|
ANCHOR SWIVELOCK PEEK 5.5 X 19.1MM AR-2323PSLC
|
Facility
|
IP
|
$5,091.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4520131
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,594.37 |
| Max. Negotiated Rate |
$4,871.07 |
| Rate for Payer: Aetna Commercial |
$4,765.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,553.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,806.16
|
| Rate for Payer: Cash Price |
$1,527.30
|
| Rate for Payer: Cigna Commercial |
$4,871.07
|
| Rate for Payer: Health EOS Commercial |
$4,712.23
|
| Rate for Payer: HFN Commercial |
$4,871.07
|
| Rate for Payer: Multiplan Commercial |
$4,235.71
|
| Rate for Payer: Preferred Network Access Commercial |
$4,871.07
|
| Rate for Payer: Quartz Beloit One Network |
$2,594.37
|
| Rate for Payer: Quartz Commercial |
$3,176.78
|
| Rate for Payer: WEA Trust Commercial |
$2,912.05
|
| Rate for Payer: WPS Commercial |
$3,921.60
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-10
|
Facility
|
IP
|
$3,783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6190980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,927.82 |
| Max. Negotiated Rate |
$3,619.57 |
| Rate for Payer: Aetna Commercial |
$3,540.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.19
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,619.57
|
| Rate for Payer: Health EOS Commercial |
$3,501.54
|
| Rate for Payer: HFN Commercial |
$3,619.57
|
| Rate for Payer: Multiplan Commercial |
$3,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.82
|
| Rate for Payer: Quartz Commercial |
$2,360.59
|
| Rate for Payer: WEA Trust Commercial |
$2,163.88
|
| Rate for Payer: WPS Commercial |
$2,914.04
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-10
|
Facility
|
OP
|
$3,783.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6190980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,101.61 |
| Max. Negotiated Rate |
$3,619.57 |
| Rate for Payer: Aetna Commercial |
$3,540.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.19
|
| Rate for Payer: Cash Price |
$1,134.90
|
| Rate for Payer: Cigna Commercial |
$3,619.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,201.71
|
| Rate for Payer: Health EOS Commercial |
$3,501.54
|
| Rate for Payer: HFN Commercial |
$3,619.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,950.74
|
| Rate for Payer: Multiplan Commercial |
$3,147.46
|
| Rate for Payer: NAPHCARE Commercial |
$2,360.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.82
|
| Rate for Payer: Quartz Commercial |
$2,557.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,360.59
|
| Rate for Payer: The Alliance Commercial |
$1,967.16
|
| Rate for Payer: WEA Trust Commercial |
$2,163.88
|
| Rate for Payer: WPS Commercial |
$2,914.04
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-4
|
Facility
|
IP
|
$15,744.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3739531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,023.14 |
| Max. Negotiated Rate |
$15,063.86 |
| Rate for Payer: Aetna Commercial |
$14,736.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,081.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,678.09
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cigna Commercial |
$15,063.86
|
| Rate for Payer: Health EOS Commercial |
$14,572.65
|
| Rate for Payer: HFN Commercial |
$15,063.86
|
| Rate for Payer: Multiplan Commercial |
$13,099.01
|
| Rate for Payer: Preferred Network Access Commercial |
$15,063.86
|
| Rate for Payer: Quartz Beloit One Network |
$8,023.14
|
| Rate for Payer: Quartz Commercial |
$9,824.26
|
| Rate for Payer: WEA Trust Commercial |
$9,005.57
|
| Rate for Payer: WPS Commercial |
$12,127.60
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-4
|
Facility
|
OP
|
$15,744.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
3739531
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,584.65 |
| Max. Negotiated Rate |
$15,063.86 |
| Rate for Payer: Aetna Commercial |
$14,736.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,081.43
|
| Rate for Payer: Aetna Managed Medicare |
$4,584.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,642.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,186.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,859.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,678.09
|
| Rate for Payer: Cash Price |
$4,723.20
|
| Rate for Payer: Cigna Commercial |
$15,063.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,163.01
|
| Rate for Payer: Health EOS Commercial |
$14,572.65
|
| Rate for Payer: HFN Commercial |
$15,063.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,280.32
|
| Rate for Payer: Multiplan Commercial |
$13,099.01
|
| Rate for Payer: NAPHCARE Commercial |
