|
KIDNEY AND URINARY TRACT PROCEDURES FOR MALIGNANCY
|
Facility
|
IP
|
$14,643.08
|
|
|
Service Code
|
APR-DRG 4422
|
| Min. Negotiated Rate |
$13,006.90 |
| Max. Negotiated Rate |
$14,643.08 |
| Rate for Payer: Anthem Medicaid |
$14,021.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,021.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,021.55
|
| Rate for Payer: Dean Health Medicaid |
$14,021.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,006.90
|
| Rate for Payer: Managed Health Services Medicaid |
$14,643.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,021.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,021.55
|
| Rate for Payer: United Healthcare Medicaid |
$14,021.55
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
|
IP
|
$19,377.97
|
|
|
Service Code
|
APR-DRG 4433
|
| Min. Negotiated Rate |
$17,212.72 |
| Max. Negotiated Rate |
$19,377.97 |
| Rate for Payer: Anthem Medicaid |
$18,555.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,555.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,555.47
|
| Rate for Payer: Dean Health Medicaid |
$18,555.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,212.72
|
| Rate for Payer: Managed Health Services Medicaid |
$19,377.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,555.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,555.47
|
| Rate for Payer: United Healthcare Medicaid |
$18,555.47
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
|
IP
|
$14,204.66
|
|
|
Service Code
|
APR-DRG 4432
|
| Min. Negotiated Rate |
$12,617.47 |
| Max. Negotiated Rate |
$14,204.66 |
| Rate for Payer: Anthem Medicaid |
$13,601.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,601.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,601.75
|
| Rate for Payer: Dean Health Medicaid |
$13,601.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,617.47
|
| Rate for Payer: Managed Health Services Medicaid |
$14,204.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,601.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,601.75
|
| Rate for Payer: United Healthcare Medicaid |
$13,601.75
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
|
IP
|
$11,837.22
|
|
|
Service Code
|
APR-DRG 4431
|
| Min. Negotiated Rate |
$10,514.56 |
| Max. Negotiated Rate |
$11,837.22 |
| Rate for Payer: Anthem Medicaid |
$11,334.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,334.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,334.79
|
| Rate for Payer: Dean Health Medicaid |
$11,334.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,514.56
|
| Rate for Payer: Managed Health Services Medicaid |
$11,837.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,334.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,334.79
|
| Rate for Payer: United Healthcare Medicaid |
$11,334.79
|
|
|
KIDNEY AND URINARY TRACT PROCEDURES FOR NON-MALIGNANCY
|
Facility
|
IP
|
$31,916.65
|
|
|
Service Code
|
APR-DRG 4434
|
| Min. Negotiated Rate |
$28,350.36 |
| Max. Negotiated Rate |
$31,916.65 |
| Rate for Payer: Anthem Medicaid |
$30,561.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$30,561.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30,561.95
|
| Rate for Payer: Dean Health Medicaid |
$30,561.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28,350.36
|
| Rate for Payer: Managed Health Services Medicaid |
$31,916.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,561.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30,561.95
|
| Rate for Payer: United Healthcare Medicaid |
$30,561.95
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$33,401.68
|
|
|
Service Code
|
MSDRG 695
|
| Min. Negotiated Rate |
$9,266.22 |
| Max. Negotiated Rate |
$33,401.68 |
| Rate for Payer: Aetna Managed Medicare |
$9,266.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,956.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,129.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,173.98
|
| Rate for Payer: Anthem Medicare Advantage |
$9,266.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,266.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,266.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,266.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,174.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,266.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,254.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,266.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,266.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,266.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,266.22
|
| Rate for Payer: NAPHCARE Commercial |
$13,899.33
|
| Rate for Payer: Quartz Medicare Advantage |
$9,266.22
|
| Rate for Payer: The Alliance Commercial |
$33,401.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,266.22
|
| Rate for Payer: United Healthcare PPO |
$18,882.74
|
| Rate for Payer: Wellcare Medicare |
$9,266.22
|
|
|
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$19,469.84
|
|
|
Service Code
|
MSDRG 696
|
| Min. Negotiated Rate |
$5,783.27 |
| Max. Negotiated Rate |
$19,469.84 |
| Rate for Payer: Aetna Managed Medicare |
$5,783.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,033.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,523.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,947.60
|
| Rate for Payer: Anthem Medicare Advantage |
$5,783.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,783.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,783.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,783.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,152.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,783.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,035.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,783.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,783.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,783.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,783.27
|
| Rate for Payer: NAPHCARE Commercial |
$8,674.91
|
| Rate for Payer: Quartz Medicare Advantage |
$5,783.27
|
| Rate for Payer: The Alliance Commercial |
$19,469.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,783.27
|
| Rate for Payer: United Healthcare PPO |
$10,927.04
|
| Rate for Payer: Wellcare Medicare |
$5,783.27
|
|
|
KIDNEY ENDOSCOPY AND BIOPSY 50555
|
Professional
|
Both
|
$2,214.00
|
|
|
Service Code
|
CPT 50555
|
| Hospital Charge Code |
3014940
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$228.61 |
| Max. Negotiated Rate |
