|
CHEST DRAIN DUAL OASIS 3620-100
|
Facility
|
OP
|
$1,065.00
|
|
| Hospital Charge Code |
4020638
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.13 |
| Max. Negotiated Rate |
$1,018.99 |
| Rate for Payer: Aetna Commercial |
$996.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.54
|
| Rate for Payer: Aetna Managed Medicare |
$310.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$719.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$553.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$531.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.03
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$1,018.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$619.83
|
| Rate for Payer: Health EOS Commercial |
$985.76
|
| Rate for Payer: HFN Commercial |
$1,018.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$830.70
|
| Rate for Payer: Multiplan Commercial |
$886.08
|
| Rate for Payer: NAPHCARE Commercial |
$664.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.99
|
| Rate for Payer: Quartz Beloit One Network |
$542.72
|
| Rate for Payer: Quartz Commercial |
$719.94
|
| Rate for Payer: Quartz Medicare Advantage |
$664.56
|
| Rate for Payer: The Alliance Commercial |
$553.80
|
| Rate for Payer: WEA Trust Commercial |
$609.18
|
| Rate for Payer: WPS Commercial |
$820.37
|
|
|
CHEST DRAIN INFANT/PED OASIS 3612-100
|
Facility
|
IP
|
$868.00
|
|
| Hospital Charge Code |
5106780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$442.33 |
| Max. Negotiated Rate |
$830.50 |
| Rate for Payer: Aetna Commercial |
$812.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$776.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.44
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$830.50
|
| Rate for Payer: Health EOS Commercial |
$803.42
|
| Rate for Payer: HFN Commercial |
$830.50
|
| Rate for Payer: Multiplan Commercial |
$722.18
|
| Rate for Payer: Preferred Network Access Commercial |
$830.50
|
| Rate for Payer: Quartz Beloit One Network |
$442.33
|
| Rate for Payer: Quartz Commercial |
$541.63
|
| Rate for Payer: WEA Trust Commercial |
$496.50
|
| Rate for Payer: WPS Commercial |
$668.62
|
|
|
CHEST DRAIN INFANT/PED OASIS 3612-100
|
Facility
|
OP
|
$868.00
|
|
| Hospital Charge Code |
5106780
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$252.76 |
| Max. Negotiated Rate |
$830.50 |
| Rate for Payer: Aetna Commercial |
$812.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$776.34
|
| Rate for Payer: Aetna Managed Medicare |
$252.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$586.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$451.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$433.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.44
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$830.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$505.18
|
| Rate for Payer: Health EOS Commercial |
$803.42
|
| Rate for Payer: HFN Commercial |
$830.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$677.04
|
| Rate for Payer: Multiplan Commercial |
$722.18
|
| Rate for Payer: NAPHCARE Commercial |
$541.63
|
| Rate for Payer: Preferred Network Access Commercial |
$830.50
|
| Rate for Payer: Quartz Beloit One Network |
$442.33
|
| Rate for Payer: Quartz Commercial |
$586.77
|
| Rate for Payer: Quartz Medicare Advantage |
$541.63
|
| Rate for Payer: The Alliance Commercial |
$451.36
|
| Rate for Payer: WEA Trust Commercial |
$496.50
|
| Rate for Payer: WPS Commercial |
$668.62
|
|
|
CHEST DRAIN SINGLE AQUASEAL 2002-000
|
Facility
|
IP
|
$659.00
|
|
| Hospital Charge Code |
2965812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.83 |
| Max. Negotiated Rate |
$630.53 |
| Rate for Payer: Aetna Commercial |
$616.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$589.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$363.24
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$630.53
|
| Rate for Payer: Health EOS Commercial |
$609.97
|
| Rate for Payer: HFN Commercial |
$630.53
|
| Rate for Payer: Multiplan Commercial |
$548.29
|
| Rate for Payer: Preferred Network Access Commercial |
$630.53
|
| Rate for Payer: Quartz Beloit One Network |
$335.83
|
| Rate for Payer: Quartz Commercial |
$411.22
|
| Rate for Payer: WEA Trust Commercial |
$376.95
|
| Rate for Payer: WPS Commercial |
$507.63
|
|
|
CHEST DRAIN SINGLE AQUASEAL 2002-000
|
Facility
|
OP
|
$659.00
|
|
| Hospital Charge Code |
2965812
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.90 |
| Max. Negotiated Rate |
$630.53 |
| Rate for Payer: Aetna Commercial |
$616.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$589.41
|
| Rate for Payer: Aetna Managed Medicare |
$191.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$445.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$342.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$328.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$363.24
|
| Rate for Payer: Cash Price |
$197.70
|
| Rate for Payer: Cigna Commercial |
$630.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$383.54
|
| Rate for Payer: Health EOS Commercial |
$609.97
|
| Rate for Payer: HFN Commercial |
$630.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$514.02
|
| Rate for Payer: Multiplan Commercial |
$548.29
|
| Rate for Payer: NAPHCARE Commercial |
$411.22
|
| Rate for Payer: Preferred Network Access Commercial |
$630.53
|
| Rate for Payer: Quartz Beloit One Network |
$335.83
|
| Rate for Payer: Quartz Commercial |
$445.48
|
| Rate for Payer: Quartz Medicare Advantage |
$411.22
|
| Rate for Payer: The Alliance Commercial |
$342.68
|
| Rate for Payer: WEA Trust Commercial |
$376.95
|
| Rate for Payer: WPS Commercial |
$507.63
|
|
|
CHEST PAIN
|
Facility
|
OP
|
$119.24
|
|
|
Service Code
|
