|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
IP
|
$49,518.00
|
|
|
Service Code
|
MS-DRG 559
|
| Min. Negotiated Rate |
$17,812.15 |
| Max. Negotiated Rate |
$49,518.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,812.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,813.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,749.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,264.30
|
| Rate for Payer: Anthem Medicare Advantage |
$17,812.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,812.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,812.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,812.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,375.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,812.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,084.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,812.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,812.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,812.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,812.15
|
| Rate for Payer: NAPHCARE Commercial |
$26,718.22
|
| Rate for Payer: Quartz Medicare Advantage |
$17,812.15
|
| Rate for Payer: The Alliance Commercial |
$49,518.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,812.15
|
| Rate for Payer: United Healthcare PPO |
$28,092.44
|
| Rate for Payer: Wellcare Medicare |
$17,812.15
|
|
|
AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC
|
Facility
IP
|
$21,063.00
|
|
|
Service Code
|
MS-DRG 561
|
| Min. Negotiated Rate |
$7,576.54 |
| Max. Negotiated Rate |
$21,063.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,576.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,364.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,543.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,916.84
|
| Rate for Payer: Anthem Medicare Advantage |
$7,576.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,576.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,576.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,576.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,228.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,576.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,213.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,576.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,576.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,576.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,576.54
|
| Rate for Payer: NAPHCARE Commercial |
$11,364.81
|
| Rate for Payer: Quartz Medicare Advantage |
$7,576.54
|
| Rate for Payer: The Alliance Commercial |
$21,063.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,576.54
|
| Rate for Payer: United Healthcare PPO |
$11,844.22
|
| Rate for Payer: Wellcare Medicare |
$7,576.54
|
|
|
AFTERCARE WITH CC/MCC
|
Facility
IP
|
$28,842.00
|
|
|
Service Code
|
MS-DRG 949
|
| Min. Negotiated Rate |
$10,374.77 |
| Max. Negotiated Rate |
$28,842.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,374.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,819.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$10,374.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,374.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,374.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,374.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,638.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,374.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,203.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,374.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,374.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,374.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,374.77
|
| Rate for Payer: NAPHCARE Commercial |
$15,562.16
|
| Rate for Payer: Quartz Medicare Advantage |
$10,374.77
|
| Rate for Payer: The Alliance Commercial |
$28,842.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,374.77
|
| Rate for Payer: United Healthcare PPO |
$15,729.03
|
| Rate for Payer: Wellcare Medicare |
$10,374.77
|
|
|
AFTERCARE WITHOUT CC/MCC
|
Facility
IP
|
$17,298.00
|
|
|
Service Code
|
MS-DRG 950
|
| Min. Negotiated Rate |
$6,222.38 |
| Max. Negotiated Rate |
$17,298.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,222.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,217.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,131.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,625.14
|
| Rate for Payer: Anthem Medicare Advantage |
$6,222.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,222.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,222.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,222.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,684.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,222.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,249.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,222.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,222.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,222.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,222.38
|
| Rate for Payer: NAPHCARE Commercial |
$9,333.57
|
| Rate for Payer: Quartz Medicare Advantage |
$6,222.38
|
| Rate for Payer: The Alliance Commercial |
$17,298.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,222.38
|
| Rate for Payer: United Healthcare PPO |