$9,824.26
|
| Rate for Payer: Preferred Network Access Commercial |
$15,063.86
|
| Rate for Payer: Quartz Beloit One Network |
$8,023.14
|
| Rate for Payer: Quartz Commercial |
$10,642.94
|
| Rate for Payer: Quartz Medicare Advantage |
$9,824.26
|
| Rate for Payer: The Alliance Commercial |
$8,186.88
|
| Rate for Payer: WEA Trust Commercial |
$9,005.57
|
| Rate for Payer: WPS Commercial |
$12,127.60
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-8
|
Facility
|
IP
|
$10,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,177.54 |
| Max. Negotiated Rate |
$9,721.09 |
| Rate for Payer: Aetna Commercial |
$9,509.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,087.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,600.19
|
| Rate for Payer: Cash Price |
$3,048.00
|
| Rate for Payer: Cigna Commercial |
$9,721.09
|
| Rate for Payer: Health EOS Commercial |
$9,404.10
|
| Rate for Payer: HFN Commercial |
$9,721.09
|
| Rate for Payer: Multiplan Commercial |
$8,453.12
|
| Rate for Payer: Preferred Network Access Commercial |
$9,721.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,177.54
|
| Rate for Payer: Quartz Commercial |
$6,339.84
|
| Rate for Payer: WEA Trust Commercial |
$5,811.52
|
| Rate for Payer: WPS Commercial |
$7,826.25
|
|
|
ANCHOR SWIVELOCK SPEEDBRIDGE SYSTEM 4.75 X 19.1MM AR-2600SBS-8
|
Facility
|
OP
|
$10,160.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,958.59 |
| Max. Negotiated Rate |
$9,721.09 |
| Rate for Payer: Aetna Commercial |
$9,509.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,087.10
|
| Rate for Payer: Aetna Managed Medicare |
$2,958.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,868.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,283.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,071.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,600.19
|
| Rate for Payer: Cash Price |
$3,048.00
|
| Rate for Payer: Cigna Commercial |
$9,721.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,913.12
|
| Rate for Payer: Health EOS Commercial |
$9,404.10
|
| Rate for Payer: HFN Commercial |
$9,721.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,924.80
|
| Rate for Payer: Multiplan Commercial |
$8,453.12
|
| Rate for Payer: NAPHCARE Commercial |
$6,339.84
|
| Rate for Payer: Preferred Network Access Commercial |
$9,721.09
|
| Rate for Payer: Quartz Beloit One Network |
$5,177.54
|
| Rate for Payer: Quartz Commercial |
$6,868.16
|
| Rate for Payer: Quartz Medicare Advantage |
$6,339.84
|
| Rate for Payer: The Alliance Commercial |
$5,283.20
|
| Rate for Payer: WEA Trust Commercial |
$5,811.52
|
| Rate for Payer: WPS Commercial |
$7,826.25
|
|
|
ANCILLARY DRUG ADMINISTRATION
|
Facility
|
OP
|
$27.52
|
|
|
Service Code
|
EAPG 00109
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$27.52 |
| Rate for Payer: Anthem Medicaid |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.46
|
| Rate for Payer: Dean Health Medicaid |
$26.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.46
|
| Rate for Payer: Managed Health Services Medicaid |
$27.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$26.46
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.46
|
| Rate for Payer: United Healthcare Medicaid |
$26.46
|
|
|
Androstenedione
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
977868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$425.78 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$30.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$114.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.55
|
| Rate for Payer: Anthem Medicare Advantage |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.45
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$425.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.45
|
| Rate for Payer: Health EOS Commercial |
$411.89
|
| Rate for Payer: HFN Commercial |
$425.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.45
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$45.68
|
| Rate for Payer: Preferred Network Access Commercial |
$425.78
|
| Rate for Payer: Quartz Beloit One Network |
$226.77
|
| Rate for Payer: Quartz Commercial |
$300.82
|
| Rate for Payer: Quartz Medicare Advantage |
$30.45
|
| Rate for Payer: The Alliance Commercial |
$121.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.45
|
| Rate for Payer: United Healthcare PPO |
$347.10
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: Wellcare Medicare |
$30.45
|
| Rate for Payer: WPS Commercial |
$342.78
|
|
|
Androstenedione
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
977868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.45 |
| Max. Negotiated Rate |
$439.66 |
