.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,062.01
|
| Rate for Payer: Quartz Commercial |
$1,300.42
|
| Rate for Payer: WEA Trust Commercial |
$1,192.05
|
| Rate for Payer: WPS Commercial |
$1,605.31
|
|
|
TRAY THAL QUICK 32F CHEST TUBE G07242
|
Facility
|
OP
|
$2,084.00
|
|
| Hospital Charge Code |
6202991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$606.86 |
| Max. Negotiated Rate |
$1,993.97 |
| Rate for Payer: Aetna Commercial |
$1,950.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,863.93
|
| Rate for Payer: Aetna Managed Medicare |
$606.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,408.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,083.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,040.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,148.70
|
| Rate for Payer: Cash Price |
$625.20
|
| Rate for Payer: Cigna Commercial |
$1,993.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,212.89
|
| Rate for Payer: Health EOS Commercial |
$1,928.95
|
| Rate for Payer: HFN Commercial |
$1,993.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,625.52
|
| Rate for Payer: Multiplan Commercial |
$1,733.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,300.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,993.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,062.01
|
| Rate for Payer: Quartz Commercial |
$1,408.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,300.42
|
| Rate for Payer: The Alliance Commercial |
$1,083.68
|
| Rate for Payer: WEA Trust Commercial |
$1,192.05
|
| Rate for Payer: WPS Commercial |
$1,605.31
|
|
|
TRAY TRANSFER SAFE-T-TRAY 31140398
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
2963216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
TRAY TRANSFER SAFE-T-TRAY 31140398
|
Facility
|
IP
|
$84.00
|
|
| Hospital Charge Code |
2963216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
TRAY UMBILICAL ARTERY 43201
|
Facility
|
IP
|
$853.00
|
|
| Hospital Charge Code |
2962920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$434.69 |
| Max. Negotiated Rate |
$816.15 |
| Rate for Payer: Aetna Commercial |
$798.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.17
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$816.15
|
| Rate for Payer: Health EOS Commercial |
$789.54
|
| Rate for Payer: HFN Commercial |
$816.15
|
| Rate for Payer: Multiplan Commercial |
$709.70
|
| Rate for Payer: Preferred Network Access Commercial |
$816.15
|
| Rate for Payer: Quartz Beloit One Network |
$434.69
|
| Rate for Payer: Quartz Commercial |
$532.27
|
| Rate for Payer: WEA Trust Commercial |
$487.92
|
| Rate for Payer: WPS Commercial |
$657.07
|
|
|
TRAY UMBILICAL ARTERY 43201
|
Facility
|
OP
|
$853.00
|
|
| Hospital Charge Code |
2962920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.39 |
| Max. Negotiated Rate |
$816.15 |
| Rate for Payer: Aetna Commercial |
$798.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.92
|
| Rate for Payer: Aetna Managed Medicare |
$248.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$576.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$443.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$425.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.17
|
| Rate for Payer: Cash Price |
$255.90
|
| Rate for Payer: Cigna Commercial |
$816.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$496.45
|
| Rate for Payer: Health EOS Commercial |
$789.54
|
| Rate for Payer: HFN Commercial |
$816.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$665.34
|
| Rate for Payer: Multiplan Commercial |
$709.70
|
| Rate for Payer: NAPHCARE Commercial |
$532.27
|
| Rate for Payer: Preferred Network Access Commercial |
$816.15
|
| Rate for Payer: Quartz Beloit One Network |
$434.69
|
| Rate for Payer: Quartz Commercial |
$576.63
|
| Rate for Payer: Quartz Medicare Advantage |
$532.27
|
| Rate for Payer: The Alliance Commercial |
$443.56
|
| Rate for Payer: WEA Trust Commercial |
$487.92
|
| Rate for Payer: WPS Commercial |
$657.07
|
|
|
TRAY UNIVERSAL BLOCK 181A143
|
Facility
|
IP
|
$574.00
|
|
| Hospital Charge Code |
4595216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.51 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$358.18
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
TRAY UNIVERSAL BLOCK 181A143
|
Facility
|
OP
|
$574.00
|
|
| Hospital Charge Code |
4595216
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$549.20 |
| Rate for Payer: Aetna Commercial |
$537.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$513.39
|
| Rate for Payer: Aetna Managed Medicare |
$167.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$388.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$316.39
|
| Rate for Payer: Cash Price |
$172.20
|
| Rate for Payer: Cigna Commercial |
$549.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.07
|
| Rate for Payer: Health EOS Commercial |
$531.29
|
| Rate for Payer: HFN Commercial |
$549.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.72
|
| Rate for Payer: Multiplan Commercial |
$477.57
|
| Rate for Payer: NAPHCARE Commercial |
$358.18
|
| Rate for Payer: Preferred Network Access Commercial |
$549.20
|
| Rate for Payer: Quartz Beloit One Network |
