|
ANOSCOPY AND BIOPSY 46606
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
CPT 46606
|
| Hospital Charge Code |
3014842
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$564.15 |
| Rate for Payer: Aetna Commercial |
$564.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Aetna Managed Medicare |
$68.08
|
| Rate for Payer: Anthem Medicare Advantage |
$68.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.08
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$564.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.08
|
| Rate for Payer: Health EOS Commercial |
$540.39
|
| Rate for Payer: HFN Commercial |
$564.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$258.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.08
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: NAPHCARE Commercial |
$102.12
|
| Rate for Payer: Preferred Network Access Commercial |
$564.15
|
| Rate for Payer: Quartz Beloit One Network |
$261.29
|
| Rate for Payer: Quartz Commercial |
$338.49
|
| Rate for Payer: Quartz Medicare Advantage |
$68.08
|
| Rate for Payer: The Alliance Commercial |
$289.33
|
| Rate for Payer: United Healthcare Medicaid |
$46.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.08
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: WPS Commercial |
$306.35
|
|
|
ANOSCOPY AND DILATION 46604
|
Professional
|
Both
|
$1,242.00
|
|
|
Service Code
|
CPT 46604
|
| Hospital Charge Code |
3014841
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.86 |
| Max. Negotiated Rate |
$1,227.10 |
| Rate for Payer: Aetna Commercial |
$1,227.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$59.62
|
| Rate for Payer: Anthem Medicare Advantage |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.62
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,227.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.62
|
| Rate for Payer: Health EOS Commercial |
$1,175.43
|
| Rate for Payer: HFN Commercial |
$1,227.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.62
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$89.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,227.10
|
| Rate for Payer: Quartz Beloit One Network |
$568.34
|
| Rate for Payer: Quartz Commercial |
$736.26
|
| Rate for Payer: Quartz Medicare Advantage |
$59.62
|
| Rate for Payer: The Alliance Commercial |
$253.40
|
| Rate for Payer: United Healthcare Medicaid |
$38.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.62
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$268.30
|
|
|
Anoscopy Diagnostic With Or Without Collection Of Specimen 46600
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 46600
|
| Hospital Charge Code |
1188850
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.24 |
| Max. Negotiated Rate |
$264.78 |
| Rate for Payer: Aetna Commercial |
$264.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$39.25
|
| Rate for Payer: Anthem Medicare Advantage |
$39.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.25
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$264.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.25
|
| Rate for Payer: Health EOS Commercial |
$253.64
|
| Rate for Payer: HFN Commercial |
$264.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$139.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.25
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$58.87
|
| Rate for Payer: Preferred Network Access Commercial |
$264.78
|
| Rate for Payer: Quartz Beloit One Network |
$122.64
|
| Rate for Payer: Quartz Commercial |
$158.87
|
| Rate for Payer: Quartz Medicare Advantage |
$39.25
|
| Rate for Payer: The Alliance Commercial |
$166.81
|
| Rate for Payer: United Healthcare Medicaid |
$32.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.25
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$176.62
|
|
|
ANOSCOPY, REMOVE LESIONS 46612
|
Professional
|
Both
|
$891.00
|
|
|
Service Code
|
CPT 46612
|
| Hospital Charge Code |
3014843
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$880.31 |
| Rate for Payer: Aetna Commercial |
$880.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$796.91
|
| Rate for Payer: Aetna Managed Medicare |
$83.51
|
| Rate for Payer: Anthem Medicare Advantage |
$83.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.51
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cash Price |
$267.30
|
| Rate for Payer: Cigna Commercial |
$880.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.51
|
| Rate for Payer: Health EOS Commercial |
$843.24
|
| Rate for Payer: HFN Commercial |
$880.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$318.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$318.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.51
|
| Rate for Payer: Multiplan Commercial |
$741.31
|
| Rate for Payer: NAPHCARE Commercial |
