|
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC
|
Facility
|
IP
|
$49,786.00
|
|
|
Service Code
|
MSDRG 843
|
| Min. Negotiated Rate |
$17,908.73 |
| Max. Negotiated Rate |
$49,786.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,908.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,022.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,910.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,417.08
|
| Rate for Payer: Anthem Medicare Advantage |
$17,908.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,908.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,908.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,908.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,545.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,908.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,281.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,908.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,908.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,908.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,908.73
|
| Rate for Payer: NAPHCARE Commercial |
$26,863.10
|
| Rate for Payer: Quartz Medicare Advantage |
$17,908.73
|
| Rate for Payer: The Alliance Commercial |
$49,786.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,908.73
|
| Rate for Payer: United Healthcare PPO |
$28,245.77
|
| Rate for Payer: Wellcare Medicare |
$17,908.73
|
|
|
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,315.00
|
|
|
Service Code
|
MSDRG 845
|
| Min. Negotiated Rate |
$8,386.56 |
| Max. Negotiated Rate |
$23,315.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,386.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,042.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,829.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,139.08
|
| Rate for Payer: Anthem Medicare Advantage |
$8,386.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,386.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,386.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,386.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,585.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,386.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,865.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,386.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,386.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,386.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,386.56
|
| Rate for Payer: NAPHCARE Commercial |
$12,579.84
|
| Rate for Payer: Quartz Medicare Advantage |
$8,386.56
|
| Rate for Payer: The Alliance Commercial |
$23,315.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,386.56
|
| Rate for Payer: United Healthcare PPO |
$13,130.05
|
| Rate for Payer: Wellcare Medicare |
$8,386.56
|
|
|
OTHER O.R. PROCEDURES FOR INJURIES WITH CC
|
Facility
|
IP
|
$53,601.00
|
|
|
Service Code
|
MSDRG 908
|
| Min. Negotiated Rate |
$19,281.07 |
| Max. Negotiated Rate |
$53,601.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,281.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,960.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,556.00
|
| Rate for Payer: Anthem Medicare Advantage |
$19,281.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,281.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,281.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,281.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,919.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,281.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,079.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,281.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,281.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,281.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,281.07
|
| Rate for Payer: NAPHCARE Commercial |
$28,921.60
|
| Rate for Payer: Quartz Medicare Advantage |
$19,281.07
|
| Rate for Payer: The Alliance Commercial |
$53,601.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,281.07
|
| Rate for Payer: United Healthcare PPO |
$30,424.24
|
| Rate for Payer: Wellcare Medicare |
$19,281.07
|
|
|
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC
|
Facility
|
IP
|
$99,207.00
|
|
|
Service Code
|
MSDRG 907
|
| Min. Negotiated Rate |
$35,685.93 |
| Max. Negotiated Rate |
$99,207.00 |
| Rate for Payer: Aetna Managed Medicare |
$35,685.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78,045.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59,821.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,834.16
|
| Rate for Payer: Anthem Medicare Advantage |
$35,685.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35,685.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35,685.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35,685.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63,091.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35,685.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72,530.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35,685.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35,685.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35,685.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35,685.93
|
| Rate for Payer: NAPHCARE Commercial |
$53,528.90
|
| Rate for Payer: Quartz Medicare Advantage |
$35,685.93
|
| Rate for Payer: The Alliance Commercial |
$99,207.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,685.93
|
| Rate for Payer: United Healthcare PPO |
$56,465.73
|
| Rate for Payer: Wellcare Medicare |
$35,685.93
|
|
|
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,379.00
|
|
|
Service Code
|
MSDRG 909
|
| Min. Negotiated Rate |
$13,085.95 |
| Max. Negotiated Rate |
$36,379.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,085.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,870.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,778.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,085.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,085.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,085.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,085.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,065.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,085.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,447.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,085.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,085.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,085.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,085.95
|
| Rate for Payer: NAPHCARE Commercial |
$19,628.92
|
| Rate for Payer: Quartz Medicare Advantage |
$13,085.95
|
| Rate for Payer: The Alliance Commercial |