| Rate for Payer: Aetna Commercial |
$439.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$30.45
|
| Rate for Payer: Anthem Medicare Advantage |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.45
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$439.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$231.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.45
|
| Rate for Payer: Health EOS Commercial |
$421.15
|
| Rate for Payer: HFN Commercial |
$439.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$107.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.45
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$45.68
|
| Rate for Payer: Preferred Network Access Commercial |
$439.66
|
| Rate for Payer: Quartz Beloit One Network |
$203.63
|
| Rate for Payer: Quartz Commercial |
$263.80
|
| Rate for Payer: Quartz Medicare Advantage |
$30.45
|
| Rate for Payer: The Alliance Commercial |
$120.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.45
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$133.99
|
|
|
Androstenedione
|
Facility
|
IP
|
$445.00
|
|
|
Service Code
|
CPT 82157
|
| Hospital Charge Code |
977868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$226.77 |
| Max. Negotiated Rate |
$425.78 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$425.78
|
| Rate for Payer: Health EOS Commercial |
$411.89
|
| Rate for Payer: HFN Commercial |
$425.78
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: Preferred Network Access Commercial |
$425.78
|
| Rate for Payer: Quartz Beloit One Network |
$226.77
|
| Rate for Payer: Quartz Commercial |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$342.78
|
|
|
ANEMIA, BLOOD AND BLOOD-FORMING ORGAN DISORDERS
|
Facility
|
OP
|
$86.48
|
|
|
Service Code
|
EAPG 00785
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Anthem Medicaid |
$83.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$83.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.15
|
| Rate for Payer: Dean Health Medicaid |
$83.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$83.15
|
| Rate for Payer: Managed Health Services Medicaid |
$86.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$83.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$83.15
|
| Rate for Payer: United Healthcare Medicaid |
$83.15
|
|
|
Anesthesia Oxymeter Capnometer
|
Facility
|
OP
|
$839.00
|
|
| Hospital Charge Code |
3101748
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$244.32 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$785.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.40
|
| Rate for Payer: Aetna Managed Medicare |
$244.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$567.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$436.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$418.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.46
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$802.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$488.30
|
| Rate for Payer: Health EOS Commercial |
$776.58
|
| Rate for Payer: HFN Commercial |
$802.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$654.42
|
| Rate for Payer: Multiplan Commercial |
$698.05
|
| Rate for Payer: NAPHCARE Commercial |
$523.54
|
| Rate for Payer: Preferred Network Access Commercial |
$802.76
|
| Rate for Payer: Quartz Beloit One Network |
$427.55
|
| Rate for Payer: Quartz Commercial |
$567.16
|
| Rate for Payer: Quartz Medicare Advantage |
$523.54
|
| Rate for Payer: The Alliance Commercial |
$436.28
|
| Rate for Payer: WEA Trust Commercial |
$479.91
|
| Rate for Payer: WPS Commercial |
$646.28
|
|
|
Anesthesia Oxymeter Capnometer
|
Facility
|
IP
|
$839.00
|
|
| Hospital Charge Code |
3101748
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$427.55 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$785.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.46
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$802.76
|
| Rate for Payer: Health EOS Commercial |
$776.58
|
| Rate for Payer: HFN Commercial |
$802.76
|
| Rate for Payer: Multiplan Commercial |
$698.05
|
| Rate for Payer: Preferred Network Access Commercial |
$802.76
|
| Rate for Payer: Quartz Beloit One Network |
$427.55
|
| Rate for Payer: Quartz Commercial |
$523.54
|
| Rate for Payer: WEA Trust Commercial |
$479.91
|
| Rate for Payer: WPS Commercial |
$646.28
|
|
|
ANEURYSM REPAIR, PSEUDO
|
Facility
|
OP
|
$15,504.00
|
|
| Hospital Charge Code |
2960327
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,514.76 |
| Max. Negotiated Rate |
$14,834.23 |
| Rate for Payer: Aetna Commercial |
$14,511.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,866.78
|
| Rate for Payer: Aetna Managed Medicare |