EAPG 00604
|
| Min. Negotiated Rate |
$114.65 |
| Max. Negotiated Rate |
$119.24 |
| Rate for Payer: Anthem Medicaid |
$114.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$114.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.65
|
| Rate for Payer: Dean Health Medicaid |
$114.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$114.65
|
| Rate for Payer: Managed Health Services Medicaid |
$119.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$114.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$114.65
|
| Rate for Payer: United Healthcare Medicaid |
$114.65
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$5,874.77
|
|
|
Service Code
|
APR-DRG 2032
|
| Min. Negotiated Rate |
$5,218.34 |
| Max. Negotiated Rate |
$5,874.77 |
| Rate for Payer: Anthem Medicaid |
$5,625.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,625.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,625.41
|
| Rate for Payer: Dean Health Medicaid |
$5,625.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,218.34
|
| Rate for Payer: Managed Health Services Medicaid |
$5,874.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,625.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,625.41
|
| Rate for Payer: United Healthcare Medicaid |
$5,625.41
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$7,277.70
|
|
|
Service Code
|
APR-DRG 2033
|
| Min. Negotiated Rate |
$6,464.50 |
| Max. Negotiated Rate |
$7,277.70 |
| Rate for Payer: Anthem Medicaid |
$6,968.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,968.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,968.80
|
| Rate for Payer: Dean Health Medicaid |
$6,968.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,464.50
|
| Rate for Payer: Managed Health Services Medicaid |
$7,277.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,968.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,968.80
|
| Rate for Payer: United Healthcare Medicaid |
$6,968.80
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$11,661.85
|
|
|
Service Code
|
APR-DRG 2034
|
| Min. Negotiated Rate |
$10,358.78 |
| Max. Negotiated Rate |
$11,661.85 |
| Rate for Payer: Anthem Medicaid |
$11,166.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,166.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,166.87
|
| Rate for Payer: Dean Health Medicaid |
$11,166.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,358.78
|
| Rate for Payer: Managed Health Services Medicaid |
$11,661.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,166.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,166.87
|
| Rate for Payer: United Healthcare Medicaid |
$11,166.87
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$20,340.32
|
|
|
Service Code
|
MSDRG 313
|
| Min. Negotiated Rate |
$6,020.68 |
| Max. Negotiated Rate |
$20,340.32 |
| Rate for Payer: Aetna Managed Medicare |
$6,020.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,709.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,041.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,440.17
|
| Rate for Payer: Anthem Medicare Advantage |
$6,020.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,020.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,020.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,020.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,699.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,020.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,674.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,020.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,020.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,020.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,020.68
|
| Rate for Payer: NAPHCARE Commercial |
$9,031.03
|
| Rate for Payer: Quartz Medicare Advantage |
$6,020.68
|
| Rate for Payer: The Alliance Commercial |
$20,340.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,020.68
|
| Rate for Payer: United Healthcare PPO |
$11,424.37
|
| Rate for Payer: Wellcare Medicare |
$6,020.68
|
|
|
CHEST PAIN
|
Facility
|
IP
|
$5,260.99
|
|
|
Service Code
|
APR-DRG 2031
|
| Min. Negotiated Rate |
$4,673.14 |
| Max. Negotiated Rate |
$5,260.99 |
| Rate for Payer: Anthem Medicaid |
$5,037.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,037.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,037.68
|
| Rate for Payer: Dean Health Medicaid |
$5,037.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,673.14
|
| Rate for Payer: Managed Health Services Medicaid |
$5,260.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,037.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,037.68
|
| Rate for Payer: United Healthcare Medicaid |
$5,037.68
|
|
|
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 |
$41.93 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$41.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.81
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.32
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$89.86
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: Quartz Medicare Advantage |
$89.86
|
| Rate for Payer: The Alliance Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
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 |
$73.38 |
| Max. Negotiated Rate |
$137.78 |
| Rate for Payer: Aetna Commercial |
$134.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.37
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$137.78
|
| Rate for Payer: Health EOS Commercial |
$133.29
|
| Rate for Payer: HFN Commercial |
$137.78
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: Preferred Network Access Commercial |
$137.78
|
| Rate for Payer: Quartz Beloit One Network |
$73.38
|
| Rate for Payer: Quartz Commercial |
$89.86
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$110.92
