|
MIGRAINE AND OTHER HEADACHES
|
Facility
|
IP
|
$9,469.77
|
|
|
Service Code
|
APR-DRG 0543
|
| Min. Negotiated Rate |
$8,411.64 |
| Max. Negotiated Rate |
$9,469.77 |
| Rate for Payer: Anthem Medicaid |
$9,067.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,067.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,067.83
|
| Rate for Payer: Dean Health Medicaid |
$9,067.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,411.64
|
| Rate for Payer: Managed Health Services Medicaid |
$9,469.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,067.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,067.83
|
| Rate for Payer: United Healthcare Medicaid |
$9,067.83
|
|
|
miLOOP 303071-9090-000
|
Facility
|
OP
|
$1,868.00
|
|
| Hospital Charge Code |
5415879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$543.96 |
| Max. Negotiated Rate |
$1,787.30 |
| Rate for Payer: Aetna Commercial |
$1,748.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,670.74
|
| Rate for Payer: Aetna Managed Medicare |
$543.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,262.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$971.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$932.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.64
|
| Rate for Payer: Cash Price |
$560.40
|
| Rate for Payer: Cigna Commercial |
$1,787.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,087.18
|
| Rate for Payer: Health EOS Commercial |
$1,729.02
|
| Rate for Payer: HFN Commercial |
$1,787.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,457.04
|
| Rate for Payer: Multiplan Commercial |
$1,554.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,165.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,787.30
|
| Rate for Payer: Quartz Beloit One Network |
$951.93
|
| Rate for Payer: Quartz Commercial |
$1,262.77
|
| Rate for Payer: Quartz Medicare Advantage |
$1,165.63
|
| Rate for Payer: The Alliance Commercial |
$971.36
|
| Rate for Payer: WEA Trust Commercial |
$1,068.50
|
| Rate for Payer: WPS Commercial |
$1,438.92
|
|
|
miLOOP 303071-9090-000
|
Facility
|
IP
|
$1,868.00
|
|
| Hospital Charge Code |
5415879
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$951.93 |
| Max. Negotiated Rate |
$1,787.30 |
| Rate for Payer: Aetna Commercial |
$1,748.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,670.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.64
|
| Rate for Payer: Cash Price |
$560.40
|
| Rate for Payer: Cigna Commercial |
$1,787.30
|
| Rate for Payer: Health EOS Commercial |
$1,729.02
|
| Rate for Payer: HFN Commercial |
$1,787.30
|
| Rate for Payer: Multiplan Commercial |
$1,554.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,787.30
|
| Rate for Payer: Quartz Beloit One Network |
$951.93
|
| Rate for Payer: Quartz Commercial |
$1,165.63
|
| Rate for Payer: WEA Trust Commercial |
$1,068.50
|
| Rate for Payer: WPS Commercial |
$1,438.92
|
|
|
MIMI PLATE TENSION BAND MATRIX MANDIBLE 1.0MM 2HL X 2HL BROAD MALLEABLE 04.503.750
|
Facility
|
IP
|
$6,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,191.62 |
| Max. Negotiated Rate |
$5,992.44 |
| Rate for Payer: Aetna Commercial |
$5,862.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,601.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,452.17
|
| Rate for Payer: Cash Price |
$1,878.90
|
| Rate for Payer: Cigna Commercial |
$5,992.44
|
| Rate for Payer: Health EOS Commercial |
$5,797.03
|
| Rate for Payer: HFN Commercial |
$5,992.44
|
| Rate for Payer: Multiplan Commercial |
$5,210.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,992.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,191.62
|
| Rate for Payer: Quartz Commercial |
$3,908.11
|
| Rate for Payer: WEA Trust Commercial |
$3,582.44
|
| Rate for Payer: WPS Commercial |
$4,824.39
|
|
|
MIMI PLATE TENSION BAND MATRIX MANDIBLE 1.0MM 2HL X 2HL BROAD MALLEABLE 04.503.750
|
Facility
|
OP
|
$6,263.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6192962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,823.79 |
| Max. Negotiated Rate |
$5,992.44 |
| Rate for Payer: Aetna Commercial |
$5,862.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,601.63
|
| Rate for Payer: Aetna Managed Medicare |
$1,823.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,233.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,256.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,126.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,452.17
|
| Rate for Payer: Cash Price |
$1,878.90
|
| Rate for Payer: Cigna Commercial |
$5,992.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,645.07
|
| Rate for Payer: Health EOS Commercial |
$5,797.03
|
| Rate for Payer: HFN Commercial |
$5,992.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,885.14
|
| Rate for Payer: Multiplan Commercial |
$5,210.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,908.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,992.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,191.62
|
| Rate for Payer: Quartz Commercial |
$4,233.79
|
| Rate for Payer: Quartz Medicare Advantage |
$3,908.11
|
| Rate for Payer: The Alliance Commercial |
$3,256.76
|
| Rate for Payer: WEA Trust Commercial |
$3,582.44
|
| Rate for Payer: WPS Commercial |
$4,824.39
|
|
|
MIMI PLATE TENSION BAND MATRIX MANDIBLE 1.0MM 2HL X 2HL NARROW 04.503.702
|
Facility
|
OP
|