$292.51
|
| Rate for Payer: Quartz Commercial |
$388.02
|
| Rate for Payer: Quartz Medicare Advantage |
$358.18
|
| Rate for Payer: The Alliance Commercial |
$298.48
|
| Rate for Payer: WEA Trust Commercial |
$328.33
|
| Rate for Payer: WPS Commercial |
$442.15
|
|
|
TRAY UROLOGIST DISP 123400
|
Facility
|
OP
|
$3,002.00
|
|
| Hospital Charge Code |
2962998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$874.18 |
| Max. Negotiated Rate |
$2,872.31 |
| Rate for Payer: Aetna Commercial |
$2,809.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,684.99
|
| Rate for Payer: Aetna Managed Medicare |
$874.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,029.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,561.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,498.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,654.70
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,872.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,747.16
|
| Rate for Payer: Health EOS Commercial |
$2,778.65
|
| Rate for Payer: HFN Commercial |
$2,872.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,341.56
|
| Rate for Payer: Multiplan Commercial |
$2,497.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,873.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,872.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,529.82
|
| Rate for Payer: Quartz Commercial |
$2,029.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.25
|
| Rate for Payer: The Alliance Commercial |
$1,561.04
|
| Rate for Payer: WEA Trust Commercial |
$1,717.14
|
| Rate for Payer: WPS Commercial |
$2,312.44
|
|
|
TRAY UROLOGIST DISP 123400
|
Facility
|
IP
|
$3,002.00
|
|
| Hospital Charge Code |
2962998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,529.82 |
| Max. Negotiated Rate |
$2,872.31 |
| Rate for Payer: Aetna Commercial |
$2,809.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,684.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,654.70
|
| Rate for Payer: Cash Price |
$900.60
|
| Rate for Payer: Cigna Commercial |
$2,872.31
|
| Rate for Payer: Health EOS Commercial |
$2,778.65
|
| Rate for Payer: HFN Commercial |
$2,872.31
|
| Rate for Payer: Multiplan Commercial |
$2,497.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,872.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,529.82
|
| Rate for Payer: Quartz Commercial |
$1,873.25
|
| Rate for Payer: WEA Trust Commercial |
$1,717.14
|
| Rate for Payer: WPS Commercial |
$2,312.44
|
|
|
Trazodone Level
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$46.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.96
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.24
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$98.59
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$106.81
|
| Rate for Payer: Quartz Medicare Advantage |
$98.59
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: United Healthcare PPO |
$123.24
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Trazodone Level
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$98.59
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Trazodone Level
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3256241
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$156.10 |
| Rate for Payer: Aetna Commercial |
$156.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$156.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.59
|
| Rate for Payer: Health EOS Commercial |
$149.53
|
| Rate for Payer: HFN Commercial |
$156.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.81
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$156.10
|
| Rate for Payer: Quartz Beloit One Network |
$72.30
|
| Rate for Payer: Quartz Commercial |
$93.66
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
TR Band
|
Facility
|
IP
|
$888.00
|
|
| Hospital Charge Code |
5184606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.52 |
| Max. Negotiated Rate |
$849.64 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$554.11
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
TR Band
|
Facility
|
OP
|
$888.00
|
|
| Hospital Charge Code |
5184606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.59 |
| Max. Negotiated Rate |
$849.64 |
| Rate for Payer: Aetna Commercial |
$831.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.23
|
| Rate for Payer: Aetna Managed Medicare |
$258.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$600.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.47
|
| Rate for Payer: Cash Price |
$266.40
|
| Rate for Payer: Cigna Commercial |
$849.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$516.82
|
| Rate for Payer: Health EOS Commercial |
$821.93
|
| Rate for Payer: HFN Commercial |
$849.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.64
|
| Rate for Payer: Multiplan Commercial |
$738.82
|
| Rate for Payer: NAPHCARE Commercial |
$554.11
|
| Rate for Payer: Preferred Network Access Commercial |
$849.64
|
| Rate for Payer: Quartz Beloit One Network |
$452.52
|
| Rate for Payer: Quartz Commercial |
$600.29
|
| Rate for Payer: Quartz Medicare Advantage |
$554.11
|
| Rate for Payer: The Alliance Commercial |
$461.76
|
