|
NM Ureteral Reflux Study
|
Professional
|
Both
|
$1,490.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
2587003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$655.60 |
| Max. Negotiated Rate |
$1,415.50 |
| Rate for Payer: Aetna Commercial |
$1,415.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.40
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$1,415.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$745.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$894.00
|
| Rate for Payer: Health EOS Commercial |
$1,355.90
|
| Rate for Payer: HFN Commercial |
$1,415.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$752.31
|
| Rate for Payer: Multiplan Commercial |
$1,192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.50
|
| Rate for Payer: Quartz Beloit One Network |
$655.60
|
| Rate for Payer: Quartz Commercial |
$849.30
|
| Rate for Payer: The Alliance Commercial |
$745.00
|
| Rate for Payer: WEA Trust Commercial |
$819.50
|
| Rate for Payer: WPS Commercial |
$1,103.64
|
|
|
NM Ureteral Reflux Study
|
Facility
|
OP
|
$1,490.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
2587003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$2,304.00 |
| Rate for Payer: Aetna Commercial |
$1,341.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.40
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,528.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,222.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,161.83
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$1,370.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$833.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,326.10
|
| Rate for Payer: HFN Commercial |
$1,370.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,192.00
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,370.80
|
| Rate for Payer: Quartz Beloit One Network |
$730.10
|
| Rate for Payer: Quartz Commercial |
$968.50
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: United Healthcare PPO |
$2,304.00
|
| Rate for Payer: WEA Trust Commercial |
$819.50
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,103.64
|
|
|
NM Ureteral Reflux Study
|
Professional
|
Both
|
$1,433.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
631395
|
| Min. Negotiated Rate |
$630.52 |
| Max. Negotiated Rate |
$1,361.35 |
| Rate for Payer: Aetna Commercial |
$1,361.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,232.38
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,361.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$716.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$859.80
|
| Rate for Payer: Health EOS Commercial |
$1,304.03
|
| Rate for Payer: HFN Commercial |
$1,361.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$752.31
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,361.35
|
| Rate for Payer: Quartz Beloit One Network |
$630.52
|
| Rate for Payer: Quartz Commercial |
$816.81
|
| Rate for Payer: The Alliance Commercial |
$716.50
|
| Rate for Payer: WEA Trust Commercial |
$788.15
|
| Rate for Payer: WPS Commercial |
$1,061.42
|
|
|
NM Ureteral Reflux Study
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
631395
|
| Min. Negotiated Rate |
$407.66 |
| Max. Negotiated Rate |
$1,630.64 |
| Rate for Payer: Aetna Commercial |
$1,289.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,232.38
|
| Rate for Payer: Aetna Managed Medicare |
$407.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$931.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$687.84
|
| Rate for Payer: Anthem Medicare Advantage |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$759.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$407.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$407.66
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,318.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$407.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$801.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$407.66
|
| Rate for Payer: Health EOS Commercial |
$1,275.37
|
| Rate for Payer: HFN Commercial |
$1,318.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,516.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$407.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$407.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$407.66
|
| Rate for Payer: Multiplan Commercial |
$1,146.40
|
| Rate for Payer: NAPHCARE Commercial |
$611.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,318.36
|
| Rate for Payer: Quartz Beloit One Network |
$702.17
|
| Rate for Payer: Quartz Commercial |
$931.45
|
| Rate for Payer: Quartz Medicare Advantage |
$407.66
|
| Rate for Payer: The Alliance Commercial |
$1,630.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$407.66
|
| Rate for Payer: WEA Trust Commercial |
$788.15
|
| Rate for Payer: Wellcare Medicare |
$407.66
|
| Rate for Payer: WPS Commercial |
$1,061.42
|
|
|
NOCTURNAL POLYSOMNOGRAM-SAS
|
Facility
|
OP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3058221
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,033.42 |
| Max. Negotiated Rate |
$7,054.56 |
| Rate for Payer: Aetna Commercial |
$6,901.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,594.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,033.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,064.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,033.42
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,054.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,033.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,291.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,033.42
|
| Rate for Payer: Health EOS Commercial |
$6,824.52
|
| Rate for Payer: HFN Commercial |
$7,054.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,844.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,033.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,033.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,033.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,033.42
|
| Rate for Payer: Multiplan Commercial |
$6,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,054.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,757.32
|
| Rate for Payer: Quartz Commercial |
$4,984.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.42
|
| Rate for Payer: The Alliance Commercial |
$4,133.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,033.42
|
| Rate for Payer: United Healthcare PPO |
$5,751.00
|
| Rate for Payer: WEA Trust Commercial |
$4,217.40
|
| Rate for Payer: Wellcare Medicare |
$1,033.42
|
| Rate for Payer: WPS Commercial |
$5,679.69
|
|
|
NOCTURNAL POLYSOMNOGRAM-SAS
|
Facility
|
IP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3058221
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,757.32 |
