|
Magnesium Level 24 Hour Urine
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
633782
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$27.87 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.57
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: United Healthcare PPO |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: Wellcare Medicare |
$6.97
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Magnesium, Random Urine w/ Creatinine
|
Facility
|
OP
|
$50.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3693511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.57
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: United Healthcare PPO |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$6.97
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Magnesium, Random Urine w/ Creatinine
|
Professional
|
Both
|
$50.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3693511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$30.66
|
|
|
Magnesium, Random Urine w/ Creatinine
|
Facility
|
IP
|
$50.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3693511
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Magnesium, RBC
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
983316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Magnesium, RBC
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
983316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$30.66
|
|
|
Magnesium, RBC
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
983316
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.57
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: United Healthcare PPO |
$67.86
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: Wellcare Medicare |
$6.97
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Magnesium, Urine
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
5474699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$37.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$35.96
|
| Rate for Payer: HFN Commercial |
$37.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$37.54
|
| Rate for Payer: Quartz Beloit One Network |
$17.39
|
| Rate for Payer: Quartz Commercial |
$22.53
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$30.66
|
|
|
Magnesium, Urine
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
5474699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.97 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$6.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.57
|
| Rate for Payer: Anthem Medicare Advantage |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.97
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.97
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.97
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$10.45
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$6.97
|
| Rate for Payer: The Alliance Commercial |
$27.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.97
|
| Rate for Payer: United Healthcare PPO |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: Wellcare Medicare |
$6.97
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Magnesium, Urine
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
5474699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
MAGNETIC RESONANCE ANGIOGRAPHY
|
Facility
|
OP
|
$399.64
|
|
|
Service Code
|
EAPG 00282
|
| Min. Negotiated Rate |
$384.27 |
| Max. Negotiated Rate |
$399.64 |
| Rate for Payer: Anthem Medicaid |
$384.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$384.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$384.27
|
| Rate for Payer: Dean Health Medicaid |
$384.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$384.27
|
| Rate for Payer: Managed Health Services Medicaid |
$399.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$384.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$384.27
|
| Rate for Payer: United Healthcare Medicaid |
$384.27
|
|
|
MAGNETIC RESONANCE IMAGING WITH CONTRAST
|
Facility
|
OP
|
$470.40
|
|
|
Service Code
|
EAPG 00295
|
| Min. Negotiated Rate |
$452.30 |
| Max. Negotiated Rate |
$470.40 |
| Rate for Payer: Anthem Medicaid |
$452.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$452.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.30
|
| Rate for Payer: Dean Health Medicaid |
$452.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$452.30
|
| Rate for Payer: Managed Health Services Medicaid |
$470.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$452.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$452.30
|
| Rate for Payer: United Healthcare Medicaid |
$452.30
|
|
|
MAGNETIC RESONANCE IMAGING WITHOUT CONTRAST
|
Facility
|
OP
|
$311.85
|
|
|
Service Code
|
EAPG 00293
|
| Min. Negotiated Rate |
$299.86 |
| Max. Negotiated Rate |
$311.85 |
| Rate for Payer: Anthem Medicaid |
$299.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$299.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$299.86
|
| Rate for Payer: Dean Health Medicaid |
$299.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$299.86
|
| Rate for Payer: Managed Health Services Medicaid |
$311.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$299.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$299.86
|
| Rate for Payer: United Healthcare Medicaid |
$299.86
|
|
|
MAGNETOCEPHALOGRAPHY
|
Facility
|
OP
|
$423.23
|
|
|
Service Code
|
EAPG 00297
|
| Min. Negotiated Rate |
$406.95 |
| Max. Negotiated Rate |
$423.23 |
| Rate for Payer: Anthem Medicaid |
$406.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$406.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$406.95
|
| Rate for Payer: Dean Health Medicaid |
$406.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$406.95
|
| Rate for Payer: Managed Health Services Medicaid |
$423.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$406.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$406.95
|
| Rate for Payer: United Healthcare Medicaid |
$406.95
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$34,897.87
|
|
|
Service Code
|
APR-DRG 1693
|
| Min. Negotiated Rate |
$30,998.47 |
| Max. Negotiated Rate |
$34,897.87 |
| Rate for Payer: Anthem Medicaid |
$33,416.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33,416.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33,416.64
|
| Rate for Payer: Dean Health Medicaid |
$33,416.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,998.47
|
| Rate for Payer: Managed Health Services Medicaid |
$34,897.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,416.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33,416.64
|
| Rate for Payer: United Healthcare Medicaid |
$33,416.64
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$23,148.34
|
|
|
Service Code
|
APR-DRG 1691
|
| Min. Negotiated Rate |
$20,561.80 |
| Max. Negotiated Rate |
$23,148.34 |
