|
TRAP QUICKCATCH SUCTION GI H332
|
Facility
|
OP
|
$84.00
|
|
| Hospital Charge Code |
4595420
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
TRAUMATIC INJURY WITH MCC
|
Facility
|
IP
|
$40,053.00
|
|
|
Service Code
|
MSDRG 913
|
| Min. Negotiated Rate |
$14,407.60 |
| Max. Negotiated Rate |
$40,053.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,407.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,260.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,960.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,764.22
|
| Rate for Payer: Anthem Medicare Advantage |
$14,407.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,407.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,407.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,407.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,270.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,407.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,142.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,407.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,407.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,407.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,407.60
|
| Rate for Payer: NAPHCARE Commercial |
$21,611.40
|
| Rate for Payer: Quartz Medicare Advantage |
$14,407.60
|
| Rate for Payer: The Alliance Commercial |
$40,053.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,407.60
|
| Rate for Payer: United Healthcare PPO |
$22,688.00
|
| Rate for Payer: Wellcare Medicare |
$14,407.60
|
|
|
TRAUMATIC INJURY WITHOUT MCC
|
Facility
|
IP
|
$24,453.00
|
|
|
Service Code
|
MSDRG 914
|
| Min. Negotiated Rate |
$8,795.87 |
| Max. Negotiated Rate |
$24,453.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,795.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,091.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,633.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,902.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8,795.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,795.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,795.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,795.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,433.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,795.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,700.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,795.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,795.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,795.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,795.87
|
| Rate for Payer: NAPHCARE Commercial |
$13,193.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,795.87
|
| Rate for Payer: The Alliance Commercial |
$24,453.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,795.87
|
| Rate for Payer: United Healthcare PPO |
$13,779.79
|
| Rate for Payer: Wellcare Medicare |
$8,795.87
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC
|
Facility
|
IP
|
$35,337.00
|
|
|
Service Code
|
MSDRG 086
|
| Min. Negotiated Rate |
$12,711.09 |
| Max. Negotiated Rate |
$35,337.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,711.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,693.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,226.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,166.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12,711.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,711.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,711.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,711.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,387.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,711.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,683.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,711.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,711.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,711.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,711.09
|
| Rate for Payer: NAPHCARE Commercial |
$19,066.64
|
| Rate for Payer: Quartz Medicare Advantage |
$12,711.09
|
| Rate for Payer: The Alliance Commercial |
$35,337.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,711.09
|
| Rate for Payer: United Healthcare PPO |
$19,994.90
|
| Rate for Payer: Wellcare Medicare |
$12,711.09
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC
|
Facility
|
IP
|
$36,382.00
|
|
|
Service Code
|
MSDRG 083
|
| Min. Negotiated Rate |
$13,086.92 |
| Max. Negotiated Rate |
$36,382.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,086.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,870.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,778.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,086.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,086.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,086.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,086.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,065.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,086.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,449.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,086.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,086.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,086.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,086.92
|
| Rate for Payer: NAPHCARE Commercial |
$19,630.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13,086.92
|
| Rate for Payer: The Alliance Commercial |
$36,382.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,086.92
|
| Rate for Payer: United Healthcare PPO |
$20,591.51
|
| Rate for Payer: Wellcare Medicare |
$13,086.92
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC
|
Facility
|
IP
|
$60,745.00
|
|
|