| Max. Negotiated Rate |
$7,054.56 |
| Rate for Payer: Aetna Commercial |
$6,901.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,594.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,064.04
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,054.56
|
| Rate for Payer: Health EOS Commercial |
$6,824.52
|
| Rate for Payer: HFN Commercial |
$7,054.56
|
| Rate for Payer: Multiplan Commercial |
$6,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,054.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,757.32
|
| Rate for Payer: Quartz Commercial |
$4,600.80
|
| Rate for Payer: WEA Trust Commercial |
$4,217.40
|
| Rate for Payer: WPS Commercial |
$5,679.69
|
|
|
NOCTURNAL PSG FOLLOW UP
|
Facility
|
OP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3058222
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$1,033.42 |
| Max. Negotiated Rate |
$7,054.56 |
| Rate for Payer: Aetna Commercial |
$6,901.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,594.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,033.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,064.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,033.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,033.42
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,054.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,033.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,291.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,033.42
|
| Rate for Payer: Health EOS Commercial |
$6,824.52
|
| Rate for Payer: HFN Commercial |
$7,054.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,844.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,033.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,033.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,033.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,033.42
|
| Rate for Payer: Multiplan Commercial |
$6,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,054.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,757.32
|
| Rate for Payer: Quartz Commercial |
$4,984.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,033.42
|
| Rate for Payer: The Alliance Commercial |
$4,133.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,033.42
|
| Rate for Payer: United Healthcare PPO |
$5,751.00
|
| Rate for Payer: WEA Trust Commercial |
$4,217.40
|
| Rate for Payer: Wellcare Medicare |
$1,033.42
|
| Rate for Payer: WPS Commercial |
$5,679.69
|
|
|
NOCTURNAL PSG FOLLOW UP
|
Facility
|
IP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3058222
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,757.32 |
| Max. Negotiated Rate |
$7,054.56 |
| Rate for Payer: Aetna Commercial |
$6,901.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,594.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,064.04
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,054.56
|
| Rate for Payer: Health EOS Commercial |
$6,824.52
|
| Rate for Payer: HFN Commercial |
$7,054.56
|
| Rate for Payer: Multiplan Commercial |
$6,134.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,054.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,757.32
|
| Rate for Payer: Quartz Commercial |
$4,600.80
|
| Rate for Payer: WEA Trust Commercial |
$4,217.40
|
| Rate for Payer: WPS Commercial |
$5,679.69
|
|
|
Nonadherent dressing charge
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
2844892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.84 |
| Max. Negotiated Rate |
$112.00 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Managed Medicare |
$7.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.67
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.00
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$18.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.80
|
| Rate for Payer: The Alliance Commercial |
$112.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
Nonadherent dressing charge
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
2844892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$16.80
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
Nonadhesive wrap charge
|
Facility
|
IP
|
$62.00
|
|
| Hospital Charge Code |
2844903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$37.20
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
Nonadhesive wrap charge
|
Facility
|
OP
|
$62.00
|
|
| Hospital Charge Code |
2844903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Aetna Managed Medicare |
$17.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.70
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$40.30
|
| Rate for Payer: Quartz Medicare Advantage |
$37.20
|
| Rate for Payer: The Alliance Commercial |
$248.00
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$57,600.00
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$20,719.39 |
| Max. Negotiated Rate |
$57,600.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,719.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,107.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,574.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,847.70
|
| Rate for Payer: Anthem Medicare Advantage |
$20,719.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,719.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,719.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,719.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,463.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,719.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,012.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,719.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,719.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,719.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,719.39
|
| Rate for Payer: NAPHCARE Commercial |
$31,079.08
|
| Rate for Payer: Quartz Medicare Advantage |
$20,719.39
|
| Rate for Payer: The Alliance Commercial |
$57,600.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,719.39
|
| Rate for Payer: United Healthcare PPO |
$32,707.46
|
| Rate for Payer: Wellcare Medicare |
$20,719.39
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$97,011.00
|
|
|
Service Code
|
MSDRG 097
|
| Min. Negotiated Rate |
$34,896.01 |
| Max. Negotiated Rate |
$97,011.00 |
| Rate for Payer: Aetna Managed Medicare |
$34,896.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,367.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,534.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,611.92
|
| Rate for Payer: Anthem Medicare Advantage |