| Rate for Payer: WEA Trust Commercial |
$507.94
|
| Rate for Payer: WPS Commercial |
$684.03
|
|
|
Treanda 1 mg Charge
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
2958920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$13.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.45
|
| Rate for Payer: Anthem Medicare Advantage |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.34
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.34
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.34
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$20.01
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$13.34
|
| Rate for Payer: The Alliance Commercial |
$53.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.34
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: Wellcare Medicare |
$13.34
|
| Rate for Payer: WPS Commercial |
$35.96
|
|
|
Treanda 1 mg Charge
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
2958920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Treanda 1 mg Charge
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
HCPCS J9034
|
| Hospital Charge Code |
2958920
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.34 |
| Max. Negotiated Rate |
$66.20 |
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$13.34
|
| Rate for Payer: Anthem Medicare Advantage |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.34
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$66.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.38
|
| Rate for Payer: Health EOS Commercial |
$63.41
|
| Rate for Payer: HFN Commercial |
$66.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.34
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$20.01
|
| Rate for Payer: Preferred Network Access Commercial |
$66.20
|
| Rate for Payer: Quartz Beloit One Network |
$30.66
|
| Rate for Payer: Quartz Commercial |
$39.72
|
| Rate for Payer: Quartz Medicare Advantage |
$13.34
|
| Rate for Payer: The Alliance Commercial |
$36.69
|
| Rate for Payer: United Healthcare Medicaid |
$13.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.34
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$35.96
|
|
|
TREAT BIG TOE FRACTURE 28496
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
CPT 28496
|
| Hospital Charge Code |
3014258
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$216.31 |
| Max. Negotiated Rate |
$1,224.48 |
| Rate for Payer: Aetna Commercial |
$908.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$822.85
|
| Rate for Payer: Aetna Managed Medicare |
$272.11
|
| Rate for Payer: Anthem Medicare Advantage |
$272.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$272.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$272.11
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.11
|
| Rate for Payer: Health EOS Commercial |
$870.69
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$853.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$853.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$272.11
|
| Rate for Payer: Multiplan Commercial |
$765.44
|
| Rate for Payer: NAPHCARE Commercial |
$408.16
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$420.99
|
| Rate for Payer: Quartz Commercial |
$545.38
|
| Rate for Payer: Quartz Medicare Advantage |
$272.11
|
| Rate for Payer: The Alliance Commercial |
$1,156.45
|
| Rate for Payer: United Healthcare Medicaid |
$216.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$272.11
|
| Rate for Payer: WEA Trust Commercial |
$526.24
|
| Rate for Payer: WPS Commercial |
$1,224.48
|
|
|
TREAT BIG TOE FRACTURE 28505
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
CPT 28505
|
| Hospital Charge Code |
3014259
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$2,061.07 |
| Rate for Payer: Aetna Commercial |
$1,393.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.10
|
| Rate for Payer: Aetna Managed Medicare |
$458.02
|
| Rate for Payer: Anthem Medicare Advantage |
$458.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$458.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$458.02
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,393.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.02
|
| Rate for Payer: Health EOS Commercial |
$1,334.42
|
| Rate for Payer: HFN Commercial |
$1,393.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,735.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,735.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$458.02
|
| Rate for Payer: Multiplan Commercial |
$1,173.12
|
| Rate for Payer: NAPHCARE Commercial |
$687.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,393.08
|
| Rate for Payer: Quartz Beloit One Network |
$645.22
|
| Rate for Payer: Quartz Commercial |
$835.85
|
| Rate for Payer: Quartz Medicare Advantage |
$458.02
|
| Rate for Payer: The Alliance Commercial |
$1,946.57
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$458.02
|
| Rate for Payer: WEA Trust Commercial |
$806.52
|
| Rate for Payer: WPS Commercial |
$2,061.07
|
|
|
TREAT CHEEK BONE FRACTURE 21356
|
Professional
|
Both
|
$2,726.00
|
|
|
Service Code
|
CPT 21356
|
| Hospital Charge Code |
3013732
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$365.37 |
| Max. Negotiated Rate |
$2,693.29 |