$2,187.43 |
| Rate for Payer: Aetna Commercial |
$2,187.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,980.20
|
| Rate for Payer: Aetna Managed Medicare |
$289.60
|
| Rate for Payer: Anthem Medicare Advantage |
$289.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$289.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$289.60
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cash Price |
$664.20
|
| Rate for Payer: Cigna Commercial |
$2,187.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$228.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.60
|
| Rate for Payer: Health EOS Commercial |
$2,095.33
|
| Rate for Payer: HFN Commercial |
$2,187.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,177.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,177.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$289.60
|
| Rate for Payer: Multiplan Commercial |
$1,842.05
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,187.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,013.13
|
| Rate for Payer: Quartz Commercial |
$1,312.46
|
| Rate for Payer: Quartz Medicare Advantage |
$289.60
|
| Rate for Payer: The Alliance Commercial |
$1,230.79
|
| Rate for Payer: United Healthcare Medicaid |
$228.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$289.60
|
| Rate for Payer: WEA Trust Commercial |
$1,266.41
|
| Rate for Payer: WPS Commercial |
$1,303.19
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$78,125.64
|
|
|
Service Code
|
APR-DRG 4404
|
| Min. Negotiated Rate |
$69,396.07 |
| Max. Negotiated Rate |
$78,125.64 |
| Rate for Payer: Anthem Medicaid |
$74,809.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$74,809.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74,809.61
|
| Rate for Payer: Dean Health Medicaid |
$74,809.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$69,396.07
|
| Rate for Payer: Managed Health Services Medicaid |
$78,125.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$74,809.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$74,809.61
|
| Rate for Payer: United Healthcare Medicaid |
$74,809.61
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$45,244.48
|
|
|
Service Code
|
APR-DRG 4402
|
| Min. Negotiated Rate |
$40,188.97 |
| Max. Negotiated Rate |
$45,244.48 |
| Rate for Payer: Anthem Medicaid |
$43,324.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$43,324.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43,324.08
|
| Rate for Payer: Dean Health Medicaid |
$43,324.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$40,188.97
|
| Rate for Payer: Managed Health Services Medicaid |
$45,244.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$43,324.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$43,324.08
|
| Rate for Payer: United Healthcare Medicaid |
$43,324.08
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$42,350.94
|
|
|
Service Code
|
APR-DRG 4401
|
| Min. Negotiated Rate |
$37,618.74 |
| Max. Negotiated Rate |
$42,350.94 |
| Rate for Payer: Anthem Medicaid |
$40,553.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$40,553.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40,553.36
|
| Rate for Payer: Dean Health Medicaid |
$40,553.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37,618.74
|
| Rate for Payer: Managed Health Services Medicaid |
$42,350.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,553.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$40,553.36
|
| Rate for Payer: United Healthcare Medicaid |
$40,553.36
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$83,402.80
|
|
|
Service Code
|
MSDRG 652
|
| Min. Negotiated Rate |
$25,238.93 |
| Max. Negotiated Rate |
$83,402.80 |
| Rate for Payer: Aetna Managed Medicare |
$25,238.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,465.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54,010.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,313.91
|
| Rate for Payer: Anthem Medicare Advantage |
$25,238.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,238.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,238.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,238.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,963.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,238.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,238.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,238.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,238.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,238.93
|
| Rate for Payer: NAPHCARE Commercial |
$37,858.39
|
| Rate for Payer: Quartz Medicare Advantage |
$25,238.93
|
| Rate for Payer: The Alliance Commercial |
$83,402.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,238.93
|
| Rate for Payer: Wellcare Medicare |
$25,238.93
|
|
|
KIDNEY TRANSPLANT
|
Facility
|
IP
|
$53,135.96
|
|
|
Service Code
|
APR-DRG 4403
|
| Min. Negotiated Rate |
$47,198.67 |
| Max. Negotiated Rate |
$53,135.96 |
| Rate for Payer: Anthem Medicaid |
$50,880.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$50,880.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50,880.61
|
| Rate for Payer: Dean Health Medicaid |
$50,880.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$47,198.67
|
| Rate for Payer: Managed Health Services Medicaid |
$53,135.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$50,880.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$50,880.61
|
| Rate for Payer: United Healthcare Medicaid |
$50,880.61
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC
|
Facility
|
IP
|
$124,686.64
|
|
|
Service Code
|
MSDRG 650
|
| Min. Negotiated Rate |
$36,511.02 |
| Max. Negotiated Rate |
$124,686.64 |
| Rate for Payer: Aetna Managed Medicare |
$36,511.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102,580.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78,627.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74,701.11
|
| Rate for Payer: Anthem Medicare Advantage |
$36,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36,511.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36,511.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82,925.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36,511.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91,209.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36,511.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36,511.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36,511.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36,511.02
|
