|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$20,342.48
|
|
|
Service Code
|
APR-DRG 0433
|
| Min. Negotiated Rate |
$18,069.46 |
| Max. Negotiated Rate |
$20,342.48 |
| Rate for Payer: Anthem Medicaid |
$19,479.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,479.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,479.04
|
| Rate for Payer: Dean Health Medicaid |
$19,479.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,069.46
|
| Rate for Payer: Managed Health Services Medicaid |
$20,342.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,479.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,479.04
|
| Rate for Payer: United Healthcare Medicaid |
$19,479.04
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$13,853.93
|
|
|
Service Code
|
APR-DRG 0432
|
| Min. Negotiated Rate |
$12,305.92 |
| Max. Negotiated Rate |
$13,853.93 |
| Rate for Payer: Anthem Medicaid |
$13,265.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,265.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,265.90
|
| Rate for Payer: Dean Health Medicaid |
$13,265.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,305.92
|
| Rate for Payer: Managed Health Services Medicaid |
$13,853.93
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,265.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,265.90
|
| Rate for Payer: United Healthcare Medicaid |
$13,265.90
|
|
|
MULTIPLE SCLEROSIS, OTHER DEMYELINATING DISEASE AND INFLAMMATORY NEUROPATHIES
|
Facility
|
IP
|
$36,125.44
|
|
|
Service Code
|
APR-DRG 0434
|
| Min. Negotiated Rate |
$32,088.87 |
| Max. Negotiated Rate |
$36,125.44 |
| Rate for Payer: Anthem Medicaid |
$34,592.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$34,592.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34,592.10
|
| Rate for Payer: Dean Health Medicaid |
$34,592.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32,088.87
|
| Rate for Payer: Managed Health Services Medicaid |
$36,125.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,592.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$34,592.10
|
| Rate for Payer: United Healthcare Medicaid |
$34,592.10
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$27,357.13
|
|
|
Service Code
|
APR-DRG 9304
|
| Min. Negotiated Rate |
$24,300.31 |
| Max. Negotiated Rate |
$27,357.13 |
| Rate for Payer: Anthem Medicaid |
$26,195.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$26,195.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26,195.96
|
| Rate for Payer: Dean Health Medicaid |
$26,195.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24,300.31
|
| Rate for Payer: Managed Health Services Medicaid |
$27,357.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$26,195.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26,195.96
|
| Rate for Payer: United Healthcare Medicaid |
$26,195.96
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$9,995.87
|
|
|
Service Code
|
APR-DRG 9302
|
| Min. Negotiated Rate |
$8,878.96 |
| Max. Negotiated Rate |
$9,995.87 |
| Rate for Payer: Anthem Medicaid |
$9,571.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,571.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,571.60
|
| Rate for Payer: Dean Health Medicaid |
$9,571.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,878.96
|
| Rate for Payer: Managed Health Services Medicaid |
$9,995.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,571.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,571.60
|
| Rate for Payer: United Healthcare Medicaid |
$9,571.60
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$15,432.23
|
|
|
Service Code
|
APR-DRG 9303
|
| Min. Negotiated Rate |
$13,707.87 |
| Max. Negotiated Rate |
$15,432.23 |
| Rate for Payer: Anthem Medicaid |
$14,777.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,777.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,777.21
|
| Rate for Payer: Dean Health Medicaid |
$14,777.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,707.87
|
| Rate for Payer: Managed Health Services Medicaid |
$15,432.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,777.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,777.21
|
| Rate for Payer: United Healthcare Medicaid |
$14,777.21
|
|
|
MULTIPLE SIGNIFICANT TRAUMA WITHOUT O.R. PROCEDURE
|
Facility
|
IP
|
$7,891.48
|
|
|
Service Code
|
APR-DRG 9301
|
| Min. Negotiated Rate |
$7,009.70 |
| Max. Negotiated Rate |
$7,891.48 |
| Rate for Payer: Anthem Medicaid |
$7,556.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,556.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,556.53
|
| Rate for Payer: Dean Health Medicaid |
$7,556.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,009.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7,891.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,556.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,556.53
|
| Rate for Payer: United Healthcare Medicaid |
$7,556.53
|
|
|
MULTIPLE SLEEP LATENCY MSLT
|
Facility
|
IP
|
$3,928.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3058216
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,001.71 |
| Max. Negotiated Rate |
$3,758.31 |
| Rate for Payer: Aetna Commercial |
$3,676.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,513.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,165.11
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cigna Commercial |
$3,758.31
|
| Rate for Payer: Health EOS Commercial |
$3,635.76
|
| Rate for Payer: HFN Commercial |
$3,758.31
|
| Rate for Payer: Multiplan Commercial |
$3,268.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,758.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,001.71
|
| Rate for Payer: Quartz Commercial |
$2,451.07
|
| Rate for Payer: WEA Trust Commercial |
$2,246.82
|
| Rate for Payer: WPS Commercial |
$3,025.74
|
|
|
MULTIPLE SLEEP LATENCY MSLT
|
Facility
|
OP
|
$3,781.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3058223
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$3,635.84 |
| Rate for Payer: Aetna Commercial |