$4,572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,331.37 |
| Max. Negotiated Rate |
$4,374.49 |
| Rate for Payer: Aetna Commercial |
$4,279.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,331.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,090.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,377.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,282.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,520.09
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,374.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,660.90
|
| Rate for Payer: Health EOS Commercial |
$4,231.84
|
| Rate for Payer: HFN Commercial |
$4,374.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,566.16
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: NAPHCARE Commercial |
$2,852.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,374.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.89
|
| Rate for Payer: Quartz Commercial |
$3,090.67
|
| Rate for Payer: Quartz Medicare Advantage |
$2,852.93
|
| Rate for Payer: The Alliance Commercial |
$2,377.44
|
| Rate for Payer: WEA Trust Commercial |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$3,521.81
|
|
|
MIMI PLATE TENSION BAND MATRIX MANDIBLE 1.0MM 2HL X 2HL NARROW 04.503.702
|
Facility
|
IP
|
$4,572.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,329.89 |
| Max. Negotiated Rate |
$4,374.49 |
| Rate for Payer: Aetna Commercial |
$4,279.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,089.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,520.09
|
| Rate for Payer: Cash Price |
$1,371.60
|
| Rate for Payer: Cigna Commercial |
$4,374.49
|
| Rate for Payer: Health EOS Commercial |
$4,231.84
|
| Rate for Payer: HFN Commercial |
$4,374.49
|
| Rate for Payer: Multiplan Commercial |
$3,803.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,374.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,329.89
|
| Rate for Payer: Quartz Commercial |
$2,852.93
|
| Rate for Payer: WEA Trust Commercial |
$2,615.18
|
| Rate for Payer: WPS Commercial |
$3,521.81
|
|
|
MIMI PLATE TENSION BAND MATRIX MANDIBLE 1.0MM 2HL X 2HL PRE-BENT RT 04.503.780
|
Facility
|
OP
|
$4,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4038109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,363.98 |
| Max. Negotiated Rate |
$4,481.65 |
| Rate for Payer: Aetna Commercial |
$4,384.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,189.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,363.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,166.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,435.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,338.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,581.82
|
| Rate for Payer: Cash Price |
$1,405.20
|
| Rate for Payer: Cigna Commercial |
$4,481.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,726.09
|
| Rate for Payer: Health EOS Commercial |
$4,335.51
|
| Rate for Payer: HFN Commercial |
$4,481.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,653.52
|
| Rate for Payer: Multiplan Commercial |
$3,897.09
|
| Rate for Payer: NAPHCARE Commercial |
$2,922.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,481.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,386.97
|
| Rate for Payer: Quartz Commercial |
$3,166.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,922.82
|
| Rate for Payer: The Alliance Commercial |
$2,435.68
|
| Rate for Payer: WEA Trust Commercial |
$2,679.25
|
| Rate for Payer: WPS Commercial |
$3,608.09
|
|
|
MIMI PLATE TENSION BAND MATRIX MANDIBLE 1.0MM 2HL X 2HL PRE-BENT RT 04.503.780
|
Facility
|
IP
|
$4,684.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4038109
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,386.97 |
| Max. Negotiated Rate |
$4,481.65 |
| Rate for Payer: Aetna Commercial |
$4,384.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,189.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,581.82
|
| Rate for Payer: Cash Price |
$1,405.20
|
| Rate for Payer: Cigna Commercial |
$4,481.65
|
| Rate for Payer: Health EOS Commercial |
$4,335.51
|
| Rate for Payer: HFN Commercial |
$4,481.65
|
| Rate for Payer: Multiplan Commercial |
$3,897.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,481.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,386.97
|
| Rate for Payer: Quartz Commercial |
$2,922.82
|
| Rate for Payer: WEA Trust Commercial |
$2,679.25
|
| Rate for Payer: WPS Commercial |
$3,608.09
|
|
|
MIMI PLATE TENSION BAND MATRIX MANDIBLE 1.0MM 3HL X 3HL NARROW 04.503.704
|
Facility
|
IP
|
$4,978.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,536.79 |
| Max. Negotiated Rate |
$4,762.95 |
| Rate for Payer: Aetna Commercial |
$4,659.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,452.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,743.87
|
| Rate for Payer: Cash Price |
$1,493.40
|
| Rate for Payer: Cigna Commercial |
$4,762.95
|
| Rate for Payer: Health EOS Commercial |
$4,607.64
|
| Rate for Payer: HFN Commercial |
$4,762.95
|
| Rate for Payer: Multiplan Commercial |
$4,141.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,762.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,536.79
|
| Rate for Payer: Quartz Commercial |
$3,106.27
|
| Rate for Payer: WEA Trust Commercial |
$2,847.42
|
| Rate for Payer: WPS Commercial |
$3,834.55
|
|
|
MIMI PLATE TENSION BAND MATRIX MANDIBLE 1.0MM 3HL X 3HL NARROW 04.503.704