| Rate for Payer: Aetna Commercial |
$2,693.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,438.13
|
| Rate for Payer: Aetna Managed Medicare |
$365.37
|
| Rate for Payer: Anthem Medicare Advantage |
$365.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$365.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$365.37
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cash Price |
$817.80
|
| Rate for Payer: Cigna Commercial |
$2,693.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$420.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$365.37
|
| Rate for Payer: Health EOS Commercial |
$2,579.89
|
| Rate for Payer: HFN Commercial |
$2,693.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,312.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,312.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$365.37
|
| Rate for Payer: Multiplan Commercial |
$2,268.03
|
| Rate for Payer: NAPHCARE Commercial |
$548.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,693.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,247.42
|
| Rate for Payer: Quartz Commercial |
$1,615.97
|
| Rate for Payer: Quartz Medicare Advantage |
$365.37
|
| Rate for Payer: The Alliance Commercial |
$1,552.83
|
| Rate for Payer: United Healthcare Medicaid |
$420.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.37
|
| Rate for Payer: WEA Trust Commercial |
$1,559.27
|
| Rate for Payer: WPS Commercial |
$1,644.18
|
|
|
TREAT CLAVICLE FRACTURE 23505
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 23505
|
| Hospital Charge Code |
3013782
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.04 |
| Max. Negotiated Rate |
$1,490.63 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$331.25
|
| Rate for Payer: Anthem Medicare Advantage |
$331.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$331.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$331.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.25
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,160.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,160.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$331.25
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$496.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$331.25
|
| Rate for Payer: The Alliance Commercial |
$1,407.81
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$331.25
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,490.63
|
|
|
TREAT ELBOW DISLOCATION 24600
|
Professional
|
Both
|
$1,011.00
|
|
|
Service Code
|
CPT 24600
|
| Hospital Charge Code |
3013844
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$78.34 |
| Max. Negotiated Rate |
$1,727.34 |
| Rate for Payer: Aetna Commercial |
$998.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$904.24
|
| Rate for Payer: Aetna Managed Medicare |
$383.85
|
| Rate for Payer: Anthem Medicare Advantage |
$383.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$383.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$383.85
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cash Price |
$303.30
|
| Rate for Payer: Cigna Commercial |
$998.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$383.85
|
| Rate for Payer: Health EOS Commercial |
$956.81
|
| Rate for Payer: HFN Commercial |
$998.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,169.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,169.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$383.85
|
| Rate for Payer: Multiplan Commercial |
$841.15
|
| Rate for Payer: NAPHCARE Commercial |
$575.78
|
| Rate for Payer: Preferred Network Access Commercial |
$998.87
|
| Rate for Payer: Quartz Beloit One Network |
$462.63
|
| Rate for Payer: Quartz Commercial |
$599.32
|
| Rate for Payer: Quartz Medicare Advantage |
$383.85
|
| Rate for Payer: The Alliance Commercial |
$1,631.38
|
| Rate for Payer: United Healthcare Medicaid |
$78.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$383.85
|
| Rate for Payer: WEA Trust Commercial |
$578.29
|
| Rate for Payer: WPS Commercial |
$1,727.34
|
|
|
TREAT ELBOW DISLOCATION 24640
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 24640
|
| Hospital Charge Code |
3013847
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.48 |
| Max. Negotiated Rate |
$378.40 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$71.42
|
| Rate for Payer: Anthem Medicare Advantage |
$71.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.42
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.42
|
| Rate for Payer: Health EOS Commercial |
$362.47
|
| Rate for Payer: HFN Commercial |
$378.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$283.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.42
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$107.13
|
| Rate for Payer: Preferred Network Access Commercial |
$378.40
|
| Rate for Payer: Quartz Beloit One Network |
$175.26
|
| Rate for Payer: Quartz Commercial |
$227.04
|
| Rate for Payer: Quartz Medicare Advantage |
$71.42
|
| Rate for Payer: The Alliance Commercial |
$303.52
|
| Rate for Payer: United Healthcare Medicaid |
$63.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.42
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$321.38
|
|