$3,539.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,381.73
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,084.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cigna Commercial |
$3,617.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,200.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$3,499.69
|
| Rate for Payer: HFN Commercial |
$3,617.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$3,145.79
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,617.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,926.80
|
| Rate for Payer: Quartz Commercial |
$2,555.96
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$2,949.18
|
| Rate for Payer: WEA Trust Commercial |
$2,162.73
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$2,912.50
|
|
|
MULTIPLE SLEEP LATENCY MSLT
|
Facility
|
IP
|
$3,781.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3058223
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,926.80 |
| Max. Negotiated Rate |
$3,617.66 |
| Rate for Payer: Aetna Commercial |
$3,539.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,381.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,084.09
|
| Rate for Payer: Cash Price |
$1,134.30
|
| Rate for Payer: Cigna Commercial |
$3,617.66
|
| Rate for Payer: Health EOS Commercial |
$3,499.69
|
| Rate for Payer: HFN Commercial |
$3,617.66
|
| Rate for Payer: Multiplan Commercial |
$3,145.79
|
| Rate for Payer: Preferred Network Access Commercial |
$3,617.66
|
| Rate for Payer: Quartz Beloit One Network |
$1,926.80
|
| Rate for Payer: Quartz Commercial |
$2,359.34
|
| Rate for Payer: WEA Trust Commercial |
$2,162.73
|
| Rate for Payer: WPS Commercial |
$2,912.50
|
|
|
MULTIPLE SLEEP LATENCY MSLT
|
Facility
|
OP
|
$3,928.00
|
|
|
Service Code
|
CPT 95805
|
| Hospital Charge Code |
3058216
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$3,758.31 |
| Rate for Payer: Aetna Commercial |
$3,676.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,513.20
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,165.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cash Price |
$1,178.40
|
| Rate for Payer: Cigna Commercial |
$3,758.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,286.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$3,635.76
|
| Rate for Payer: HFN Commercial |
$3,758.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$3,268.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$3,758.31
|
| Rate for Payer: Quartz Beloit One Network |
$2,001.71
|
| Rate for Payer: Quartz Commercial |
$2,655.33
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$3,063.84
|
| Rate for Payer: WEA Trust Commercial |
$2,246.82
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$3,025.74
|
|
|
MUMFORD PROCEDURE/CLAVICLE RESECTION, DISTAL/SUBACROMIAL DECOMPRESSION
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2960235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,373.21 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$2,905.97
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
MUMFORD PROCEDURE/CLAVICLE RESECTION, DISTAL/SUBACROMIAL DECOMPRESSION
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2960235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,356.12 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,148.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,421.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,324.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,710.37
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,632.46
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,905.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$3,148.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,905.97
|
| Rate for Payer: The Alliance Commercial |
$2,421.64
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
Mumps Antibody IgG
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$13.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.53
|
| Rate for Payer: Anthem Medicare Advantage |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.57
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.57
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.57
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$20.36
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$290.68
|
| Rate for Payer: Quartz Medicare Advantage |
$13.57
|
| Rate for Payer: The Alliance Commercial |
$54.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.57
|
| Rate for Payer: United Healthcare PPO |
$335.40
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: Wellcare Medicare |
$13.57
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
Mumps Antibody IgG
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$219.13 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$268.32
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
Mumps Antibody IgG
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna Commercial |
$424.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$13.57
|
| Rate for Payer: Anthem Medicare Advantage |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.57
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$424.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.57
|
| Rate for Payer: Health EOS Commercial |
$406.95
|
| Rate for Payer: HFN Commercial |
$424.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.57
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$20.36
|
| Rate for Payer: Preferred Network Access Commercial |
$424.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.77
|
| Rate for Payer: Quartz Commercial |
$254.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.57
|
| Rate for Payer: The Alliance Commercial |
$53.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.57
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$59.72
|
|
|
Mumps Antibody IgM
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Mumps Antibody IgM
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$13.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.53
