|
CHEST DRAIN DUAL OASIS 3620-100
|
Facility
OP
|
$1,065.00
|
|
| Hospital Charge Code |
4020638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.20 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$958.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.90
|
| Rate for Payer: Aetna Managed Medicare |
$298.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$692.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$532.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.45
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$979.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$595.97
|
| Rate for Payer: Health EOS Commercial |
$947.85
|
| Rate for Payer: HFN Commercial |
$979.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$798.75
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: NAPHCARE Commercial |
$639.00
|
| Rate for Payer: Preferred Network Access Commercial |
$979.80
|
| Rate for Payer: Quartz Beloit One Network |
$521.85
|
| Rate for Payer: Quartz Commercial |
$692.25
|
| Rate for Payer: Quartz Medicare Advantage |
$639.00
|
| Rate for Payer: The Alliance Commercial |
$4,260.00
|
| Rate for Payer: WEA Trust Commercial |
$585.75
|
| Rate for Payer: WPS Commercial |
$788.85
|
|
|
CHEST DRAIN INFANT/PED OASIS 3612-100
|
Facility
OP
|
$868.00
|
|
| Hospital Charge Code |
5106780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$243.04 |
| Max. Negotiated Rate |
$3,472.00 |
| Rate for Payer: Aetna Commercial |
$781.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$746.48
|
| Rate for Payer: Aetna Managed Medicare |
$243.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$564.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$434.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$416.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.04
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$798.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$485.73
|
| Rate for Payer: Health EOS Commercial |
$772.52
|
| Rate for Payer: HFN Commercial |
$798.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: NAPHCARE Commercial |
$520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$798.56
|
| Rate for Payer: Quartz Beloit One Network |
$425.32
|
| Rate for Payer: Quartz Commercial |
$564.20
|
| Rate for Payer: Quartz Medicare Advantage |
$520.80
|
| Rate for Payer: The Alliance Commercial |
$3,472.00
|
| Rate for Payer: WEA Trust Commercial |
$477.40
|
| Rate for Payer: WPS Commercial |
$642.93
|
|
|
CHEST DRAIN INFANT/PED OASIS 3612-100
|
Facility
IP
|
$868.00
|
|
| Hospital Charge Code |
5106780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$425.32 |
| Max. Negotiated Rate |
$798.56 |
| Rate for Payer: Aetna Commercial |
$781.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.04
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$798.56
|
| Rate for Payer: Health EOS Commercial |
$772.52
|
| Rate for Payer: HFN Commercial |
$798.56
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: NAPHCARE Commercial |
$520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$798.56
|
| Rate for Payer: Quartz Beloit One Network |
$425.32
|
| Rate for Payer: Quartz Commercial |
$520.80
|
| Rate for Payer: WEA Trust Commercial |
$477.40
|
| Rate for Payer: WPS Commercial |
$642.93
|
|
|
CHEST DRAIN SINGLE AQUASEAL 2002-000
|
Facility
IP
|
$659.00
|
|
| Hospital Charge Code |
2965812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.91 |
| Max. Negotiated Rate |
$606.28 |
| Rate for Payer: Aetna Commercial |
$593.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.27
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$606.28
|
| Rate for Payer: Health EOS Commercial |
$586.51
|
| Rate for Payer: HFN Commercial |
$606.28
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: NAPHCARE Commercial |
$395.40
|
| Rate for Payer: Preferred Network Access Commercial |
$606.28
|
| Rate for Payer: Quartz Beloit One Network |
$322.91
|
| Rate for Payer: Quartz Commercial |
$395.40
|
| Rate for Payer: WEA Trust Commercial |
$362.45
|
| Rate for Payer: WPS Commercial |
$488.12
|
|
|
CHEST DRAIN SINGLE AQUASEAL 2002-000
|
Facility
OP
|
$659.00
|
|
| Hospital Charge Code |
2965812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$184.52 |
| Max. Negotiated Rate |
$2,636.00 |
| Rate for Payer: Aetna Commercial |
$593.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$566.74
|
| Rate for Payer: Aetna Managed Medicare |
$184.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$428.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$316.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.27
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$606.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.78
|
| Rate for Payer: Health EOS Commercial |
$586.51
|
| Rate for Payer: HFN Commercial |
$606.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.25
|
| Rate for Payer: Multiplan Commercial |
$527.20
|
| Rate for Payer: NAPHCARE Commercial |
$395.40
|
| Rate for Payer: Preferred Network Access Commercial |
$606.28
|
| Rate for Payer: Quartz Beloit One Network |
$322.91
|
| Rate for Payer: Quartz Commercial |
$428.35
|
| Rate for Payer: Quartz Medicare Advantage |
$395.40
|
| Rate for Payer: The Alliance Commercial |
$2,636.00
|
| Rate for Payer: WEA Trust Commercial |
$362.45
|
| Rate for Payer: WPS Commercial |
$488.12
|
|
|
CHEST PAIN
|
Facility
IP
|
$19,558.00
|
|
|
Service Code
|
MS-DRG 313
|
| Min. Negotiated Rate |
$7,035.27 |
| Max. Negotiated Rate |
$19,558.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,035.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,105.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,578.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,000.16
|
| Rate for Payer: Anthem Medicare Advantage |
$7,035.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,035.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,035.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,035.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,211.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,035.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,110.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,035.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,035.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,035.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,035.27