$9,536.70
|
| Rate for Payer: Wellcare Medicare |
$6,222.38
|
|
|
AGNA 1
|
Facility
OP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
AGNA 1
|
Facility
IP
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
AGNA 1
|
Professional
|
$88.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942953
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$47.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$53.02
|
|
|
AICD GENERATOR PROCEDURES
|
Facility
IP
|
$120,792.00
|
|
|
Service Code
|
MS-DRG 245
|
| Min. Negotiated Rate |
$43,450.38 |
| Max. Negotiated Rate |
$120,792.00 |
| Rate for Payer: Aetna Managed Medicare |
$43,450.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95,039.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72,846.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69,209.34
|
| Rate for Payer: Anthem Medicare Advantage |
$43,450.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43,450.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43,450.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43,450.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76,828.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43,450.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88,362.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43,450.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43,450.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43,450.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43,450.38
|
| Rate for Payer: NAPHCARE Commercial |
$65,175.57
|
| Rate for Payer: Quartz Medicare Advantage |
$43,450.38
|
| Rate for Payer: The Alliance Commercial |
$120,792.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43,450.38
|
| Rate for Payer: United Healthcare PPO |
$68,791.18
|
| Rate for Payer: Wellcare Medicare |
$43,450.38
|
|
|
AICD LEAD PROCEDURES
|
Facility
IP
|
$94,278.00
|
|
|
Service Code
|
MS-DRG 265
|
| Min. Negotiated Rate |
$33,912.90 |
| Max. Negotiated Rate |
$94,278.00 |
| Rate for Payer: Aetna Managed Medicare |
$33,912.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74,059.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56,765.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53,931.34
|
| Rate for Payer: Anthem Medicare Advantage |
$33,912.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33,912.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33,912.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33,912.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59,868.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33,912.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68,914.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33,912.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33,912.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33,912.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33,912.90
|
| Rate for Payer: NAPHCARE Commercial |
$50,869.35
|
| Rate for Payer: Quartz Medicare Advantage |
$33,912.90
|
| Rate for Payer: The Alliance Commercial |
$94,278.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,912.90
|
| Rate for Payer: United Healthcare PPO |
$53,651.17
|
| Rate for Payer: Wellcare Medicare |
$33,912.90
|
|
|
AIRBORNE ISOLATION
|
Facility
IP
|
$670.00
|
|
| Hospital Charge Code |
3075872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$616.40 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.10
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$616.40
|
| Rate for Payer: Health EOS Commercial |
$596.30
|
| Rate for Payer: HFN Commercial |
$616.40
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: NAPHCARE Commercial |
$402.00
|
| Rate for Payer: Preferred Network Access Commercial |
$616.40
|
| Rate for Payer: Quartz Beloit One Network |
$328.30
|
| Rate for Payer: Quartz Commercial |
$402.00
|
| Rate for Payer: WEA Trust Commercial |
$368.50
|
| Rate for Payer: WPS Commercial |
$496.27
|
|
|
AIRBORNE ISOLATION
|
Facility
OP
|
$670.00
|
|
| Hospital Charge Code |
3075872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$2,680.00 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.20
|
| Rate for Payer: Aetna Managed Medicare |
$187.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$435.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$321.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.10
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$616.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$374.93
|
| Rate for Payer: Health EOS Commercial |
$596.30
|
| Rate for Payer: HFN Commercial |
$616.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$502.50
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: NAPHCARE Commercial |
$402.00
|
| Rate for Payer: Preferred Network Access Commercial |
$616.40
|
| Rate for Payer: Quartz Beloit One Network |
$328.30
|
| Rate for Payer: Quartz Commercial |
$435.50
|
| Rate for Payer: Quartz Medicare Advantage |
$402.00
|
| Rate for Payer: The Alliance Commercial |
$2,680.00
|
| Rate for Payer: WEA Trust Commercial |
$368.50
|
| Rate for Payer: WPS Commercial |
$496.27
|
|
|
Airborne - Isolation Required
|
Facility
IP
|
$670.00
|
|
| Hospital Charge Code |
3031397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$328.30 |
| Max. Negotiated Rate |