| Rate for Payer: NAPHCARE Commercial |
$54,766.53
|
| Rate for Payer: Quartz Medicare Advantage |
$36,511.02
|
| Rate for Payer: The Alliance Commercial |
$124,686.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36,511.02
|
| Rate for Payer: United Healthcare PPO |
$71,007.61
|
| Rate for Payer: Wellcare Medicare |
$36,511.02
|
|
|
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC
|
Facility
|
IP
|
$95,955.60
|
|
|
Service Code
|
MSDRG 651
|
| Min. Negotiated Rate |
$28,886.52 |
| Max. Negotiated Rate |
$95,955.60 |
| Rate for Payer: Aetna Managed Medicare |
$28,886.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80,857.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61,976.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58,881.90
|
| Rate for Payer: Anthem Medicare Advantage |
$28,886.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,886.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,886.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,886.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65,364.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,886.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70,136.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,886.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,886.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,886.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,886.52
|
| Rate for Payer: NAPHCARE Commercial |
$43,329.78
|
| Rate for Payer: Quartz Medicare Advantage |
$28,886.52
|
| Rate for Payer: The Alliance Commercial |
$95,955.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,886.52
|
| Rate for Payer: United Healthcare PPO |
$54,602.05
|
| Rate for Payer: Wellcare Medicare |
$28,886.52
|
|
|
KINESIO GOLD TEX TAPE - BLACK 081605120
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2971981
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - BLACK 081605120
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2971981
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - BLUE 081605278
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2971982
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - BLUE 081605278
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2971982
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - RED # A840241
|
Facility
|
OP
|
$266.00
|
|
| Hospital Charge Code |
2971983
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$77.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.48
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$165.98
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$165.98
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIO GOLD TEX TAPE - RED # A840241
|
Facility
|
IP
|
$266.00
|
|
| Hospital Charge Code |
2971983
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
KINESIOTAPE BEIGE 5cm x31.5 BULK 0816-05-146
|
Facility
|
IP
|
$964.00
|
|
| Hospital Charge Code |
2969774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$491.25 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$601.54
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
KINESIOTAPE BEIGE 5cm x31.5 BULK 0816-05-146
|
Facility
|
OP
|
$964.00
|
|
| Hospital Charge Code |
2969774
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$280.72 |
| Max. Negotiated Rate |
$922.36 |
| Rate for Payer: Aetna Commercial |
$902.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.20
|
| Rate for Payer: Aetna Managed Medicare |
$280.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.36
|
| Rate for Payer: Cash Price |
$289.20
|
| Rate for Payer: Cigna Commercial |
$922.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.05
|
| Rate for Payer: Health EOS Commercial |
$892.28
|
| Rate for Payer: HFN Commercial |
$922.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$751.92
|
| Rate for Payer: Multiplan Commercial |
$802.05
|
| Rate for Payer: NAPHCARE Commercial |
$601.54
|
| Rate for Payer: Preferred Network Access Commercial |
$922.36
|
| Rate for Payer: Quartz Beloit One Network |
$491.25
|
| Rate for Payer: Quartz Commercial |
$651.66
|
| Rate for Payer: Quartz Medicare Advantage |
$601.54
|
| Rate for Payer: The Alliance Commercial |
$501.28
|
| Rate for Payer: WEA Trust Commercial |
$551.41
|
| Rate for Payer: WPS Commercial |
$742.57
|
|
|
KIT 3.0 SUTURETAK DISP INSTR AR-8934DSC
|
Facility
|
IP
|
$1,802.00
|
|
| Hospital Charge Code |
6217008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$918.30 |
| Max. Negotiated Rate |
$1,724.15 |
| Rate for Payer: Aetna Commercial |
$1,686.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,611.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.26
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,724.15
|
| Rate for Payer: Health EOS Commercial |
$1,667.93
|
| Rate for Payer: HFN Commercial |
$1,724.15
|
| Rate for Payer: Multiplan Commercial |
$1,499.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,724.15
|
| Rate for Payer: Quartz Beloit One Network |
$918.30
|
| Rate for Payer: Quartz Commercial |
$1,124.45
|
| Rate for Payer: WEA Trust Commercial |
$1,030.74
|
| Rate for Payer: WPS Commercial |
$1,388.08
|
|
|
KIT 3.0 SUTURETAK DISP INSTR AR-8934DSC
|
Facility
|
OP
|
$1,802.00
|
|
| Hospital Charge Code |
6217008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$524.74 |
| Max. Negotiated Rate |
$1,724.15 |
| Rate for Payer: Aetna Commercial |
$1,686.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,611.71
|
| Rate for Payer: Aetna Managed Medicare |
$524.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,218.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$937.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$899.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$993.26
|
| Rate for Payer: Cash Price |
$540.60
|
| Rate for Payer: Cigna Commercial |
$1,724.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,048.76
|
| Rate for Payer: Health EOS Commercial |
$1,667.93
|
| Rate for Payer: HFN Commercial |
$1,724.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,405.56
|
| Rate for Payer: Multiplan Commercial |
$1,499.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,124.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,724.15
|
| Rate for Payer: Quartz Beloit One Network |
$918.30
|
| Rate for Payer: Quartz Commercial |
$1,218.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,124.45
|
| Rate for Payer: The Alliance Commercial |
$937.04
|
| Rate for Payer: WEA Trust Commercial |
$1,030.74
|
| Rate for Payer: WPS Commercial |
$1,388.08
|
|