|
Facility
|
OP
|
$4,978.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,449.59 |
| Max. Negotiated Rate |
$4,762.95 |
| Rate for Payer: Aetna Commercial |
$4,659.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,452.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,449.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,365.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,588.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,485.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,743.87
|
| Rate for Payer: Cash Price |
$1,493.40
|
| Rate for Payer: Cigna Commercial |
$4,762.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,897.20
|
| Rate for Payer: Health EOS Commercial |
$4,607.64
|
| Rate for Payer: HFN Commercial |
$4,762.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,882.84
|
| Rate for Payer: Multiplan Commercial |
$4,141.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,106.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,762.95
|
| Rate for Payer: Quartz Beloit One Network |
$2,536.79
|
| Rate for Payer: Quartz Commercial |
$3,365.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,106.27
|
| Rate for Payer: The Alliance Commercial |
$2,588.56
|
| Rate for Payer: WEA Trust Commercial |
$2,847.42
|
| Rate for Payer: WPS Commercial |
$3,834.55
|
|
|
Mineral Oil 25ml (sterile) [Med]
|
Facility
|
IP
|
$34.00
|
|
| Hospital Charge Code |
2974964
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$21.22
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$26.19
|
|
|
Mineral Oil 25ml (sterile) [Med]
|
Facility
|
OP
|
$34.00
|
|
| Hospital Charge Code |
2974964
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.90 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Aetna Managed Medicare |
$9.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.79
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.52
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: NAPHCARE Commercial |
$21.22
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$22.98
|
| Rate for Payer: Quartz Medicare Advantage |
$21.22
|
| Rate for Payer: The Alliance Commercial |
$17.68
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$26.19
|
|
|
MINOR AUDIOMETRIC TESTS AND SCREENING SERVICES
|
Facility
|
OP
|
$57.65
|
|
|
Service Code
|
EAPG 00229
|
| Min. Negotiated Rate |
$55.44 |
| Max. Negotiated Rate |
$57.65 |
| Rate for Payer: Anthem Medicaid |
$55.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$55.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.44
|
| Rate for Payer: Dean Health Medicaid |
$55.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$55.44
|
| Rate for Payer: Managed Health Services Medicaid |
$57.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$55.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$55.44
|
| Rate for Payer: United Healthcare Medicaid |
$55.44
|
|
|
MINOR BLADDER PROCEDURES WITH CC
|
Facility
|
IP
|
$40,673.36
|
|
|
Service Code
|
MSDRG 663
|
| Min. Negotiated Rate |
$12,148.77 |
| Max. Negotiated Rate |
$40,673.36 |
| Rate for Payer: Aetna Managed Medicare |
$12,148.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,169.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,424.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,154.64
|
| Rate for Payer: Anthem Medicare Advantage |
$12,148.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,813.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,588.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.77
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.16
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.77
|
| Rate for Payer: The Alliance Commercial |
$40,673.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.77
|
| Rate for Payer: United Healthcare PPO |
$23,035.04
|
| Rate for Payer: Wellcare Medicare |
$12,148.77
|
|
|
MINOR BLADDER PROCEDURES WITH MCC
|
Facility
|
IP
|
$83,190.64
|
|
|
Service Code
|
MSDRG 662
|
| Min. Negotiated Rate |
$23,952.34 |
| Max. Negotiated Rate |
$83,190.64 |
| Rate for Payer: Aetna Managed Medicare |
$23,952.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66,799.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51,201.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48,644.54
|
| Rate for Payer: Anthem Medicare Advantage |
$23,952.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,952.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,952.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,952.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53,999.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,952.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60,773.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,952.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,952.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,952.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,952.34
|
| Rate for Payer: NAPHCARE Commercial |
$35,928.52
|
| Rate for Payer: Quartz Medicare Advantage |
$23,952.34
|
| Rate for Payer: The Alliance Commercial |
$83,190.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,952.34
|
| Rate for Payer: United Healthcare PPO |
$47,312.62
|
| Rate for Payer: Wellcare Medicare |
$23,952.34
|
|
|
MINOR BLADDER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$29,685.76
|
|
|
Service Code
|
MSDRG 664
|