|
| Rate for Payer: Anthem Medicare Advantage |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.57
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.57
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.57
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$20.36
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$13.57
|
| Rate for Payer: The Alliance Commercial |
$54.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.57
|
| Rate for Payer: United Healthcare PPO |
$117.78
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: Wellcare Medicare |
$13.57
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Mumps Antibody IgM
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 86735
|
| Hospital Charge Code |
978021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.57 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$13.57
|
| Rate for Payer: Anthem Medicare Advantage |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.57
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$149.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.57
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.57
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$20.36
|
| Rate for Payer: Preferred Network Access Commercial |
$149.19
|
| Rate for Payer: Quartz Beloit One Network |
$69.10
|
| Rate for Payer: Quartz Commercial |
$89.51
|
| Rate for Payer: Quartz Medicare Advantage |
$13.57
|
| Rate for Payer: The Alliance Commercial |
$53.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.57
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$59.72
|
|
|
Mumps RNA Qual PCR
|
Professional
|
Both
|
$175.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6243427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$173.39 |
| Rate for Payer: Aetna Commercial |
$173.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.97
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna Commercial |
$173.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$166.09
|
| Rate for Payer: HFN Commercial |
$173.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$146.02
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$173.39
|
| Rate for Payer: Quartz Beloit One Network |
$80.31
|
| Rate for Payer: Quartz Commercial |
$104.04
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$100.39
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Mumps RNA Qual PCR
|
Facility
|
IP
|
$175.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6243427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.43 |
| Max. Negotiated Rate |
$167.92 |
| Rate for Payer: Aetna Commercial |
$164.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.74
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna Commercial |
$167.92
|
| Rate for Payer: Health EOS Commercial |
$162.44
|
| Rate for Payer: HFN Commercial |
$167.92
|
| Rate for Payer: Multiplan Commercial |
$146.02
|
| Rate for Payer: Preferred Network Access Commercial |
$167.92
|
| Rate for Payer: Quartz Beloit One Network |
$89.43
|
| Rate for Payer: Quartz Commercial |
$109.51
|
| Rate for Payer: WEA Trust Commercial |
$100.39
|
| Rate for Payer: WPS Commercial |
$135.19
|
|
|
Mumps RNA Qual PCR
|
Facility
|
OP
|
$175.50
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6243427
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$167.92 |
| Rate for Payer: Aetna Commercial |
$164.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.97
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cash Price |
$52.65
|
| Rate for Payer: Cigna Commercial |
$167.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$162.44
|
| Rate for Payer: HFN Commercial |
$167.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$146.02
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$167.92
|
| Rate for Payer: Quartz Beloit One Network |
$89.43
|
| Rate for Payer: Quartz Commercial |
$118.64
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$136.89
|
| Rate for Payer: WEA Trust Commercial |
$100.39
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$135.19
|
|
|
MUPIROCIN TOPICAL 2% OINTMENT (MED)
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
5415725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$19.97
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
MUPIROCIN TOPICAL 2% OINTMENT (MED)
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
5415725
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Aetna Managed Medicare |
$9.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: NAPHCARE Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$21.63
|
| Rate for Payer: Quartz Medicare Advantage |
$19.97
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
MURPHY RING SPLINT
|
Facility
|
OP
|
$1,076.00
|
|
| Hospital Charge Code |
2971403
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.33 |
| Max. Negotiated Rate |
$1,029.52 |
| Rate for Payer: Aetna Commercial |
$1,007.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$962.37
|
| Rate for Payer: Aetna Managed Medicare |
$313.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$727.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$559.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$537.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$593.09
|
| Rate for Payer: Cash Price |
$322.80
|
| Rate for Payer: Cigna Commercial |
$1,029.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$626.23
|
| Rate for Payer: Health EOS Commercial |
$995.95
|
| Rate for Payer: HFN Commercial |
$1,029.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$839.28
|
| Rate for Payer: Multiplan Commercial |
$895.23
|
| Rate for Payer: NAPHCARE Commercial |
$671.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.52
|
| Rate for Payer: Quartz Beloit One Network |
$548.33
|
| Rate for Payer: Quartz Commercial |
$727.38
|
| Rate for Payer: Quartz Medicare Advantage |
$671.42
|
| Rate for Payer: The Alliance Commercial |
$559.52
|
| Rate for Payer: WEA Trust Commercial |
$615.47
|
| Rate for Payer: WPS Commercial |
$828.84
|
|