$616.40 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.10
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$616.40
|
| Rate for Payer: Health EOS Commercial |
$596.30
|
| Rate for Payer: HFN Commercial |
$616.40
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: NAPHCARE Commercial |
$402.00
|
| Rate for Payer: Preferred Network Access Commercial |
$616.40
|
| Rate for Payer: Quartz Beloit One Network |
$328.30
|
| Rate for Payer: Quartz Commercial |
$402.00
|
| Rate for Payer: WEA Trust Commercial |
$368.50
|
| Rate for Payer: WPS Commercial |
$496.27
|
|
|
Airborne - Isolation Required
|
Facility
OP
|
$670.00
|
|
| Hospital Charge Code |
3031397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$187.60 |
| Max. Negotiated Rate |
$2,680.00 |
| Rate for Payer: Aetna Commercial |
$603.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$576.20
|
| Rate for Payer: Aetna Managed Medicare |
$187.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$435.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$321.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$355.10
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$616.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$374.93
|
| Rate for Payer: Health EOS Commercial |
$596.30
|
| Rate for Payer: HFN Commercial |
$616.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$502.50
|
| Rate for Payer: Multiplan Commercial |
$536.00
|
| Rate for Payer: NAPHCARE Commercial |
$402.00
|
| Rate for Payer: Preferred Network Access Commercial |
$616.40
|
| Rate for Payer: Quartz Beloit One Network |
$328.30
|
| Rate for Payer: Quartz Commercial |
$435.50
|
| Rate for Payer: Quartz Medicare Advantage |
$402.00
|
| Rate for Payer: The Alliance Commercial |
$2,680.00
|
| Rate for Payer: WEA Trust Commercial |
$368.50
|
| Rate for Payer: WPS Commercial |
$496.27
|
|
|
Airway
|
Facility
OP
|
$2.00
|
|
| Hospital Charge Code |
3040317
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1.20
|
| Rate for Payer: The Alliance Commercial |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
Airway
|
Facility
IP
|
$2.00
|
|
| Hospital Charge Code |
3040317
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.98 |
| Max. Negotiated Rate |
$1.84 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.20
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
|
AIRWAY 100 MM STER DISP
|
Facility
IP
|
$26.00
|
|
| Hospital Charge Code |
2963593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
AIRWAY 100 MM STER DISP
|
Facility
OP
|
$26.00
|
|
| Hospital Charge Code |
2963593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.60
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
AIRWAY 60 MM STER DISP
|
Facility
IP
|
$25.00
|
|
| Hospital Charge Code |
2963591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
AIRWAY 60 MM STER DISP
|
Facility
OP
|
$25.00
|
|
| Hospital Charge Code |
2963591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.00 |
| Max. Negotiated Rate |
$100.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Managed Medicare |
$7.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$15.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
AIRWAY 70 MM STER DISP
|
Facility
OP
|
$26.00
|
|
| Hospital Charge Code |
2963592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.60
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
AIRWAY 70 MM STER DISP
|
Facility
IP
|
$26.00
|
|
| Hospital Charge Code |
2963592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
AIRWAY 80 MM STER DISP SZ 3
|
Facility
OP
|
$33.00
|
|
| Hospital Charge Code |
2965846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.38
|
| Rate for Payer: Aetna Managed Medicare |
$9.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.49
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$30.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.47
|
| Rate for Payer: Health EOS Commercial |
$29.37
|
| Rate for Payer: HFN Commercial |
$30.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.80
|
| Rate for Payer: Preferred Network Access Commercial |
$30.36
|
| Rate for Payer: Quartz Beloit One Network |
$16.17
|
| Rate for Payer: Quartz Commercial |
$21.45
|
| Rate for Payer: Quartz Medicare Advantage |
$19.80
|
| Rate for Payer: The Alliance Commercial |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$18.15
|
| Rate for Payer: WPS Commercial |
$24.44
|
|
|
AIRWAY 80 MM STER DISP SZ 3
|
Facility
IP
|
$33.00
|
|
| Hospital Charge Code |
2965846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.49
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$30.36
|
| Rate for Payer: Health EOS Commercial |
$29.37
|
| Rate for Payer: HFN Commercial |
$30.36
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.80
|
| Rate for Payer: Preferred Network Access Commercial |
$30.36
|
| Rate for Payer: Quartz Beloit One Network |
$16.17
|
| Rate for Payer: Quartz Commercial |
$19.80
|
| Rate for Payer: WEA Trust Commercial |
$18.15
|
| Rate for Payer: WPS Commercial |
$24.44
|
|
|
AIRWAY 90 MM STER DISP
|
Facility
IP
|
$26.00
|
|
| Hospital Charge Code |
2963594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
AIRWAY 90 MM STER DISP
|
Facility
OP
|
$26.00
|
|
| Hospital Charge Code |
2963594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.60
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