$34,896.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34,896.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34,896.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34,896.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61,734.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34,896.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70,919.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34,896.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34,896.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34,896.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34,896.01
|
| Rate for Payer: NAPHCARE Commercial |
$52,344.02
|
| Rate for Payer: Quartz Medicare Advantage |
$34,896.01
|
| Rate for Payer: The Alliance Commercial |
$97,011.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,896.01
|
| Rate for Payer: United Healthcare PPO |
$55,211.78
|
| Rate for Payer: Wellcare Medicare |
$34,896.01
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$35,419.00
|
|
|
Service Code
|
MSDRG 099
|
| Min. Negotiated Rate |
$12,740.73 |
| Max. Negotiated Rate |
$35,419.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,740.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,693.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,226.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,166.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12,740.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,740.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,740.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,740.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,387.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,740.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,743.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,740.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,740.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,740.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,740.73
|
| Rate for Payer: NAPHCARE Commercial |
$19,111.10
|
| Rate for Payer: Quartz Medicare Advantage |
$12,740.73
|
| Rate for Payer: The Alliance Commercial |
$35,419.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,740.73
|
| Rate for Payer: United Healthcare PPO |
$20,041.96
|
| Rate for Payer: Wellcare Medicare |
$12,740.73
|
|
|
Nonesterified Fatty Acids (Free Fatty Acids)
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
3328196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.72 |
| Max. Negotiated Rate |
$75.08 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Aetna Managed Medicare |
$18.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.16
|
| Rate for Payer: Anthem Medicaid |
$18.72
|
| Rate for Payer: Anthem Medicare Advantage |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.77
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.38
|
| Rate for Payer: Dean Health Medicaid |
$18.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.77
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.77
|
| Rate for Payer: Managed Health Services Medicaid |
$19.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$28.16
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.72
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$26.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.77
|
| Rate for Payer: The Alliance Commercial |
$75.08
|
| Rate for Payer: United Healthcare Medicaid |
$18.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.77
|
| Rate for Payer: United Healthcare PPO |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: Wellcare Medicare |
$18.77
|
| Rate for Payer: WMAP Medicaid |
$18.72
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
Nonesterified Fatty Acids (Free Fatty Acids)
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
3328196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
Nonesterified Fatty Acids (Free Fatty Acids)
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
CPT 82725
|
| Hospital Charge Code |
3328196
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$66.26 |
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.00
|
| Rate for Payer: Health EOS Commercial |
$36.40
|
| Rate for Payer: HFN Commercial |
$38.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.26
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Preferred Network Access Commercial |
$38.00
|
| Rate for Payer: Quartz Beloit One Network |
$17.60
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
NON-EXTENSIVE BURNS
|
Facility
|
IP
|
$54,585.00
|
|
|
Service Code
|
MSDRG 935
|
| Min. Negotiated Rate |
$19,634.91 |
| Max. Negotiated Rate |
$54,585.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,634.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,799.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,805.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,167.12
|
| Rate for Payer: Anthem Medicare Advantage |
$19,634.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,634.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,634.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,634.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,598.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,634.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,801.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,634.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,634.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,634.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,634.91
|
| Rate for Payer: NAPHCARE Commercial |
$29,452.36
|
| Rate for Payer: Quartz Medicare Advantage |
$19,634.91
|
| Rate for Payer: The Alliance Commercial |
$54,585.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,634.91
|
| Rate for Payer: United Healthcare PPO |
$30,985.94
|
| Rate for Payer: Wellcare Medicare |
$19,634.91
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC
|
Facility
|
IP
|
$45,437.00
|
|
|
Service Code
|
MSDRG 988
|
| Min. Negotiated Rate |
$16,344.18 |
| Max. Negotiated Rate |
$45,437.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,344.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,666.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,337.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,972.60
|
| Rate for Payer: Anthem Medicare Advantage |
$16,344.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,344.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,344.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,344.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,831.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,344.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,091.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,344.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,344.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,344.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,344.18
|
| Rate for Payer: NAPHCARE Commercial |
$24,516.27
|
| Rate for Payer: Quartz Medicare Advantage |