| Min. Negotiated Rate |
$8,524.14 |
| Max. Negotiated Rate |
$29,685.76 |
| Rate for Payer: Aetna Managed Medicare |
$8,524.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,842.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,508.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,634.32
|
| Rate for Payer: Anthem Medicare Advantage |
$8,524.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,524.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,524.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,524.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,465.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,524.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,529.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,524.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,524.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,524.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,524.14
|
| Rate for Payer: NAPHCARE Commercial |
$12,786.21
|
| Rate for Payer: Quartz Medicare Advantage |
$8,524.14
|
| Rate for Payer: The Alliance Commercial |
$29,685.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,524.14
|
| Rate for Payer: United Healthcare PPO |
$16,760.80
|
| Rate for Payer: Wellcare Medicare |
$8,524.14
|
|
|
MINOR DERMATOLOGY SERVICES
|
Facility
|
OP
|
$30.14
|
|
|
Service Code
|
EAPG 00177
|
| Min. Negotiated Rate |
$28.98 |
| Max. Negotiated Rate |
$30.14 |
| Rate for Payer: Anthem Medicaid |
$28.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.98
|
| Rate for Payer: Dean Health Medicaid |
$28.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.98
|
| Rate for Payer: Managed Health Services Medicaid |
$30.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.98
|
| Rate for Payer: United Healthcare Medicaid |
$28.98
|
|
|
MINOR DEVICE EVALUATION AND INTERROGATION
|
Facility
|
OP
|
$58.96
|
|
|
Service Code
|
EAPG 00488
|
| Min. Negotiated Rate |
$56.70 |
| Max. Negotiated Rate |
$58.96 |
| Rate for Payer: Anthem Medicaid |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$56.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.70
|
| Rate for Payer: Dean Health Medicaid |
$56.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$56.70
|
| Rate for Payer: Managed Health Services Medicaid |
$58.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$56.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$56.70
|
| Rate for Payer: United Healthcare Medicaid |
$56.70
|
|
|
Minor Dressing Change
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3026412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
Minor Dressing Change
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3026412
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
MINOR EAR, NOSE, MOUTH AND THROAT PROCEDURES
|
Facility
|
OP
|
$95.65
|
|
|
Service Code
|
EAPG 00249
|
| Min. Negotiated Rate |
$91.97 |
| Max. Negotiated Rate |
$95.65 |
| Rate for Payer: Anthem Medicaid |
$91.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$91.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.97
|
| Rate for Payer: Dean Health Medicaid |
$91.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$91.97
|
| Rate for Payer: Managed Health Services Medicaid |
$95.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$91.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$91.97
|
| Rate for Payer: United Healthcare Medicaid |
$91.97
|
|
|
MINOR FEMALE REPRODUCTIVE PROCEDURES
|
Facility
|
OP
|
$104.82
|
|
|
Service Code
|
EAPG 00417
|
| Min. Negotiated Rate |
$100.79 |
| Max. Negotiated Rate |
$104.82 |
| Rate for Payer: Anthem Medicaid |
$100.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$100.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.79
|
| Rate for Payer: Dean Health Medicaid |
$100.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$100.79
|
| Rate for Payer: Managed Health Services Medicaid |
$104.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$100.79
|
| Rate for Payer: United Healthcare Medicaid |
$100.79
|
|
|
MINOR MUSCULOSKELETAL PROCEDURES
|
Facility
|
OP
|
$338.06
|
|
|
Service Code
|
EAPG 02030
|
| Min. Negotiated Rate |
$325.05 |
| Max. Negotiated Rate |
$338.06 |
| Rate for Payer: Anthem Medicaid |
$325.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$325.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.05
|
| Rate for Payer: Dean Health Medicaid |
$325.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$325.05
|
| Rate for Payer: Managed Health Services Medicaid |
$338.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$325.05
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$325.05
|
| Rate for Payer: United Healthcare Medicaid |
$325.05
|
|
|
MINOR OPHTHALMOLOGICAL INJECTION, SCRAPING AND TESTS
|
Facility
|
OP
|
$65.52
|
|
|
Service Code
|
EAPG 00419
|
| Min. Negotiated Rate |
$62.99 |
| Max. Negotiated Rate |
$65.52 |
| Rate for Payer: Anthem Medicaid |
$62.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$62.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.99
|
| Rate for Payer: Dean Health Medicaid |
$62.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$62.99
|
| Rate for Payer: Managed Health Services Medicaid |
$65.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$62.99
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$62.99
|
| Rate for Payer: United Healthcare Medicaid |
$62.99
|
|