|
| Rate for Payer: NAPHCARE Commercial |
$10,552.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,035.27
|
| Rate for Payer: The Alliance Commercial |
$19,558.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,035.27
|
| Rate for Payer: United Healthcare PPO |
$10,984.97
|
| Rate for Payer: Wellcare Medicare |
$7,035.27
|
|
|
CHEST TUBE 28 FR RT ANGLE 8128
|
Facility
IP
|
$144.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
3953355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$86.40
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
CHEST TUBE 28 FR RT ANGLE 8128
|
Facility
OP
|
$144.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
3953355
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Aetna Managed Medicare |
$40.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.58
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.00
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: Quartz Medicare Advantage |
$86.40
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
CHEST TUBE 28 FR STRAIGHT 8028
|
Facility
IP
|
$106.00
|
|
| Hospital Charge Code |
3953354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.94 |
| Max. Negotiated Rate |
$97.52 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$63.60
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
CHEST TUBE 28 FR STRAIGHT 8028
|
Facility
OP
|
$106.00
|
|
| Hospital Charge Code |
3953354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.68 |
| Max. Negotiated Rate |
$424.00 |
| Rate for Payer: Aetna Commercial |
$95.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.16
|
| Rate for Payer: Aetna Managed Medicare |
$29.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.18
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$97.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$94.34
|
| Rate for Payer: HFN Commercial |
$97.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.50
|
| Rate for Payer: Multiplan Commercial |
$84.80
|
| Rate for Payer: NAPHCARE Commercial |
$63.60
|
| Rate for Payer: Preferred Network Access Commercial |
$97.52
|
| Rate for Payer: Quartz Beloit One Network |
$51.94
|
| Rate for Payer: Quartz Commercial |
$68.90
|
| Rate for Payer: Quartz Medicare Advantage |
$63.60
|
| Rate for Payer: The Alliance Commercial |
$424.00
|
| Rate for Payer: WEA Trust Commercial |
$58.30
|
| Rate for Payer: WPS Commercial |
$78.51
|
|
|
CHEST TUBE 32 FR RT ANGLE 8132
|
Facility
IP
|
$150.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
3953357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.50
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: Health EOS Commercial |
$133.50
|
| Rate for Payer: HFN Commercial |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.00
|
| Rate for Payer: Preferred Network Access Commercial |
$138.00
|
| Rate for Payer: Quartz Beloit One Network |
$73.50
|
| Rate for Payer: Quartz Commercial |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
CHEST TUBE 32 FR RT ANGLE 8132
|
Facility
OP
|
$150.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
3953357
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Aetna Managed Medicare |
$42.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.50
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.94
|
| Rate for Payer: Health EOS Commercial |
$133.50
|
| Rate for Payer: HFN Commercial |
$138.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.00
|
| Rate for Payer: Preferred Network Access Commercial |
$138.00
|
| Rate for Payer: Quartz Beloit One Network |
$73.50
|
| Rate for Payer: Quartz Commercial |
$97.50
|
| Rate for Payer: Quartz Medicare Advantage |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
CHEST TUBE 36FR RIGHT ANGLE 8136
|
Facility
OP
|
$367.00
|
|
| Hospital Charge Code |
2965813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.76 |
| Max. Negotiated Rate |
$1,468.00 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$102.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$238.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$183.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.37
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.25
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$220.20
|
| Rate for Payer: The Alliance Commercial |
$1,468.00
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
CHEST TUBE 36FR RIGHT ANGLE 8136
|
Facility
IP
|
$367.00
|
|
| Hospital Charge Code |
2965813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
CHEST TUBE INSERTION KIT 17100
|
Facility
IP
|
$1,062.00
|
|
| Hospital Charge Code |
3331521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$520.38 |
| Max. Negotiated Rate |
$977.04 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.86
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$977.04
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$637.20
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
CHEST TUBE INSERTION KIT 17100
|
Facility
OP
|
$1,062.00
|
|
| Hospital Charge Code |
3331521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.36 |
| Max. Negotiated Rate |
$4,248.00 |
| Rate for Payer: Aetna Commercial |
$955.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.32
|
| Rate for Payer: Aetna Managed Medicare |
$297.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$531.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.86
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$977.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.30
|
| Rate for Payer: Health EOS Commercial |
$945.18
|
| Rate for Payer: HFN Commercial |
$977.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.50
|
| Rate for Payer: Multiplan Commercial |
$849.60
|
| Rate for Payer: NAPHCARE Commercial |
$637.20
|
| Rate for Payer: Preferred Network Access Commercial |
$977.04
|
| Rate for Payer: Quartz Beloit One Network |
$520.38
|
| Rate for Payer: Quartz Commercial |
$690.30
|
| Rate for Payer: Quartz Medicare Advantage |
$637.20
|
| Rate for Payer: The Alliance Commercial |