Service Code
|
MSDRG 085
|
| Min. Negotiated Rate |
$21,850.72 |
| Max. Negotiated Rate |
$60,745.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,850.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,624.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,503.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,681.06
|
| Rate for Payer: Anthem Medicare Advantage |
$21,850.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,850.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,850.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,850.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,499.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,850.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44,319.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,850.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,850.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,850.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,850.72
|
| Rate for Payer: NAPHCARE Commercial |
$32,776.08
|
| Rate for Payer: Quartz Medicare Advantage |
$21,850.72
|
| Rate for Payer: The Alliance Commercial |
$60,745.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,850.72
|
| Rate for Payer: United Healthcare PPO |
$34,503.38
|
| Rate for Payer: Wellcare Medicare |
$21,850.72
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC
|
Facility
|
IP
|
$60,891.00
|
|
|
Service Code
|
MSDRG 082
|
| Min. Negotiated Rate |
$21,903.33 |
| Max. Negotiated Rate |
$60,891.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,903.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,834.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,664.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,833.84
|
| Rate for Payer: Anthem Medicare Advantage |
$21,903.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,903.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,903.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,903.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,668.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,903.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44,426.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,903.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,903.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,903.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,903.33
|
| Rate for Payer: NAPHCARE Commercial |
$32,855.00
|
| Rate for Payer: Quartz Medicare Advantage |
$21,903.33
|
| Rate for Payer: The Alliance Commercial |
$60,891.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,903.33
|
| Rate for Payer: United Healthcare PPO |
$34,586.87
|
| Rate for Payer: Wellcare Medicare |
$21,903.33
|
|
|
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$23,881.00
|
|
|
Service Code
|
MSDRG 087
|
| Min. Negotiated Rate |
$8,590.26 |
| Max. Negotiated Rate |
$23,881.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,590.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,672.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,312.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,597.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8,590.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,590.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,590.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,590.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,094.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,590.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,280.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,590.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,590.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,590.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,590.26
|
| Rate for Payer: NAPHCARE Commercial |
$12,885.39
|
| Rate for Payer: Quartz Medicare Advantage |
$8,590.26
|
| Rate for Payer: The Alliance Commercial |
$23,881.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,590.26
|
| Rate for Payer: United Healthcare PPO |
$13,453.40
|
| Rate for Payer: Wellcare Medicare |
$8,590.26
|
|
|
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC
|
Facility
|
IP
|
$24,772.00
|
|
|
Service Code
|
MSDRG 084
|
| Min. Negotiated Rate |
$8,910.63 |
| Max. Negotiated Rate |
$24,772.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,910.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,301.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,794.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,055.76
|
| Rate for Payer: Anthem Medicare Advantage |
$8,910.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,910.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,910.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,910.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,603.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,910.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,934.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,910.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,910.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,910.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,910.63
|
| Rate for Payer: NAPHCARE Commercial |
$13,365.94
|
| Rate for Payer: Quartz Medicare Advantage |
$8,910.63
|
| Rate for Payer: The Alliance Commercial |
$24,772.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,910.63
|
| Rate for Payer: United Healthcare PPO |
$13,961.97
|
| Rate for Payer: Wellcare Medicare |
$8,910.63
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC
|
Facility
|
IP
|
$40,364.00
|
|
|
Service Code
|
MSDRG 604
|
| Min. Negotiated Rate |
$14,519.49 |
| Max. Negotiated Rate |
