|
APLIGRAF PROCESS A 11USCOM01
|
Facility
OP
|
$8,210.00
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
2965441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$40.51 |
| Max. Negotiated Rate |
$7,553.20 |
| Rate for Payer: Aetna Commercial |
$7,389.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,060.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,298.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,336.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,105.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,940.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,351.30
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$7,553.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.51
|
| Rate for Payer: Health EOS Commercial |
$7,306.90
|
| Rate for Payer: HFN Commercial |
$7,553.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,157.50
|
| Rate for Payer: Multiplan Commercial |
$6,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,926.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,553.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,022.90
|
| Rate for Payer: Quartz Commercial |
$5,336.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,926.00
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: WEA Trust Commercial |
$4,515.50
|
| Rate for Payer: WPS Commercial |
$6,081.15
|
|
|
APLIGRAFT APPLICATION
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
APLIGRAFT APPLICATION
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Apolipoprotein
|
Facility
IP
|
$94.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4812606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
Apolipoprotein
|
Professional
|
$94.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4812606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$92.80 |
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$85.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.30
|
| Rate for Payer: Quartz Beloit One Network |
$41.36
|
| Rate for Payer: Quartz Commercial |
$53.58
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$83.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$92.80
|
|
|
Apolipoprotein
|
Facility
OP
|
$94.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4812606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.01
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Managed Health Services Medicaid |
$22.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$31.64
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.79
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: United Healthcare Medicaid |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare PPO |
$70.50
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: Wellcare Medicare |
$21.09
|
| Rate for Payer: WMAP Medicaid |
$21.79
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
Apolipoprotein A1
|
Facility
IP
|
$111.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
3256221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Apolipoprotein A1
|
Professional
|
$111.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
3256221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$105.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$101.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$105.45
|
| Rate for Payer: Quartz Beloit One Network |
$48.84
|
| Rate for Payer: Quartz Commercial |
$63.27
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$83.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$92.80
|
|
|
Apolipoprotein A1
|
Facility
OP
|
$111.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
3256221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.01
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Managed Health Services Medicaid |
$22.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$31.64
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.79
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: United Healthcare Medicaid |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare PPO |
$83.25
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: Wellcare Medicare |
$21.09
|
| Rate for Payer: WMAP Medicaid |
$21.79
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Apolipoprotein B / 5224
|
Facility
OP
|
$252.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
977871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$1,008.00 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.72
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.01
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$231.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$224.28
|
| Rate for Payer: HFN Commercial |
$231.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Managed Health Services Medicaid |
$22.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.64
|
| Rate for Payer: Preferred Network Access Commercial |
$231.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.79
|
| Rate for Payer: Quartz Beloit One Network |
$123.48
|
| Rate for Payer: Quartz Commercial |
$163.80
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$1,008.00
|
| Rate for Payer: United Healthcare Medicaid |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare PPO |
$189.00
|
| Rate for Payer: WEA Trust Commercial |
$138.60
|
| Rate for Payer: Wellcare Medicare |
$21.09
|
| Rate for Payer: WMAP Medicaid |
$21.79
|
| Rate for Payer: WPS Commercial |
$186.66
|
|
|
Apolipoprotein B / 5224
|
Professional
|
$252.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
977871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$239.40 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.72
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$239.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$229.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$239.40
|
| Rate for Payer: Quartz Beloit One Network |
$110.88
|
| Rate for Payer: Quartz Commercial |
$143.64
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$83.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: WEA Trust Commercial |
$138.60
|
| Rate for Payer: WPS Commercial |
$92.80
|
|
|
Apolipoprotein B / 5224
|
Facility
IP
|
$252.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
977871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.48 |
| Max. Negotiated Rate |
$231.84 |
| Rate for Payer: Aetna Commercial |
$226.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.56
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$231.84
|
| Rate for Payer: Health EOS Commercial |
$224.28
|
| Rate for Payer: HFN Commercial |
$231.84
|
| Rate for Payer: Multiplan Commercial |
$201.60
|
| Rate for Payer: NAPHCARE Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.84
|
| Rate for Payer: Quartz Beloit One Network |
$123.48
|
| Rate for Payer: Quartz Commercial |
$151.20
|
| Rate for Payer: WEA Trust Commercial |
$138.60
|
| Rate for Payer: WPS Commercial |
$186.66
|
|
|
Apolipoprotein (FSURE)
|
Facility
IP
|
$96.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4538811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Apolipoprotein (FSURE)
|
Professional
|
$96.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4538811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$92.80 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$87.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$91.20
|
| Rate for Payer: Quartz Beloit One Network |
$42.24
|
| Rate for Payer: Quartz Commercial |
$54.72