$125.27
|
| Rate for Payer: Preferred Network Access Commercial |
$880.31
|
| Rate for Payer: Quartz Beloit One Network |
$407.72
|
| Rate for Payer: Quartz Commercial |
$528.18
|
| Rate for Payer: Quartz Medicare Advantage |
$83.51
|
| Rate for Payer: The Alliance Commercial |
$354.93
|
| Rate for Payer: United Healthcare Medicaid |
$61.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.51
|
| Rate for Payer: WEA Trust Commercial |
$509.65
|
| Rate for Payer: WPS Commercial |
$375.80
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$20,780.89
|
|
|
Service Code
|
APR-DRG 0594
|
| Min. Negotiated Rate |
$18,458.89 |
| Max. Negotiated Rate |
$20,780.89 |
| Rate for Payer: Anthem Medicaid |
$19,898.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,898.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,898.85
|
| Rate for Payer: Dean Health Medicaid |
$19,898.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,458.89
|
| Rate for Payer: Managed Health Services Medicaid |
$20,780.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,898.85
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,898.85
|
| Rate for Payer: United Healthcare Medicaid |
$19,898.85
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$6,313.18
|
|
|
Service Code
|
APR-DRG 0591
|
| Min. Negotiated Rate |
$5,607.76 |
| Max. Negotiated Rate |
$6,313.18 |
| Rate for Payer: Anthem Medicaid |
$6,045.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,045.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,045.22
|
| Rate for Payer: Dean Health Medicaid |
$6,045.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,607.76
|
| Rate for Payer: Managed Health Services Medicaid |
$6,313.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,045.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,045.22
|
| Rate for Payer: United Healthcare Medicaid |
$6,045.22
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$14,029.30
|
|
|
Service Code
|
APR-DRG 0593
|
| Min. Negotiated Rate |
$12,461.70 |
| Max. Negotiated Rate |
$14,029.30 |
| Rate for Payer: Anthem Medicaid |
$13,433.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,433.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,433.82
|
| Rate for Payer: Dean Health Medicaid |
$13,433.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,461.70
|
| Rate for Payer: Managed Health Services Medicaid |
$14,029.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,433.82
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,433.82
|
| Rate for Payer: United Healthcare Medicaid |
$13,433.82
|
|
|
ANOXIC AND OTHER SEVERE BRAIN DAMAGE
|
Facility
|
IP
|
$10,171.24
|
|
|
Service Code
|
APR-DRG 0592
|
| Min. Negotiated Rate |
$9,034.73 |
| Max. Negotiated Rate |
$10,171.24 |
| Rate for Payer: Anthem Medicaid |
$9,739.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,739.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,739.52
|
| Rate for Payer: Dean Health Medicaid |
$9,739.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,034.73
|
| Rate for Payer: Managed Health Services Medicaid |
$10,171.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,739.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,739.52
|
| Rate for Payer: United Healthcare Medicaid |
$9,739.52
|
|
|
ANTENNA PATIENT PROGRAMMER INTERSTIM 37092
|
Facility
|
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5349495
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$745.04 |
| Max. Negotiated Rate |
$1,398.84 |
| Rate for Payer: Aetna Commercial |
$1,368.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.85
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,398.84
|
| Rate for Payer: Health EOS Commercial |
$1,353.23
|
| Rate for Payer: HFN Commercial |
$1,398.84
|
| Rate for Payer: Multiplan Commercial |
$1,216.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.84
|
| Rate for Payer: Quartz Beloit One Network |
$745.04
|
| Rate for Payer: Quartz Commercial |
$912.29
|
| Rate for Payer: WEA Trust Commercial |
$836.26
|
| Rate for Payer: WPS Commercial |
$1,126.18
|
|
|
ANTENNA PATIENT PROGRAMMER INTERSTIM 37092
|
Facility
|
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1787
|
| Hospital Charge Code |
5349495
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$425.73 |
| Max. Negotiated Rate |
$1,398.84 |
| Rate for Payer: Aetna Commercial |
$1,368.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,307.61
|
| Rate for Payer: Aetna Managed Medicare |
$425.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$988.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$760.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$729.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.85
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,398.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$850.88
