|
AICD LEAD PROCEDURES
|
Facility
|
IP
|
$98,049.12
|
|
|
Service Code
|
MSDRG 265
|
| Min. Negotiated Rate |
$28,215.67 |
| Max. Negotiated Rate |
$98,049.12 |
| Rate for Payer: Aetna Managed Medicare |
$28,215.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78,946.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60,511.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57,490.01
|
| Rate for Payer: Anthem Medicare Advantage |
$28,215.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,215.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,215.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,215.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63,819.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,215.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71,671.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,215.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,215.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,215.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,215.67
|
| Rate for Payer: NAPHCARE Commercial |
$42,323.50
|
| Rate for Payer: Quartz Medicare Advantage |
$28,215.67
|
| Rate for Payer: The Alliance Commercial |
$98,049.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,215.67
|
| Rate for Payer: United Healthcare PPO |
$55,797.22
|
| Rate for Payer: Wellcare Medicare |
$28,215.67
|
|
|
AIDS
|
Facility
|
OP
|
$119.24
|
|
|
Service Code
|
EAPG 00881
|
| 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
|
|
|
AIRBORNE ISOLATION
|
Facility
|
OP
|
$670.00
|
|
| Hospital Charge Code |
3075872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$195.10 |
| Max. Negotiated Rate |
$641.06 |
| Rate for Payer: Aetna Commercial |
$627.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.25
|
| Rate for Payer: Aetna Managed Medicare |
$195.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$452.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.30
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$641.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.94
|
| Rate for Payer: Health EOS Commercial |
$620.15
|
| Rate for Payer: HFN Commercial |
$641.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$522.60
|
| Rate for Payer: Multiplan Commercial |
$557.44
|
| Rate for Payer: NAPHCARE Commercial |
$418.08
|
| Rate for Payer: Preferred Network Access Commercial |
$641.06
|
| Rate for Payer: Quartz Beloit One Network |
$341.43
|
| Rate for Payer: Quartz Commercial |
$452.92
|
| Rate for Payer: Quartz Medicare Advantage |
$418.08
|
| Rate for Payer: The Alliance Commercial |
$348.40
|
| Rate for Payer: WEA Trust Commercial |
$383.24
|
| Rate for Payer: WPS Commercial |
$516.10
|
|
|
AIRBORNE ISOLATION
|
Facility
|
IP
|
$670.00
|
|
| Hospital Charge Code |
3075872
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$341.43 |
| Max. Negotiated Rate |
$641.06 |
| Rate for Payer: Aetna Commercial |
$627.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.30
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$641.06
|
| Rate for Payer: Health EOS Commercial |
$620.15
|
| Rate for Payer: HFN Commercial |
$641.06
|
| Rate for Payer: Multiplan Commercial |
$557.44
|
| Rate for Payer: Preferred Network Access Commercial |
$641.06
|
| Rate for Payer: Quartz Beloit One Network |
$341.43
|
| Rate for Payer: Quartz Commercial |
$418.08
|
| Rate for Payer: WEA Trust Commercial |
$383.24
|
| Rate for Payer: WPS Commercial |
$516.10
|
|
|
Airborne - Isolation Required
|
Facility
|
IP
|
$670.00
|
|
| Hospital Charge Code |
3031397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$341.43 |
| Max. Negotiated Rate |
$641.06 |
| Rate for Payer: Aetna Commercial |
$627.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.30
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$641.06
|
| Rate for Payer: Health EOS Commercial |
$620.15
|
| Rate for Payer: HFN Commercial |
$641.06
|
| Rate for Payer: Multiplan Commercial |
$557.44
|
| Rate for Payer: Preferred Network Access Commercial |
$641.06
|
| Rate for Payer: Quartz Beloit One Network |
$341.43
|
| Rate for Payer: Quartz Commercial |
$418.08
|
| Rate for Payer: WEA Trust Commercial |
$383.24
|
| Rate for Payer: WPS Commercial |
$516.10
|
|
|
Airborne - Isolation Required
|
Facility
|
OP
|
$670.00
|
|
| Hospital Charge Code |
3031397
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$195.10 |
| Max. Negotiated Rate |
$641.06 |
| Rate for Payer: Aetna Commercial |
$627.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$599.25
|
| Rate for Payer: Aetna Managed Medicare |
$195.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$452.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$348.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$334.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$369.30
|
| Rate for Payer: Cash Price |
$201.00
|
| Rate for Payer: Cigna Commercial |
$641.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.94
|
| Rate for Payer: Health EOS Commercial |
$620.15
|
| Rate for Payer: HFN Commercial |
$641.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$522.60
|
| Rate for Payer: Multiplan Commercial |
$557.44
|
| Rate for Payer: NAPHCARE Commercial |