|
|
|
CHEST TUBE 28 FR STRAIGHT 8028
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
3953354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
CHEST TUBE 28 FR STRAIGHT 8028
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
3953354
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$30.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.68
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$66.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$66.14
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
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 |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
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 |
$43.68 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
CHEST TUBE 36FR RIGHT ANGLE 8136
|
Facility
|
OP
|
$367.00
|
|
| Hospital Charge Code |
2965813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$106.87 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$106.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$190.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.59
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.26
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$229.01
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$248.09
|
| Rate for Payer: Quartz Medicare Advantage |
$229.01
|
| Rate for Payer: The Alliance Commercial |
$190.84
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
CHEST TUBE 36FR RIGHT ANGLE 8136
|
Facility
|
IP
|
$367.00
|
|
| Hospital Charge Code |
2965813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$229.01
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
CHEST TUBE INSERTION KIT 17100
|
Facility
|
IP
|
$1,062.00
|
|
| Hospital Charge Code |
3331521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$541.20 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$662.69
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
CHEST TUBE INSERTION KIT 17100
|
Facility
|
OP
|
$1,062.00
|
|
| Hospital Charge Code |
3331521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$309.25 |
| Max. Negotiated Rate |
$1,016.12 |
| Rate for Payer: Aetna Commercial |
$994.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$949.85
|
| Rate for Payer: Aetna Managed Medicare |
$309.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$717.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$552.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$530.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$585.37
|
| Rate for Payer: Cash Price |
$318.60
|
| Rate for Payer: Cigna Commercial |
$1,016.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.08
|
| Rate for Payer: Health EOS Commercial |
$982.99
|
| Rate for Payer: HFN Commercial |
$1,016.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$828.36
|
| Rate for Payer: Multiplan Commercial |
$883.58
|
| Rate for Payer: NAPHCARE Commercial |
$662.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,016.12
|
| Rate for Payer: Quartz Beloit One Network |
$541.20
|
| Rate for Payer: Quartz Commercial |
$717.91
|
| Rate for Payer: Quartz Medicare Advantage |
$662.69
|
| Rate for Payer: The Alliance Commercial |
$552.24
|
| Rate for Payer: WEA Trust Commercial |
$607.46
|
| Rate for Payer: WPS Commercial |
$818.06
|
|
|
CHEST TUBE INSERTION KIT MNS2250
|
Facility
|
IP
|
$1,385.00
|
|
| Hospital Charge Code |
5591232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$705.80 |
| Max. Negotiated Rate |
$1,325.17 |
| Rate for Payer: Aetna Commercial |
$1,296.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,238.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.41
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,325.17
|
| Rate for Payer: Health EOS Commercial |
$1,281.96
|
| Rate for Payer: HFN Commercial |
$1,325.17
|
| Rate for Payer: Multiplan Commercial |
$1,152.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,325.17
|
| Rate for Payer: Quartz Beloit One Network |
$705.80
|
| Rate for Payer: Quartz Commercial |
$864.24
|
| Rate for Payer: WEA Trust Commercial |
$792.22
|
| Rate for Payer: WPS Commercial |
$1,066.87
|
|
|
CHEST TUBE INSERTION KIT MNS2250
|
Facility
|
OP
|
$1,385.00
|
|
| Hospital Charge Code |
5591232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$403.31 |
| Max. Negotiated Rate |
$1,325.17 |
| Rate for Payer: Aetna Commercial |
$1,296.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,238.74
|
| Rate for Payer: Aetna Managed Medicare |
$403.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$936.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$720.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$691.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$763.41
|
| Rate for Payer: Cash Price |
$415.50
|
| Rate for Payer: Cigna Commercial |
$1,325.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$806.07
|
| Rate for Payer: Health EOS Commercial |
$1,281.96
|
| Rate for Payer: HFN Commercial |
$1,325.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,080.30
|
| Rate for Payer: Multiplan Commercial |
$1,152.32
|
| Rate for Payer: NAPHCARE Commercial |
$864.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,325.17
|
| Rate for Payer: Quartz Beloit One Network |
$705.80
|
| Rate for Payer: Quartz Commercial |
$936.26
|
| Rate for Payer: Quartz Medicare Advantage |
$864.24
|
| Rate for Payer: The Alliance Commercial |
$720.20
|
| Rate for Payer: WEA Trust Commercial |
$792.22
|
| Rate for Payer: WPS Commercial |
$1,066.87
|
|
|
CHEST TUBE PLACEMENT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959926
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CHEST TUBE PLACEMENT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959926
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