$36,379.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,085.95
|
| Rate for Payer: United Healthcare PPO |
$20,589.99
|
| Rate for Payer: Wellcare Medicare |
$13,085.95
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC
|
Facility
|
IP
|
$107,855.00
|
|
|
Service Code
|
MSDRG 958
|
| Min. Negotiated Rate |
$38,796.88 |
| Max. Negotiated Rate |
$107,855.00 |
| Rate for Payer: Aetna Managed Medicare |
$38,796.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84,759.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64,967.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61,723.12
|
| Rate for Payer: Anthem Medicare Advantage |
$38,796.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38,796.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38,796.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38,796.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68,518.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38,796.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78,873.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38,796.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38,796.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38,796.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38,796.88
|
| Rate for Payer: NAPHCARE Commercial |
$58,195.32
|
| Rate for Payer: Quartz Medicare Advantage |
$38,796.88
|
| Rate for Payer: The Alliance Commercial |
$107,855.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,796.88
|
| Rate for Payer: United Healthcare PPO |
$61,404.11
|
| Rate for Payer: Wellcare Medicare |
$38,796.88
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC
|
Facility
|
IP
|
$192,603.00
|
|
|
Service Code
|
MSDRG 957
|
| Min. Negotiated Rate |
$69,281.80 |
| Max. Negotiated Rate |
$192,603.00 |
| Rate for Payer: United Healthcare PPO |
$109,796.58
|
| Rate for Payer: Wellcare Medicare |
$69,281.80
|
| Rate for Payer: Aetna Managed Medicare |
$69,281.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$151,685.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116,265.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110,459.94
|
| Rate for Payer: Anthem Medicare Advantage |
$69,281.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69,281.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69,281.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69,281.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122,620.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69,281.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141,033.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69,281.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69,281.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69,281.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69,281.80
|
| Rate for Payer: NAPHCARE Commercial |
$103,922.70
|
| Rate for Payer: Quartz Medicare Advantage |
$69,281.80
|
| Rate for Payer: The Alliance Commercial |
$192,603.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69,281.80
|
|
|
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC
|
Facility
|
IP
|
$67,647.00
|
|
|
Service Code
|
MSDRG 959
|
| Min. Negotiated Rate |
$24,333.36 |
| Max. Negotiated Rate |
$67,647.00 |
| Rate for Payer: Aetna Managed Medicare |
$24,333.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53,079.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40,684.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,653.34
|
| Rate for Payer: Anthem Medicare Advantage |
$24,333.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,333.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,333.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,333.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42,908.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,333.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49,381.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,333.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,333.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,333.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,333.36
|
| Rate for Payer: NAPHCARE Commercial |
$36,500.04
|
| Rate for Payer: Quartz Medicare Advantage |
$24,333.36
|
| Rate for Payer: The Alliance Commercial |
$67,647.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,333.36
|
| Rate for Payer: United Healthcare PPO |
$38,444.36
|
| Rate for Payer: Wellcare Medicare |
$24,333.36
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC
|
Facility
|
IP
|
$49,722.00
|
|
|
Service Code
|
MSDRG 803
|
| Min. Negotiated Rate |
$17,885.78 |
| Max. Negotiated Rate |
$49,722.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,885.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,022.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,910.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,417.08
|
| Rate for Payer: Anthem Medicare Advantage |
$17,885.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,885.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,885.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,885.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,545.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,885.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,234.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,885.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,885.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,885.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,885.78
|
| Rate for Payer: NAPHCARE Commercial |
$26,828.67
|
| Rate for Payer: Quartz Medicare Advantage |
$17,885.78
|
| Rate for Payer: The Alliance Commercial |
$49,722.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,885.78
|
| Rate for Payer: United Healthcare PPO |
$28,209.33
|
| Rate for Payer: Wellcare Medicare |
$17,885.78
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC
|
Facility
|
IP
|
$91,532.00
|
|
|
Service Code
|
MSDRG 802
|
| Min. Negotiated Rate |
$32,925.02 |
| Max. Negotiated Rate |
$91,532.00 |
| Rate for Payer: Aetna Managed Medicare |
$32,925.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71,122.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54,514.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,792.42
|
| Rate for Payer: Anthem Medicare Advantage |
$32,925.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,925.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,925.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,925.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57,494.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,925.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66,110.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,925.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,925.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,925.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,925.02