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$83.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$92.80
|
|
|
Apolipoprotein (FSURE)
|
Facility
OP
|
$96.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4538811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.01
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Managed Health Services Medicaid |
$22.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$31.64
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.79
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$384.00
|
| Rate for Payer: United Healthcare Medicaid |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare PPO |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: Wellcare Medicare |
$21.09
|
| Rate for Payer: WMAP Medicaid |
$21.79
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Apoliprotein
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4566649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
Apoliprotein
|
Professional
|
$90.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4566649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$92.80 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$81.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$85.50
|
| Rate for Payer: Quartz Beloit One Network |
$39.60
|
| Rate for Payer: Quartz Commercial |
$51.30
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$83.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$92.80
|
|
|
Apoliprotein
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4566649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.09 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$21.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.01
|
| Rate for Payer: Anthem Medicaid |
$21.79
|
| Rate for Payer: Anthem Medicare Advantage |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.09
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicaid |
$21.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.09
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.09
|
| Rate for Payer: Managed Health Services Medicaid |
$22.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.09
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$31.64
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.79
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$58.50
|
| Rate for Payer: Quartz Medicare Advantage |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$360.00
|
| Rate for Payer: United Healthcare Medicaid |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.09
|
| Rate for Payer: United Healthcare PPO |
$67.50
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: Wellcare Medicare |
$21.09
|
| Rate for Payer: WMAP Medicaid |
$21.79
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
APPENDECTOMY, OPEN
|
Facility
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959811
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
APPENDECTOMY, OPEN
|
Facility
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959811
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
APPENDECTOMY, OPEN, PEDIATRIC
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2950472
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
APPENDECTOMY, OPEN, PEDIATRIC
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2950472
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
APPENDIX PROCEDURES WITH CC
|
Facility
IP
|
$40,553.00
|
|
|
Service Code
|
MS-DRG 398
|
| Min. Negotiated Rate |
$14,587.41 |
| Max. Negotiated Rate |
$40,553.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,587.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,679.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,282.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,069.78
|
| Rate for Payer: Anthem Medicare Advantage |
$14,587.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,587.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,587.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,587.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,609.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,587.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,509.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,587.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,587.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,587.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,587.41
|
| Rate for Payer: NAPHCARE Commercial |
$21,881.12
|
| Rate for Payer: Quartz Medicare Advantage |
$14,587.41
|
| Rate for Payer: The Alliance Commercial |
$40,553.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,587.41
|
| Rate for Payer: United Healthcare PPO |
$22,973.41
|
| Rate for Payer: Wellcare Medicare |
$14,587.41
|
|
|
APPENDIX PROCEDURES WITH MCC
|
Facility
IP
|
$60,048.00
|
|
|
Service Code
|
MS-DRG 397
|
| Min. Negotiated Rate |
$21,600.15 |
| Max. Negotiated Rate |
$60,048.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,600.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47,205.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,182.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,375.50
|
| Rate for Payer: Anthem Medicare Advantage |
$21,600.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,600.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,600.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,600.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,159.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,600.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,808.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,600.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,600.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,600.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,600.15
|
| Rate for Payer: NAPHCARE Commercial |
$32,400.22
|
| Rate for Payer: Quartz Medicare Advantage |
$21,600.15
|
| Rate for Payer: The Alliance Commercial |
$60,048.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,600.15
|
| Rate for Payer: United Healthcare PPO |
$34,105.63
|
| Rate for Payer: Wellcare Medicare |
$21,600.15
|
|
|
APPENDIX PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$29,913.00
|
|
|
Service Code
|
MS-DRG 399
|
| Min. Negotiated Rate |
$10,760.17 |
| Max. Negotiated Rate |
$29,913.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,760.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,287.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,849.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,958.58
|
| Rate for Payer: Anthem Medicare Advantage |
$10,760.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,760.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,760.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,760.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,825.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,760.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,705.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,760.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,760.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,760.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,760.17
|
| Rate for Payer: NAPHCARE Commercial |
$16,140.26
|
| Rate for Payer: Quartz Medicare Advantage |
$10,760.17
|
| Rate for Payer: The Alliance Commercial |
$29,913.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,760.17
|
| Rate for Payer: United Healthcare PPO |
$16,897.97
|
| Rate for Payer: Wellcare Medicare |
$10,760.17
|
|
