|
CONE STOMA W/ CONNECTOR 7723
|
Facility
|
IP
|
$125.00
|
|
| Hospital Charge Code |
2964029
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
CONE STOMA W/ CONNECTOR 7723
|
Facility
|
OP
|
$125.00
|
|
| Hospital Charge Code |
2964029
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$36.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$78.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$78.00
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
CONIZATION OF CERVIX 57520
|
Professional
|
Both
|
$1,731.00
|
|
|
Service Code
|
CPT 57520
|
| Hospital Charge Code |
3015091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$260.56 |
| Max. Negotiated Rate |
$1,710.23 |
| Rate for Payer: Aetna Commercial |
$1,710.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,548.21
|
| Rate for Payer: Aetna Managed Medicare |
$260.56
|
| Rate for Payer: Anthem Medicare Advantage |
$260.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$260.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$260.56
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cash Price |
$519.30
|
| Rate for Payer: Cigna Commercial |
$1,710.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.56
|
| Rate for Payer: Health EOS Commercial |
$1,638.22
|
| Rate for Payer: HFN Commercial |
$1,710.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,018.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,018.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$260.56
|
| Rate for Payer: Multiplan Commercial |
$1,440.19
|
| Rate for Payer: NAPHCARE Commercial |
$390.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,710.23
|
| Rate for Payer: Quartz Beloit One Network |
$792.11
|
| Rate for Payer: Quartz Commercial |
$1,026.14
|
| Rate for Payer: Quartz Medicare Advantage |
$260.56
|
| Rate for Payer: The Alliance Commercial |
$1,107.39
|
| Rate for Payer: United Healthcare Medicaid |
$282.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.56
|
| Rate for Payer: WEA Trust Commercial |
$990.13
|
| Rate for Payer: WPS Commercial |
$1,172.53
|
|
|
Conization of Cervix 5752022
|
Professional
|
Both
|
$2,076.00
|
|
|
Service Code
|
CPT 57520 22
|
| Hospital Charge Code |
5296606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$282.10 |
| Max. Negotiated Rate |
$2,051.09 |
| Rate for Payer: Aetna Commercial |
$2,051.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,856.77
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cash Price |
$622.80
|
| Rate for Payer: Cigna Commercial |
$2,051.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,295.42
|
| Rate for Payer: Health EOS Commercial |
$1,964.73
|
| Rate for Payer: HFN Commercial |
$2,051.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,018.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,018.94
|
| Rate for Payer: Multiplan Commercial |
$1,727.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,051.09
|
| Rate for Payer: Quartz Beloit One Network |
$949.98
|
| Rate for Payer: Quartz Commercial |
$1,230.65
|
| Rate for Payer: The Alliance Commercial |
$1,079.52
|
| Rate for Payer: United Healthcare Medicaid |
$282.10
|
| Rate for Payer: WEA Trust Commercial |
$1,187.47
|
| Rate for Payer: WPS Commercial |
$1,599.14
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 57520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 57522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
Conjugated Estrogen Vaginal Cream [Med]
|
Facility
|
OP
|
$955.00
|
|
| Hospital Charge Code |
2974974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$278.10 |
| Max. Negotiated Rate |
$913.74 |
| Rate for Payer: Aetna Commercial |
$893.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$854.15
|
| Rate for Payer: Aetna Managed Medicare |
$278.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$645.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$496.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$476.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$526.40
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$913.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$555.81
|
| Rate for Payer: Health EOS Commercial |
$883.95
|
| Rate for Payer: HFN Commercial |
$913.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$744.90
|
| Rate for Payer: Multiplan Commercial |
$794.56
|
| Rate for Payer: NAPHCARE Commercial |
$595.92
|
| Rate for Payer: Preferred Network Access Commercial |
$913.74
|
| Rate for Payer: Quartz Beloit One Network |
$486.67
|
| Rate for Payer: Quartz Commercial |
$645.58
|
| Rate for Payer: Quartz Medicare Advantage |
$595.92
|
| Rate for Payer: The Alliance Commercial |
$496.60
|
| Rate for Payer: WEA Trust Commercial |
$546.26
|
| Rate for Payer: WPS Commercial |
$735.64
|
|
|
Conjugated Estrogen Vaginal Cream [Med]
|
Facility
|
IP
|
$955.00
|
|
| Hospital Charge Code |
2974974
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$486.67 |
| Max. Negotiated Rate |
$913.74 |
| Rate for Payer: Aetna Commercial |
$893.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$854.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$526.40
|
| Rate for Payer: Cash Price |
$286.50
|
| Rate for Payer: Cigna Commercial |
$913.74
|
| Rate for Payer: Health EOS Commercial |
$883.95
|
| Rate for Payer: HFN Commercial |
$913.74
|
| Rate for Payer: Multiplan Commercial |
$794.56
|
| Rate for Payer: Preferred Network Access Commercial |
$913.74
|
| Rate for Payer: Quartz Beloit One Network |
$486.67
|
| Rate for Payer: Quartz Commercial |
$595.92
|
| Rate for Payer: WEA Trust Commercial |
$546.26
|
| Rate for Payer: WPS Commercial |
$735.64
|
|
|
CONJUNCTIVITIS
|
Facility
|
OP
|
$82.55
|
|
|
Service Code
|
EAPG 00555
|
| Min. Negotiated Rate |