$16,344.18
|
| Rate for Payer: The Alliance Commercial |
$45,437.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,344.18
|
| Rate for Payer: United Healthcare PPO |
$25,762.16
|
| Rate for Payer: Wellcare Medicare |
$16,344.18
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC
|
Facility
|
IP
|
$90,093.00
|
|
|
Service Code
|
MSDRG 987
|
| Min. Negotiated Rate |
$32,407.65 |
| Max. Negotiated Rate |
$90,093.00 |
| Rate for Payer: Aetna Managed Medicare |
$32,407.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,912.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54,353.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,639.64
|
| Rate for Payer: Anthem Medicare Advantage |
$32,407.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,407.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,407.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,407.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57,324.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,407.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65,845.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,407.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,407.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,407.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,407.65
|
| Rate for Payer: NAPHCARE Commercial |
$48,611.48
|
| Rate for Payer: Quartz Medicare Advantage |
$32,407.65
|
| Rate for Payer: The Alliance Commercial |
$90,093.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,407.65
|
| Rate for Payer: United Healthcare PPO |
$51,261.68
|
| Rate for Payer: Wellcare Medicare |
$32,407.65
|
|
|
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC
|
Facility
|
IP
|
$29,041.00
|
|
|
Service Code
|
MSDRG 989
|
| Min. Negotiated Rate |
$10,446.49 |
| Max. Negotiated Rate |
$29,041.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,446.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,367.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,500.24
|
| Rate for Payer: Anthem Medicare Advantage |
$10,446.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,446.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,446.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,446.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,316.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,446.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,065.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,446.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,446.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,446.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,446.49
|
| Rate for Payer: NAPHCARE Commercial |
$15,669.74
|
| Rate for Payer: Quartz Medicare Advantage |
$10,446.49
|
| Rate for Payer: The Alliance Commercial |
$29,041.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,446.49
|
| Rate for Payer: United Healthcare PPO |
$16,400.03
|
| Rate for Payer: Wellcare Medicare |
$10,446.49
|
|
|
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC
|
Facility
|
IP
|
$27,584.00
|
|
|
Service Code
|
MSDRG 600
|
| Min. Negotiated Rate |
$9,922.42 |
| Max. Negotiated Rate |
$27,584.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,922.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,563.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,736.34
|
| Rate for Payer: Anthem Medicare Advantage |
$9,922.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,922.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,922.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,922.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,468.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,922.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,997.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,922.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,922.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,922.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,922.42
|
| Rate for Payer: NAPHCARE Commercial |
$14,883.63
|
| Rate for Payer: Quartz Medicare Advantage |
$9,922.42
|
| Rate for Payer: The Alliance Commercial |
$27,584.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,922.42
|
| Rate for Payer: United Healthcare PPO |
$15,568.12
|
| Rate for Payer: Wellcare Medicare |
$9,922.42
|
|
|
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$17,163.00
|
|
|
Service Code
|
MSDRG 601
|
| Min. Negotiated Rate |
$6,173.60 |
| Max. Negotiated Rate |
$17,163.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,173.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,007.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,970.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,472.36
|
| Rate for Payer: Anthem Medicare Advantage |
$6,173.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,173.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,173.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,173.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,515.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,173.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,140.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,173.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,173.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,173.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,173.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,260.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6,173.60
|
| Rate for Payer: The Alliance Commercial |
$17,163.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,173.60
|
| Rate for Payer: United Healthcare PPO |
$9,451.69
|
| Rate for Payer: Wellcare Medicare |
$6,173.60
|
|
|
Non-Rebreather Mask - Adult
|
Facility
|
OP
|
$2.00
|
|
| Hospital Charge Code |
3040337
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.56 |
| Max. Negotiated Rate |
$8.00 |
| Rate for Payer: Aetna Commercial |
$1.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.72
|
| Rate for Payer: Aetna Managed Medicare |
$0.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.06
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.12
|
| Rate for Payer: Health EOS Commercial |
$1.78
|
| Rate for Payer: HFN Commercial |
$1.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.50
|
| Rate for Payer: Multiplan Commercial |
$1.60
|
| Rate for Payer: NAPHCARE Commercial |
$1.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1.84
|
| Rate for Payer: Quartz Beloit One Network |
$0.98
|
| Rate for Payer: Quartz Commercial |
$1.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1.20
|
| Rate for Payer: The Alliance Commercial |
$8.00
|
| Rate for Payer: WEA Trust Commercial |
$1.10
|
| Rate for Payer: WPS Commercial |
$1.48
|
|