$4,514.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,480.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,062.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,739.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,545.80
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cigna Commercial |
$14,834.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,023.33
|
| Rate for Payer: Health EOS Commercial |
$14,350.50
|
| Rate for Payer: HFN Commercial |
$14,834.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,093.12
|
| Rate for Payer: Multiplan Commercial |
$12,899.33
|
| Rate for Payer: NAPHCARE Commercial |
$9,674.50
|
| Rate for Payer: Preferred Network Access Commercial |
$14,834.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,900.84
|
| Rate for Payer: Quartz Commercial |
$10,480.70
|
| Rate for Payer: Quartz Medicare Advantage |
$9,674.50
|
| Rate for Payer: The Alliance Commercial |
$8,062.08
|
| Rate for Payer: WEA Trust Commercial |
$8,868.29
|
| Rate for Payer: WPS Commercial |
$11,942.73
|
|
|
ANEURYSM REPAIR, PSEUDO
|
Facility
|
IP
|
$15,504.00
|
|
| Hospital Charge Code |
2960327
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,900.84 |
| Max. Negotiated Rate |
$14,834.23 |
| Rate for Payer: Aetna Commercial |
$14,511.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,866.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,545.80
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cigna Commercial |
$14,834.23
|
| Rate for Payer: Health EOS Commercial |
$14,350.50
|
| Rate for Payer: HFN Commercial |
$14,834.23
|
| Rate for Payer: Multiplan Commercial |
$12,899.33
|
| Rate for Payer: Preferred Network Access Commercial |
$14,834.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,900.84
|
| Rate for Payer: Quartz Commercial |
$9,674.50
|
| Rate for Payer: WEA Trust Commercial |
$8,868.29
|
| Rate for Payer: WPS Commercial |
$11,942.73
|
|
|
ANGEL SYSTEM WITH ASPIRATION KIT ACDA ABS-10062T
|
Facility
|
OP
|
$8,444.00
|
|
| Hospital Charge Code |
5458899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,458.89 |
| Max. Negotiated Rate |
$8,079.22 |
| Rate for Payer: Aetna Commercial |
$7,903.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,552.31
|
| Rate for Payer: Aetna Managed Medicare |
$2,458.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,708.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,390.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,215.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,654.33
|
| Rate for Payer: Cash Price |
$2,533.20
|
| Rate for Payer: Cigna Commercial |
$8,079.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,914.41
|
| Rate for Payer: Health EOS Commercial |
$7,815.77
|
| Rate for Payer: HFN Commercial |
$8,079.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,586.32
|
| Rate for Payer: Multiplan Commercial |
$7,025.41
|
| Rate for Payer: NAPHCARE Commercial |
$5,269.06
|
| Rate for Payer: Preferred Network Access Commercial |
$8,079.22
|
| Rate for Payer: Quartz Beloit One Network |
$4,303.06
|
| Rate for Payer: Quartz Commercial |
$5,708.14
|
| Rate for Payer: Quartz Medicare Advantage |
$5,269.06
|
| Rate for Payer: The Alliance Commercial |
$4,390.88
|
| Rate for Payer: WEA Trust Commercial |
$4,829.97
|
| Rate for Payer: WPS Commercial |
$6,504.41
|
|
|
ANGEL SYSTEM WITH ASPIRATION KIT ACDA ABS-10062T
|
Facility
|
IP
|
$8,444.00
|
|
| Hospital Charge Code |
5458899
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,303.06 |
| Max. Negotiated Rate |
$8,079.22 |
| Rate for Payer: Aetna Commercial |
$7,903.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,552.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,654.33
|
| Rate for Payer: Cash Price |
$2,533.20
|
| Rate for Payer: Cigna Commercial |
$8,079.22
|
| Rate for Payer: Health EOS Commercial |
$7,815.77
|
| Rate for Payer: HFN Commercial |
$8,079.22
|
| Rate for Payer: Multiplan Commercial |
$7,025.41
|
| Rate for Payer: Preferred Network Access Commercial |
$8,079.22
|
| Rate for Payer: Quartz Beloit One Network |
$4,303.06
|
| Rate for Payer: Quartz Commercial |
$5,269.06
|
| Rate for Payer: WEA Trust Commercial |
$4,829.97
|
| Rate for Payer: WPS Commercial |
$6,504.41
|
|
|
ANGINA PECTORIS
|
Facility
|
IP
|
$19,635.20
|
|
|
Service Code
|
MSDRG 311
|
| Min. Negotiated Rate |
$5,882.06 |
| Max. Negotiated Rate |
$19,635.20 |
| Rate for Payer: Aetna Managed Medicare |