$79.37 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Anthem Medicaid |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$79.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.37
|
| Rate for Payer: Dean Health Medicaid |
$79.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$79.37
|
| Rate for Payer: Managed Health Services Medicaid |
$82.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$79.37
|
| Rate for Payer: United Healthcare Medicaid |
$79.37
|
|
|
CONNECTING NUT LONG M8 X 15MM HOFFMANN LIMB 4933-1-011
|
Facility
|
IP
|
$424.00
|
|
| Hospital Charge Code |
6181533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$216.07 |
| Max. Negotiated Rate |
$405.68 |
| Rate for Payer: Aetna Commercial |
$396.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$379.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.71
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$405.68
|
| Rate for Payer: Health EOS Commercial |
$392.45
|
| Rate for Payer: HFN Commercial |
$405.68
|
| Rate for Payer: Multiplan Commercial |
$352.77
|
| Rate for Payer: Preferred Network Access Commercial |
$405.68
|
| Rate for Payer: Quartz Beloit One Network |
$216.07
|
| Rate for Payer: Quartz Commercial |
$264.58
|
| Rate for Payer: WEA Trust Commercial |
$242.53
|
| Rate for Payer: WPS Commercial |
$326.61
|
|
|
CONNECTING NUT LONG M8 X 15MM HOFFMANN LIMB 4933-1-011
|
Facility
|
OP
|
$424.00
|
|
| Hospital Charge Code |
6181533
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$123.47 |
| Max. Negotiated Rate |
$405.68 |
| Rate for Payer: Aetna Commercial |
$396.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$379.23
|
| Rate for Payer: Aetna Managed Medicare |
$123.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$286.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$220.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.71
|
| Rate for Payer: Cash Price |
$127.20
|
| Rate for Payer: Cigna Commercial |
$405.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.77
|
| Rate for Payer: Health EOS Commercial |
$392.45
|
| Rate for Payer: HFN Commercial |
$405.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$330.72
|
| Rate for Payer: Multiplan Commercial |
$352.77
|
| Rate for Payer: NAPHCARE Commercial |
$264.58
|
| Rate for Payer: Preferred Network Access Commercial |
$405.68
|
| Rate for Payer: Quartz Beloit One Network |
$216.07
|
| Rate for Payer: Quartz Commercial |
$286.62
|
| Rate for Payer: Quartz Medicare Advantage |
$264.58
|
| Rate for Payer: The Alliance Commercial |
$220.48
|
| Rate for Payer: WEA Trust Commercial |
$242.53
|
| Rate for Payer: WPS Commercial |
$326.61
|
|
|
CONNECTING NUT SHORT M8 X 6MM HOFFMANN LIMB 4933-1-010
|
Facility
|
IP
|
$368.00
|
|
| Hospital Charge Code |
5599713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
CONNECTING NUT SHORT M8 X 6MM HOFFMANN LIMB 4933-1-010
|
Facility
|
OP
|
$368.00
|
|
| Hospital Charge Code |
5599713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$107.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$229.63
|
| Rate for Payer: The Alliance Commercial |
$191.36
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
CONNECTING TUBE 30CM FOR 3FR - 6FR CATHETERS M0067401000
|
Facility
|
OP
|
$290.00
|
|
| Hospital Charge Code |
5349546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
CONNECTING TUBE 30CM FOR 3FR - 6FR CATHETERS M0067401000
|
Facility
|
IP
|
$290.00
|
|
| Hospital Charge Code |
5349546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
CONNECTIVE TISSUE DIAGNOSES
|
Facility
|
OP
|
$90.41
|
|
|
Service Code
|
EAPG 00655
|
| Min. Negotiated Rate |
$86.93 |
| Max. Negotiated Rate |
$90.41 |
| Rate for Payer: Anthem Medicaid |
$86.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$86.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.93
|
| Rate for Payer: Dean Health Medicaid |
$86.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$86.93
|
| Rate for Payer: Managed Health Services Medicaid |
$90.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.93
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$86.93
|
| Rate for Payer: United Healthcare Medicaid |
$86.93
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$9,732.82
|
|
|
Service Code
|
APR-DRG 3462
|
| Min. Negotiated Rate |
$8,645.30 |
| Max. Negotiated Rate |
$9,732.82 |
| Rate for Payer: Anthem Medicaid |
$9,319.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,319.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,319.72
|
| Rate for Payer: Dean Health Medicaid |
$9,319.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,645.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9,732.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,319.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,319.72
|
| Rate for Payer: United Healthcare Medicaid |
$9,319.72
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$26,655.66
|
|
|
Service Code
|
APR-DRG 3464
|
| Min. Negotiated Rate |
$23,677.22 |
| Max. Negotiated Rate |
$26,655.66 |
| Rate for Payer: Anthem Medicaid |
$25,524.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$25,524.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25,524.27
|
| Rate for Payer: Dean Health Medicaid |
$25,524.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23,677.22
|
| Rate for Payer: Managed Health Services Medicaid |
$26,655.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,524.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$25,524.27
|
| Rate for Payer: United Healthcare Medicaid |
$25,524.27
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$14,555.39
|
|
|
Service Code
|
APR-DRG 3463
|
| Min. Negotiated Rate |
$12,929.01 |
| Max. Negotiated Rate |
$14,555.39 |
| Rate for Payer: Anthem Medicaid |
$13,937.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,937.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,937.59