$40,364.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,519.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,679.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,282.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,069.78
|
| Rate for Payer: Anthem Medicare Advantage |
$14,519.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,519.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,519.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,519.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,609.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,519.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,370.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,519.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,519.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,519.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,519.49
|
| Rate for Payer: NAPHCARE Commercial |
$21,779.24
|
| Rate for Payer: Quartz Medicare Advantage |
$14,519.49
|
| Rate for Payer: The Alliance Commercial |
$40,364.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,519.49
|
| Rate for Payer: United Healthcare PPO |
$22,865.62
|
| Rate for Payer: Wellcare Medicare |
$14,519.49
|
|
|
TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC
|
Facility
|
IP
|
$24,482.00
|
|
|
Service Code
|
MSDRG 605
|
| Min. Negotiated Rate |
$8,806.39 |
| Max. Negotiated Rate |
$24,482.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,806.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,091.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,633.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,902.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8,806.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,806.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,806.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,806.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,433.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,806.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,721.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,806.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,806.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,806.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,806.39
|
| Rate for Payer: NAPHCARE Commercial |
$13,209.58
|
| Rate for Payer: Quartz Medicare Advantage |
$8,806.39
|
| Rate for Payer: The Alliance Commercial |
$24,482.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,806.39
|
| Rate for Payer: United Healthcare PPO |
$13,796.49
|
| Rate for Payer: Wellcare Medicare |
$8,806.39
|
|
|
TRAY ACCUCATH IV 18GA X 2.25 IN CATHETER & GUIDEWIRE AC1182252
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
6171928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.93 |
| Max. Negotiated Rate |
$788.44 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$514.20
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
TRAY ACCUCATH IV 18GA X 2.25 IN CATHETER & GUIDEWIRE AC1182252
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
6171928
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.96 |
| Max. Negotiated Rate |
$3,428.00 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Aetna Managed Medicare |
$239.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$557.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$428.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$411.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$479.58
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$642.75
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$557.05
|
| Rate for Payer: Quartz Medicare Advantage |
$514.20
|
| Rate for Payer: The Alliance Commercial |
$3,428.00
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
TRAY ACCUCATH IV 20GA X 2.25 IN CATHETER & GUIDEWIRE AC1202252
|
Facility
|
OP
|
$857.00
|
|
| Hospital Charge Code |
6171929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.96 |
| Max. Negotiated Rate |
$3,428.00 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Aetna Managed Medicare |
$239.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$557.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$428.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$411.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$479.58
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$642.75
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$557.05
|
| Rate for Payer: Quartz Medicare Advantage |
$514.20
|
| Rate for Payer: The Alliance Commercial |
$3,428.00
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
TRAY ACCUCATH IV 20GA X 2.25 IN CATHETER & GUIDEWIRE AC1202252
|
Facility
|
IP
|
$857.00
|
|
| Hospital Charge Code |
6171929
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.93 |
| Max. Negotiated Rate |
$788.44 |
| Rate for Payer: Aetna Commercial |
$771.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$737.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$454.21
|
| Rate for Payer: Cash Price |
$257.10
|
| Rate for Payer: Cigna Commercial |
$788.44
|
| Rate for Payer: Health EOS Commercial |
$762.73
|
| Rate for Payer: HFN Commercial |
$788.44
|
| Rate for Payer: Multiplan Commercial |
$685.60
|
| Rate for Payer: NAPHCARE Commercial |
$514.20
|
| Rate for Payer: Preferred Network Access Commercial |
$788.44
|
| Rate for Payer: Quartz Beloit One Network |
$419.93
|
| Rate for Payer: Quartz Commercial |
$514.20
|
| Rate for Payer: WEA Trust Commercial |
$471.35
|
| Rate for Payer: WPS Commercial |
$634.78
|
|
|
TRAY AMNIOCENTESIS 20 x 3.5
|
Facility
|
IP
|
$328.00
|
|
| Hospital Charge Code |
2963119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.72 |
| Max. Negotiated Rate |
$301.76 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$196.80