$5,882.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,314.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,738.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,152.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5,882.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,882.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,882.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,882.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,380.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,882.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,157.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,882.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,882.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,882.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,882.06
|
| Rate for Payer: NAPHCARE Commercial |
$8,823.09
|
| Rate for Payer: Quartz Medicare Advantage |
$5,882.06
|
| Rate for Payer: The Alliance Commercial |
$19,635.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,882.06
|
| Rate for Payer: United Healthcare PPO |
$11,021.77
|
| Rate for Payer: Wellcare Medicare |
$5,882.06
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$14,380.03
|
|
|
Service Code
|
APR-DRG 1984
|
| Min. Negotiated Rate |
$12,773.24 |
| Max. Negotiated Rate |
$14,380.03 |
| Rate for Payer: Anthem Medicaid |
$13,769.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,769.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,769.67
|
| Rate for Payer: Dean Health Medicaid |
$13,769.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,773.24
|
| Rate for Payer: Managed Health Services Medicaid |
$14,380.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,769.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,769.67
|
| Rate for Payer: United Healthcare Medicaid |
$13,769.67
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
OP
|
$90.41
|
|
|
Service Code
|
EAPG 00598
|
| 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
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$4,997.94
|
|
|
Service Code
|
APR-DRG 1981
|
| Min. Negotiated Rate |
$4,439.48 |
| Max. Negotiated Rate |
$4,997.94 |
| Rate for Payer: Anthem Medicaid |
$4,785.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,785.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,785.80
|
| Rate for Payer: Dean Health Medicaid |
$4,785.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,439.48
|
| Rate for Payer: Managed Health Services Medicaid |
$4,997.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,785.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,785.80
|
| Rate for Payer: United Healthcare Medicaid |
$4,785.80
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$5,874.77
|
|
|
Service Code
|
APR-DRG 1982
|
| Min. Negotiated Rate |
$5,218.34 |
| Max. Negotiated Rate |
$5,874.77 |
| Rate for Payer: Anthem Medicaid |
$5,625.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,625.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,625.41
|
| Rate for Payer: Dean Health Medicaid |
$5,625.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,218.34
|
| Rate for Payer: Managed Health Services Medicaid |
$5,874.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,625.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,625.41
|
| Rate for Payer: United Healthcare Medicaid |
$5,625.41
|
|
|
ANGINA PECTORIS AND CORONARY ATHEROSCLEROSIS
|
Facility
|
IP
|
$7,803.80
|
|
|
Service Code
|
APR-DRG 1983
|
| Min. Negotiated Rate |
$6,931.82 |
| Max. Negotiated Rate |
$7,803.80 |
| Rate for Payer: Anthem Medicaid |
$7,472.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,472.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,472.56
|
| Rate for Payer: Dean Health Medicaid |
$7,472.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,931.82
|
| Rate for Payer: Managed Health Services Medicaid |
$7,803.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,472.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,472.56
|
| Rate for Payer: United Healthcare Medicaid |
$7,472.56
|
|
|
Angio Abdominal S&I
|
Facility
|
IP
|
$5,487.00
|
|
|
Service Code
|
CPT 75625
|
| Hospital Charge Code |
3052537
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,796.18 |
| Max. Negotiated Rate |
$5,249.96 |
| Rate for Payer: Aetna Commercial |
$5,135.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,907.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,024.43
|
| Rate for Payer: Cash Price |
$1,646.10
|
| Rate for Payer: Cigna Commercial |
$5,249.96
|
| Rate for Payer: Health EOS Commercial |
$5,078.77
|
| Rate for Payer: HFN Commercial |
$5,249.96
|
| Rate for Payer: Multiplan Commercial |
$4,565.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,249.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,796.18
|
| Rate for Payer: Quartz Commercial |
$3,423.89
|
| Rate for Payer: WEA Trust Commercial |
$3,138.56
|
| Rate for Payer: WPS Commercial |
$4,226.64
|
|