|
| Rate for Payer: Dean Health Medicaid |
$13,937.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,929.01
|
| Rate for Payer: Managed Health Services Medicaid |
$14,555.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,937.59
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,937.59
|
| Rate for Payer: United Healthcare Medicaid |
$13,937.59
|
|
|
CONNECTIVE TISSUE DISORDERS
|
Facility
|
IP
|
$6,926.96
|
|
|
Service Code
|
APR-DRG 3461
|
| Min. Negotiated Rate |
$6,152.96 |
| Max. Negotiated Rate |
$6,926.96 |
| Rate for Payer: Anthem Medicaid |
$6,632.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,632.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,632.95
|
| Rate for Payer: Dean Health Medicaid |
$6,632.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,152.96
|
| Rate for Payer: Managed Health Services Medicaid |
$6,926.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,632.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,632.95
|
| Rate for Payer: United Healthcare Medicaid |
$6,632.95
|
|
|
CONNECTIVE TISSUE DISORDERS WITH CC
|
Facility
|
IP
|
$33,493.20
|
|
|
Service Code
|
MSDRG 546
|
| Min. Negotiated Rate |
$9,339.74 |
| Max. Negotiated Rate |
$33,493.20 |
| Rate for Payer: Aetna Managed Medicare |
$9,339.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,166.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,289.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,326.51
|
| Rate for Payer: Anthem Medicare Advantage |
$9,339.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,339.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,339.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,339.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,344.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,339.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,321.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,339.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,339.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,339.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,339.74
|
| Rate for Payer: NAPHCARE Commercial |
$14,009.61
|
| Rate for Payer: Quartz Medicare Advantage |
$9,339.74
|
| Rate for Payer: The Alliance Commercial |
$33,493.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,339.74
|
| Rate for Payer: United Healthcare PPO |
$18,934.83
|
| Rate for Payer: Wellcare Medicare |
$9,339.74
|
|
|
CONNECTIVE TISSUE DISORDERS WITH MCC
|
Facility
|
IP
|
$69,269.20
|
|
|
Service Code
|
MSDRG 545
|
| Min. Negotiated Rate |
$19,512.12 |
| Max. Negotiated Rate |
$69,269.20 |
| Rate for Payer: Aetna Managed Medicare |
$19,512.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54,148.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41,504.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39,432.03
|
| Rate for Payer: Anthem Medicare Advantage |
$19,512.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,512.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,512.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,512.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,773.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,512.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,562.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,512.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,512.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,512.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,512.12
|
| Rate for Payer: NAPHCARE Commercial |
$29,268.17
|
| Rate for Payer: Quartz Medicare Advantage |
$19,512.12
|
| Rate for Payer: The Alliance Commercial |
$69,269.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,512.12
|
| Rate for Payer: United Healthcare PPO |
$39,363.24
|
| Rate for Payer: Wellcare Medicare |
$19,512.12
|
|
|
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$23,097.36
|
|
|
Service Code
|
MSDRG 547
|
| Min. Negotiated Rate |
$6,910.56 |
| Max. Negotiated Rate |
$23,097.36 |
| Rate for Payer: Aetna Managed Medicare |
$6,910.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,245.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,984.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,286.48
|
| Rate for Payer: Anthem Medicare Advantage |
$6,910.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,910.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,910.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,910.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,749.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,910.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,495.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,910.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,910.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,910.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,910.56
|
| Rate for Payer: NAPHCARE Commercial |
$10,365.84
|
| Rate for Payer: Quartz Medicare Advantage |
$6,910.56
|
| Rate for Payer: The Alliance Commercial |
$23,097.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,910.56
|
| Rate for Payer: United Healthcare PPO |
$12,842.16
|
| Rate for Payer: Wellcare Medicare |
$6,910.56
|
|
|
CONNECTOR 1/2x1/2 C140S
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
2965779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
CONNECTOR 1/2x1/2 C140S
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
2965779
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$54.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.08
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$116.06
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$116.06
|
| Rate for Payer: The Alliance Commercial |
$96.72
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