|
| Rate for Payer: NAPHCARE Commercial |
$49,387.53
|
| Rate for Payer: Quartz Medicare Advantage |
$32,925.02
|
| Rate for Payer: The Alliance Commercial |
$91,532.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,925.02
|
| Rate for Payer: United Healthcare PPO |
$51,468.14
|
| Rate for Payer: Wellcare Medicare |
$32,925.02
|
|
|
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC
|
Facility
|
IP
|
$32,500.00
|
|
|
Service Code
|
MSDRG 804
|
| Min. Negotiated Rate |
$11,690.68 |
| Max. Negotiated Rate |
$32,500.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,690.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,385.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,458.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,486.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11,690.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,690.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,690.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,690.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,521.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,690.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,602.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,690.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,690.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,690.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,690.68
|
| Rate for Payer: NAPHCARE Commercial |
$17,536.02
|
| Rate for Payer: Quartz Medicare Advantage |
$11,690.68
|
| Rate for Payer: The Alliance Commercial |
$32,500.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,690.68
|
| Rate for Payer: United Healthcare PPO |
$18,375.08
|
| Rate for Payer: Wellcare Medicare |
$11,690.68
|
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC
|
Facility
|
IP
|
$48,449.00
|
|
|
Service Code
|
MSDRG 205
|
| Min. Negotiated Rate |
$17,427.69 |
| Max. Negotiated Rate |
$48,449.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,427.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,973.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,106.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,653.18
|
| Rate for Payer: Anthem Medicare Advantage |
$17,427.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,427.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,427.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,697.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,300.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,427.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,427.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,427.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,427.69
|
| Rate for Payer: NAPHCARE Commercial |
$26,141.54
|
| Rate for Payer: Quartz Medicare Advantage |
$17,427.69
|
| Rate for Payer: The Alliance Commercial |
$48,449.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,427.69
|
| Rate for Payer: United Healthcare PPO |
$27,482.16
|
| Rate for Payer: Wellcare Medicare |
$17,427.69
|
|
|
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC
|
Facility
|
IP
|
$24,607.00
|
|
|
Service Code
|
MSDRG 206
|
| Min. Negotiated Rate |
$8,851.34 |
| Max. Negotiated Rate |
$24,607.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,851.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,091.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,633.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,902.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8,851.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,851.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,851.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,851.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,433.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,851.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,813.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,851.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,851.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,851.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,851.34
|
| Rate for Payer: NAPHCARE Commercial |
$13,277.01
|
| Rate for Payer: Quartz Medicare Advantage |
$8,851.34
|
| Rate for Payer: The Alliance Commercial |
$24,607.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,851.34
|
| Rate for Payer: United Healthcare PPO |
$13,867.84
|
| Rate for Payer: Wellcare Medicare |
$8,851.34
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$48,702.00
|
|
|
Service Code
|
MSDRG 167
|
| Min. Negotiated Rate |
$17,518.55 |
| Max. Negotiated Rate |
$48,702.00 |
| Rate for Payer: Wellcare Medicare |
$17,518.55
|
| Rate for Payer: Aetna Managed Medicare |
$17,518.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,183.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,267.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,805.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17,518.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,518.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,518.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,518.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,867.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,518.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,486.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,518.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,518.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,518.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,518.55
|
| Rate for Payer: NAPHCARE Commercial |
$26,277.82
|
| Rate for Payer: Quartz Medicare Advantage |
$17,518.55
|
| Rate for Payer: The Alliance Commercial |
$48,702.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,518.55
|
| Rate for Payer: United Healthcare PPO |
$27,626.38
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$108,201.00
|
|
|
Service Code
|
MSDRG 166
|
| Min. Negotiated Rate |
$38,921.21 |
| Max. Negotiated Rate |
$108,201.00 |
| Rate for Payer: Aetna Managed Medicare |
$38,921.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85,178.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65,288.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62,028.68
|
| Rate for Payer: Anthem Medicare Advantage |