|
| Rate for Payer: Health EOS Commercial |
$1,353.23
|
| Rate for Payer: HFN Commercial |
$1,398.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,140.36
|
| Rate for Payer: Multiplan Commercial |
$1,216.38
|
| Rate for Payer: NAPHCARE Commercial |
$912.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,398.84
|
| Rate for Payer: Quartz Beloit One Network |
$745.04
|
| Rate for Payer: Quartz Commercial |
$988.31
|
| Rate for Payer: Quartz Medicare Advantage |
$912.29
|
| Rate for Payer: The Alliance Commercial |
$760.24
|
| Rate for Payer: WEA Trust Commercial |
$836.26
|
| Rate for Payer: WPS Commercial |
$1,126.18
|
|
|
ANTEPARTUM ENCOUNTERS FOR NON-ROUTINE AND ABNORMAL FINDINGS
|
Facility
|
OP
|
$100.89
|
|
|
Service Code
|
EAPG 00768
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Anthem Medicaid |
$97.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$97.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.01
|
| Rate for Payer: Dean Health Medicaid |
$97.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.01
|
| Rate for Payer: Managed Health Services Medicaid |
$100.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.01
|
| Rate for Payer: United Healthcare Medicaid |
$97.01
|
|
|
ANTEPARTUM PROCEDURES
|
Facility
|
OP
|
$542.46
|
|
|
Service Code
|
EAPG 00178
|
| Min. Negotiated Rate |
$521.60 |
| Max. Negotiated Rate |
$542.46 |
| Rate for Payer: Anthem Medicaid |
$521.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$521.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$521.60
|
| Rate for Payer: Dean Health Medicaid |
$521.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$521.60
|
| Rate for Payer: Managed Health Services Medicaid |
$542.46
|
| Rate for Payer: Molina Healthcare Medicaid |
$521.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$521.60
|
| Rate for Payer: United Healthcare Medicaid |
$521.60
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$14,643.08
|
|
|
Service Code
|
APR-DRG 5473
|
| 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
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$9,294.41
|
|
|
Service Code
|
APR-DRG 5472
|
| Min. Negotiated Rate |
$8,255.87 |
| Max. Negotiated Rate |
$9,294.41 |
| Rate for Payer: Anthem Medicaid |
$8,899.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,899.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,899.91
|
| Rate for Payer: Dean Health Medicaid |
$8,899.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,255.87
|
| Rate for Payer: Managed Health Services Medicaid |
$9,294.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,899.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,899.91
|
| Rate for Payer: United Healthcare Medicaid |
$8,899.91
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$5,085.62
|
|
|
Service Code
|
APR-DRG 5471
|
| Min. Negotiated Rate |
$4,517.36 |
| Max. Negotiated Rate |
$5,085.62 |
| Rate for Payer: Anthem Medicaid |
$4,869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,869.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,869.76
|
| Rate for Payer: Dean Health Medicaid |
$4,869.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,517.36
|
| Rate for Payer: Managed Health Services Medicaid |
$5,085.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,869.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,869.76
|
| Rate for Payer: United Healthcare Medicaid |
$4,869.76
|
|
|
ANTEPARTUM WITH O.R. PROCEDURE
|
Facility
|
IP
|
$28,058.59
|
|
|
Service Code
|
APR-DRG 5474
|
| Min. Negotiated Rate |
$24,923.39 |
| Max. Negotiated Rate |
$28,058.59 |
| Rate for Payer: Anthem Medicaid |
$26,867.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,867.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,867.65
|
| Rate for Payer: Dean Health Medicaid |
$26,867.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,923.39
|
| Rate for Payer: Managed Health Services Medicaid |
$28,058.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,867.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,867.65
|
| Rate for Payer: United Healthcare Medicaid |
$26,867.65
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$14,818.44
|
|
|
Service Code
|
APR-DRG 5664
|
| Min. Negotiated Rate |
$13,162.67 |
| Max. Negotiated Rate |
$14,818.44 |
| Rate for Payer: Anthem Medicaid |
$14,189.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,189.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,189.48
|
| Rate for Payer: Dean Health Medicaid |
$14,189.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,162.67
|
| Rate for Payer: Managed Health Services Medicaid |
$14,818.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,189.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,189.48
|
| Rate for Payer: United Healthcare Medicaid |