$4,248.00
|
| Rate for Payer: WEA Trust Commercial |
$584.10
|
| Rate for Payer: WPS Commercial |
$786.62
|
|
|
CHEST TUBE INSERTION KIT MNS2250
|
Facility
IP
|
$1,385.00
|
|
| Hospital Charge Code |
5591232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$678.65 |
| Max. Negotiated Rate |
$1,274.20 |
| Rate for Payer: Aetna Commercial |
$1,246.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.05
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,274.20
|
| Rate for Payer: Health EOS Commercial |
$1,232.65
|
| Rate for Payer: HFN Commercial |
$1,274.20
|
| Rate for Payer: Multiplan Commercial |
$1,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$831.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.20
|
| Rate for Payer: Quartz Beloit One Network |
$678.65
|
| Rate for Payer: Quartz Commercial |
$831.00
|
| Rate for Payer: WEA Trust Commercial |
$761.75
|
| Rate for Payer: WPS Commercial |
$1,025.87
|
|
|
CHEST TUBE INSERTION KIT MNS2250
|
Facility
OP
|
$1,385.00
|
|
| Hospital Charge Code |
5591232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.80 |
| Max. Negotiated Rate |
$5,540.00 |
| Rate for Payer: Aetna Commercial |
$1,246.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,191.10
|
| Rate for Payer: Aetna Managed Medicare |
$387.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$900.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$692.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$664.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$734.05
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,274.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$775.05
|
| Rate for Payer: Health EOS Commercial |
$1,232.65
|
| Rate for Payer: HFN Commercial |
$1,274.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,038.75
|
| Rate for Payer: Multiplan Commercial |
$1,108.00
|
| Rate for Payer: NAPHCARE Commercial |
$831.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.20
|
| Rate for Payer: Quartz Beloit One Network |
$678.65
|
| Rate for Payer: Quartz Commercial |
$900.25
|
| Rate for Payer: Quartz Medicare Advantage |
$831.00
|
| Rate for Payer: The Alliance Commercial |
$5,540.00
|
| Rate for Payer: WEA Trust Commercial |
$761.75
|
| Rate for Payer: WPS Commercial |
$1,025.87
|
|
|
CHEST TUBE PLACEMENT
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959926
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CHEST TUBE PLACEMENT
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959926
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Chicken Pox Vaccine, SC 90716
|
Professional
|
$306.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
3455568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.64 |
| Max. Negotiated Rate |
$290.70 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$290.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.60
|
| Rate for Payer: Health EOS Commercial |
$278.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.93
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: Preferred Network Access Commercial |
$290.70
|
| Rate for Payer: Quartz Beloit One Network |
$134.64
|
| Rate for Payer: Quartz Commercial |
$174.42
|
| Rate for Payer: The Alliance Commercial |
$153.00
|
| Rate for Payer: United Healthcare Medicaid |
$174.24
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Chicken Pox Vaccine, SC 90716
|
Facility
IP
|
$306.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
3455568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$149.94 |
| Max. Negotiated Rate |
$281.52 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$183.60
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Chicken Pox Vaccine, SC 90716
|
Facility
OP
|
$306.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
3455568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.68 |
| Max. Negotiated Rate |
$1,224.00 |
| Rate for Payer: Aetna Commercial |
$275.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$263.16
|
| Rate for Payer: Aetna Managed Medicare |
$85.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$153.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$146.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.18
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$281.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.24
|
| Rate for Payer: Health EOS Commercial |
$272.34
|
| Rate for Payer: HFN Commercial |
$281.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$229.50
|
| Rate for Payer: Multiplan Commercial |
$244.80
|
| Rate for Payer: NAPHCARE Commercial |
$183.60
|
| Rate for Payer: Preferred Network Access Commercial |
$281.52
|
| Rate for Payer: Quartz Beloit One Network |
$149.94
|
| Rate for Payer: Quartz Commercial |
$198.90
|
| Rate for Payer: Quartz Medicare Advantage |
$183.60
|
| Rate for Payer: The Alliance Commercial |
$1,224.00
|
| Rate for Payer: WEA Trust Commercial |
$168.30
|
| Rate for Payer: WPS Commercial |
$226.65
|
|
|
Chicken Pox Vaccine, SC 90716VFC
|
Professional
|
$20.83
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
5100630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$236.93 |
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.50
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.93
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Preferred Network Access Commercial |
$19.79
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.87
|
| Rate for Payer: The Alliance Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicaid |
$174.24
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
Chicken Pox Vaccine, SC 90716VFC
|
Facility
IP
|
$20.83
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
5100630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.04
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.16
|
| Rate for Payer: Health EOS Commercial |
$18.54
|
| Rate for Payer: HFN Commercial |
$19.16
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: NAPHCARE Commercial |
$12.50
|
| Rate for Payer: Preferred Network Access Commercial |
$19.16
|
| Rate for Payer: Quartz Beloit One Network |
$10.21
|
| Rate for Payer: Quartz Commercial |
$12.50
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