$418.08
|
| Rate for Payer: Preferred Network Access Commercial |
$641.06
|
| Rate for Payer: Quartz Beloit One Network |
$341.43
|
| Rate for Payer: Quartz Commercial |
$452.92
|
| Rate for Payer: Quartz Medicare Advantage |
$418.08
|
| Rate for Payer: The Alliance Commercial |
$348.40
|
| Rate for Payer: WEA Trust Commercial |
$383.24
|
| Rate for Payer: WPS Commercial |
$516.10
|
|
|
Airway
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
3040317
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Airway
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
3040317
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.58 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.16
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.56
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$1.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.25
|
| Rate for Payer: The Alliance Commercial |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
AIRWAY 100 MM STER DISP
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
2963593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
AIRWAY 100 MM STER DISP
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
2963593
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
AIRWAY 60 MM STER DISP
|
Facility
|
IP
|
$25.00
|
|
| Hospital Charge Code |
2963591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| 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: 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 60 MM STER DISP
|
Facility
|
OP
|
$25.00
|
|
| Hospital Charge Code |
2963591
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.28 |
| Max. Negotiated Rate |
$23.92 |
| 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 |
$7.50
|
| 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 |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
AIRWAY 70 MM STER DISP
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
2963592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
AIRWAY 70 MM STER DISP
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
2963592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
AIRWAY 80 MM STER DISP SZ 3
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
2965846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.21
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.74
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: NAPHCARE Commercial |
$20.59
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$22.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.59
|
| Rate for Payer: The Alliance Commercial |
$17.16
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
AIRWAY 80 MM STER DISP SZ 3
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
2965846
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$20.59
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
AIRWAY 90 MM STER DISP
|
Facility
|
IP
|
$26.00
|
|
| Hospital Charge Code |
2963594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
AIRWAY 90 MM STER DISP
|
Facility
|
OP
|
$26.00
|
|
| Hospital Charge Code |
2963594
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.57 |
| Max. Negotiated Rate |
$24.88 |
| Rate for Payer: Aetna Commercial |
$24.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.25
|
| Rate for Payer: Aetna Managed Medicare |
$7.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.33
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$24.07
|
| Rate for Payer: HFN Commercial |
$24.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.28
|
| Rate for Payer: Multiplan Commercial |
$21.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.22
|
| Rate for Payer: Preferred Network Access Commercial |
$24.88
|
| Rate for Payer: Quartz Beloit One Network |
$13.25
|
| Rate for Payer: Quartz Commercial |
$17.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.22
|
| Rate for Payer: The Alliance Commercial |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$14.87
|
| Rate for Payer: WPS Commercial |
$20.03
|
|
|
Airway - BCE
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
3101734
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.61
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.32
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$27.46
|
| Rate for Payer: The Alliance Commercial |
$22.88
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
Airway - BCE
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
3101734
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
AIRWAY IGEL SIZE 3 8203000
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
5496860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
AIRWAY IGEL SIZE 3 8203000
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
5496860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
AIRWAY IGEL SIZE 4 8204000
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
5496861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
AIRWAY IGEL SIZE 4 8204000
|
Facility
|
IP
|
$514.00
|
|
| Hospital Charge Code |
5496861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
AIRWAY IGEL SIZE 5 8205000
|
Facility
|
OP
|
$514.00
|
|
| Hospital Charge Code |
5496862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