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
TRAY AMNIOCENTESIS 20 x 3.5
|
Facility
|
OP
|
$328.00
|
|
| Hospital Charge Code |
2963119
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.84 |
| Max. Negotiated Rate |
$1,312.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Aetna Managed Medicare |
$91.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.55
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$213.20
|
| Rate for Payer: Quartz Medicare Advantage |
$196.80
|
| Rate for Payer: The Alliance Commercial |
$1,312.00
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
Tray Anest Single 19Ga622G
|
Facility
|
IP
|
$758.00
|
|
| Hospital Charge Code |
3101765
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$371.42 |
| Max. Negotiated Rate |
$697.36 |
| Rate for Payer: Aetna Commercial |
$682.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.74
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$697.36
|
| Rate for Payer: Health EOS Commercial |
$674.62
|
| Rate for Payer: HFN Commercial |
$697.36
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: NAPHCARE Commercial |
$454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$697.36
|
| Rate for Payer: Quartz Beloit One Network |
$371.42
|
| Rate for Payer: Quartz Commercial |
$454.80
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
|
Tray Anest Single 19Ga622G
|
Facility
|
OP
|
$758.00
|
|
| Hospital Charge Code |
3101765
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$212.24 |
| Max. Negotiated Rate |
$3,032.00 |
| Rate for Payer: Aetna Commercial |
$682.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$651.88
|
| Rate for Payer: Aetna Managed Medicare |
$212.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$363.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$401.74
|
| Rate for Payer: Cash Price |
$227.40
|
| Rate for Payer: Cigna Commercial |
$697.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.18
|
| Rate for Payer: Health EOS Commercial |
$674.62
|
| Rate for Payer: HFN Commercial |
$697.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.50
|
| Rate for Payer: Multiplan Commercial |
$606.40
|
| Rate for Payer: NAPHCARE Commercial |
$454.80
|
| Rate for Payer: Preferred Network Access Commercial |
$697.36
|
| Rate for Payer: Quartz Beloit One Network |
$371.42
|
| Rate for Payer: Quartz Commercial |
$492.70
|
| Rate for Payer: Quartz Medicare Advantage |
$454.80
|
| Rate for Payer: The Alliance Commercial |
$3,032.00
|
| Rate for Payer: WEA Trust Commercial |
$416.90
|
| Rate for Payer: WPS Commercial |
$561.45
|
|
|
TRAY ARTHROSCOPY KNEE DYNJS0810
|
Facility
|
OP
|
$747.00
|
|
| Hospital Charge Code |
6153642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.16 |
| Max. Negotiated Rate |
$2,988.00 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Aetna Managed Medicare |
$209.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$485.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.02
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.25
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$485.55
|
| Rate for Payer: Quartz Medicare Advantage |
$448.20
|
| Rate for Payer: The Alliance Commercial |
$2,988.00
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
TRAY ARTHROSCOPY KNEE DYNJS0810
|
Facility
|
IP
|
$747.00
|
|
| Hospital Charge Code |
6153642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.03 |
| Max. Negotiated Rate |
$687.24 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$448.20
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
TRAY BONE BIOPSY & MARROW JAMSHIDI NEEDLE 11G BAK4511
|
Facility
|
IP
|
$780.00
|
|
| Hospital Charge Code |
2962868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.20 |
| Max. Negotiated Rate |
$717.60 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$468.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.75
|
|
|
TRAY BONE BIOPSY & MARROW JAMSHIDI NEEDLE 11G BAK4511
|
Facility
|
OP
|
$780.00
|
|
| Hospital Charge Code |
2962868
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.40 |
| Max. Negotiated Rate |
$3,120.00 |
| Rate for Payer: Aetna Commercial |
$702.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$670.80
|
| Rate for Payer: Aetna Managed Medicare |
$218.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$507.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$390.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$374.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.40
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$717.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$436.49
|
| Rate for Payer: Health EOS Commercial |
$694.20
|
| Rate for Payer: HFN Commercial |
$717.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.00
|
| Rate for Payer: Multiplan Commercial |
$624.00
|
| Rate for Payer: NAPHCARE Commercial |
$468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.60
|
| Rate for Payer: Quartz Beloit One Network |
$382.20
|
| Rate for Payer: Quartz Commercial |
$507.00
|
| Rate for Payer: Quartz Medicare Advantage |
$468.00
|
| Rate for Payer: The Alliance Commercial |
$3,120.00
|
| Rate for Payer: WEA Trust Commercial |
$429.00
|
| Rate for Payer: WPS Commercial |
$577.75
|
|
|
TRAY CATH 16FR SURE STEP LF INTS16
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
2963586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$28.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$61.20
|
| Rate for Payer: The Alliance Commercial |
$408.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
TRAY CATH 16FR SURE STEP LF INTS16
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
2963586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