$14,189.48
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$2,630.49
|
|
|
Service Code
|
APR-DRG 5661
|
| Min. Negotiated Rate |
$2,336.57 |
| Max. Negotiated Rate |
$2,630.49 |
| Rate for Payer: Anthem Medicaid |
$2,518.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,518.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,518.84
|
| Rate for Payer: Dean Health Medicaid |
$2,518.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,336.57
|
| Rate for Payer: Managed Health Services Medicaid |
$2,630.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,518.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,518.84
|
| Rate for Payer: United Healthcare Medicaid |
$2,518.84
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$7,102.33
|
|
|
Service Code
|
APR-DRG 5663
|
| Min. Negotiated Rate |
$6,308.73 |
| Max. Negotiated Rate |
$7,102.33 |
| Rate for Payer: Anthem Medicaid |
$6,800.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,800.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,800.87
|
| Rate for Payer: Dean Health Medicaid |
$6,800.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,308.73
|
| Rate for Payer: Managed Health Services Medicaid |
$7,102.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,800.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,800.87
|
| Rate for Payer: United Healthcare Medicaid |
$6,800.87
|
|
|
ANTEPARTUM WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$3,858.06
|
|
|
Service Code
|
APR-DRG 5662
|
| Min. Negotiated Rate |
$3,426.97 |
| Max. Negotiated Rate |
$3,858.06 |
| Rate for Payer: Anthem Medicaid |
$3,694.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,694.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,694.30
|
| Rate for Payer: Dean Health Medicaid |
$3,694.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,426.97
|
| Rate for Payer: Managed Health Services Medicaid |
$3,858.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,694.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,694.30
|
| Rate for Payer: United Healthcare Medicaid |
$3,694.30
|
|
|
ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE, INCLUDING CYSTOURETHROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 57240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
ANTERIOR COLPORRPHAPY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
ANTERIOR COLPORRPHAPY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959808
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
ANTERIOR CRUCIATE LIG RECON W/HAMSTRING
|
Facility
|
OP
|
$8,979.00
|
|
| Hospital Charge Code |
2959778
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,614.68 |
| Max. Negotiated Rate |
$8,591.11 |
| Rate for Payer: Aetna Commercial |
$8,404.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,030.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,614.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,069.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,669.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,482.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,949.22
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Cigna Commercial |
$8,591.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,225.78
|
| Rate for Payer: Health EOS Commercial |
$8,310.96
|
| Rate for Payer: HFN Commercial |
$8,591.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,003.62
|
| Rate for Payer: Multiplan Commercial |
$7,470.53
|
| Rate for Payer: NAPHCARE Commercial |
$5,602.90
|
| Rate for Payer: Preferred Network Access Commercial |
$8,591.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,575.70
|
| Rate for Payer: Quartz Commercial |
$6,069.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,602.90
|
| Rate for Payer: The Alliance Commercial |
$4,669.08
|
| Rate for Payer: WEA Trust Commercial |
$5,135.99
|
| Rate for Payer: WPS Commercial |
$6,916.52
|
|
|
ANTERIOR CRUCIATE LIG RECON W/HAMSTRING
|
Facility
|
IP
|
$8,979.00
|
|
| Hospital Charge Code |
2959778
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,575.70 |
| Max. Negotiated Rate |
$8,591.11 |
| Rate for Payer: Aetna Commercial |
$8,404.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,030.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,949.22
|
| Rate for Payer: Cash Price |
$2,693.70
|
| Rate for Payer: Cigna Commercial |
$8,591.11
|
| Rate for Payer: Health EOS Commercial |
$8,310.96
|
| Rate for Payer: HFN Commercial |
$8,591.11
|
| Rate for Payer: Multiplan Commercial |
$7,470.53
|
| Rate for Payer: Preferred Network Access Commercial |
$8,591.11
|
| Rate for Payer: Quartz Beloit One Network |
$4,575.70
|
| Rate for Payer: Quartz Commercial |
$5,602.90
|
| Rate for Payer: WEA Trust Commercial |
$5,135.99
|
| Rate for Payer: WPS Commercial |
$6,916.52
|
|