| Rate for Payer: Anthem Medicaid |
$22,165.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,165.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,165.81
|
| Rate for Payer: Dean Health Medicaid |
$22,165.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,561.80
|
| Rate for Payer: Managed Health Services Medicaid |
$23,148.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,165.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,165.81
|
| Rate for Payer: United Healthcare Medicaid |
$22,165.81
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$49,891.68
|
|
|
Service Code
|
APR-DRG 1694
|
| Min. Negotiated Rate |
$44,316.91 |
| Max. Negotiated Rate |
$49,891.68 |
| Rate for Payer: Anthem Medicaid |
$47,774.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$47,774.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47,774.04
|
| Rate for Payer: Dean Health Medicaid |
$47,774.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44,316.91
|
| Rate for Payer: Managed Health Services Medicaid |
$49,891.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$47,774.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$47,774.04
|
| Rate for Payer: United Healthcare Medicaid |
$47,774.04
|
|
|
MAJOR ABDOMINAL VASCULAR PROCEDURES
|
Facility
|
IP
|
$27,620.18
|
|
|
Service Code
|
APR-DRG 1692
|
| Min. Negotiated Rate |
$24,533.96 |
| Max. Negotiated Rate |
$27,620.18 |
| Rate for Payer: Anthem Medicaid |
$26,447.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,447.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,447.84
|
| Rate for Payer: Dean Health Medicaid |
$26,447.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,533.96
|
| Rate for Payer: Managed Health Services Medicaid |
$27,620.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,447.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,447.84
|
| Rate for Payer: United Healthcare Medicaid |
$26,447.84
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$24,638.95
|
|
|
Service Code
|
APR-DRG 2613
|
| Min. Negotiated Rate |
$21,885.85 |
| Max. Negotiated Rate |
$24,638.95 |
| Rate for Payer: Anthem Medicaid |
$23,593.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,593.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,593.15
|
| Rate for Payer: Dean Health Medicaid |
$23,593.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,885.85
|
| Rate for Payer: Managed Health Services Medicaid |
$24,638.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,593.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,593.15
|
| Rate for Payer: United Healthcare Medicaid |
$23,593.15
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$20,079.43
|
|
|
Service Code
|
APR-DRG 2612
|
| Min. Negotiated Rate |
$17,835.80 |
| Max. Negotiated Rate |
$20,079.43 |
| Rate for Payer: Anthem Medicaid |
$19,227.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,227.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,227.16
|
| Rate for Payer: Dean Health Medicaid |
$19,227.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,835.80
|
| Rate for Payer: Managed Health Services Medicaid |
$20,079.43
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,227.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,227.16
|
| Rate for Payer: United Healthcare Medicaid |
$19,227.16
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$14,292.35
|
|
|
Service Code
|
APR-DRG 2611
|
| Min. Negotiated Rate |
$12,695.35 |
| Max. Negotiated Rate |
$14,292.35 |
| Rate for Payer: Anthem Medicaid |
$13,685.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,685.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,685.71
|
| Rate for Payer: Dean Health Medicaid |
$13,685.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,695.35
|
| Rate for Payer: Managed Health Services Medicaid |
$14,292.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,685.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,685.71
|
| Rate for Payer: United Healthcare Medicaid |
$13,685.71
|
|
|
MAJOR BILIARY TRACT PROCEDURES
|
Facility
|
IP
|
$46,822.78
|
|
|
Service Code
|
APR-DRG 2614
|
| Min. Negotiated Rate |
$41,590.91 |
| Max. Negotiated Rate |
$46,822.78 |
| Rate for Payer: Anthem Medicaid |
$44,835.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$44,835.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44,835.39
|
| Rate for Payer: Dean Health Medicaid |
$44,835.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$41,590.91
|
| Rate for Payer: Managed Health Services Medicaid |
$46,822.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$44,835.39
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44,835.39
|
| Rate for Payer: United Healthcare Medicaid |
$44,835.39
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$23,323.70
|
|
|
Service Code
|
APR-DRG 4412
|
| Min. Negotiated Rate |
$20,717.57 |
| Max. Negotiated Rate |
$23,323.70 |
| Rate for Payer: Anthem Medicaid |
$22,333.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,333.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,333.73
|
| Rate for Payer: Dean Health Medicaid |
$22,333.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,717.57
|
| Rate for Payer: Managed Health Services Medicaid |
$23,323.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,333.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,333.73
|
| Rate for Payer: United Healthcare Medicaid |
$22,333.73
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$30,162.99
|
|
|
Service Code
|
APR-DRG 4413
|
| Min. Negotiated Rate |
$26,792.65 |
| Max. Negotiated Rate |
$30,162.99 |
| Rate for Payer: Anthem Medicaid |
$28,882.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28,882.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28,882.72
|
| Rate for Payer: Dean Health Medicaid |
$28,882.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,792.65
|
| Rate for Payer: Managed Health Services Medicaid |
$30,162.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,882.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28,882.72
|
| Rate for Payer: United Healthcare Medicaid |
$28,882.72
|
|
|
MAJOR BLADDER PROCEDURES
|
Facility
|
IP
|
$18,764.18
|
|
|
Service Code
|
APR-DRG 4411
|
| Min. Negotiated Rate |
$16,667.52 |
| Max. Negotiated Rate |
$18,764.18 |
| Rate for Payer: Anthem Medicaid |
$17,967.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,967.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,967.74
|
| Rate for Payer: Dean Health Medicaid |
$17,967.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,667.52
|
| Rate for Payer: Managed Health Services Medicaid |
$18,764.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,967.74
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,967.74
|
| Rate for Payer: United Healthcare Medicaid |
$17,967.74
|
|