$38,921.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38,921.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38,921.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38,921.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68,857.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38,921.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79,127.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38,921.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38,921.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38,921.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38,921.21
|
| Rate for Payer: NAPHCARE Commercial |
$58,381.82
|
| Rate for Payer: Quartz Medicare Advantage |
$38,921.21
|
| Rate for Payer: The Alliance Commercial |
$108,201.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,921.21
|
| Rate for Payer: United Healthcare PPO |
$61,601.46
|
| Rate for Payer: Wellcare Medicare |
$38,921.21
|
|
|
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,363.00
|
|
|
Service Code
|
MSDRG 168
|
| Min. Negotiated Rate |
$13,080.22 |
| Max. Negotiated Rate |
$36,363.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,080.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,870.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,778.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,080.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,080.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,080.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,080.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,065.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,080.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,436.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,080.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,080.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,080.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,080.22
|
| Rate for Payer: NAPHCARE Commercial |
$19,620.33
|
| Rate for Payer: Quartz Medicare Advantage |
$13,080.22
|
| Rate for Payer: The Alliance Commercial |
$36,363.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,080.22
|
| Rate for Payer: United Healthcare PPO |
$20,580.88
|
| Rate for Payer: Wellcare Medicare |
$13,080.22
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC
|
Facility
|
IP
|
$46,755.00
|
|
|
Service Code
|
MSDRG 580
|
| Min. Negotiated Rate |
$16,818.51 |
| Max. Negotiated Rate |
$46,755.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,818.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,715.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,141.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,736.50
|
| Rate for Payer: Anthem Medicare Advantage |
$16,818.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,818.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,818.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,818.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,679.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,818.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,058.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,818.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,818.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,818.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,818.51
|
| Rate for Payer: NAPHCARE Commercial |
$25,227.76
|
| Rate for Payer: Quartz Medicare Advantage |
$16,818.51
|
| Rate for Payer: The Alliance Commercial |
$46,755.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,818.51
|
| Rate for Payer: United Healthcare PPO |
$26,515.13
|
| Rate for Payer: Wellcare Medicare |
$16,818.51
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC
|
Facility
|
IP
|
$89,176.00
|
|
|
Service Code
|
MSDRG 579
|
| Min. Negotiated Rate |
$32,077.72 |
| Max. Negotiated Rate |
$89,176.00 |
| Rate for Payer: Aetna Managed Medicare |
$32,077.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,073.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,710.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,028.52
|
| Rate for Payer: Anthem Medicare Advantage |
$32,077.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,077.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,077.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,077.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,646.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,077.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65,172.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,077.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,077.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,077.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,077.72
|
| Rate for Payer: NAPHCARE Commercial |
$48,116.58
|
| Rate for Payer: Quartz Medicare Advantage |
$32,077.72
|
| Rate for Payer: The Alliance Commercial |
$89,176.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,077.72
|
| Rate for Payer: United Healthcare PPO |
$50,737.94
|
| Rate for Payer: Wellcare Medicare |
$32,077.72
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$36,124.00
|
|
|
Service Code
|
MSDRG 581
|
| Min. Negotiated Rate |
$12,994.16 |
| Max. Negotiated Rate |
$36,124.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,994.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,323.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,709.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,625.30
|
| Rate for Payer: Anthem Medicare Advantage |
$12,994.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,994.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,994.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,994.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,895.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,994.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,260.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,994.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,994.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,994.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,994.16
|
| Rate for Payer: NAPHCARE Commercial |
$19,491.24
|
| Rate for Payer: Quartz Medicare Advantage |
$12,994.16
|
| Rate for Payer: The Alliance Commercial |
$36,124.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,994.16
|
| Rate for Payer: United Healthcare PPO |
$20,444.25
|
| Rate for Payer: Wellcare Medicare |
$12,994.16
|
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
|
IP
|
$68,144.00
|
|
|
Service Code
|
MSDRG 253
|
| Min. Negotiated Rate |
$24,512.18 |
| Max. Negotiated Rate |
$68,144.00 |
| Rate for Payer: Aetna Managed Medicare |
$24,512.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53,499.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41,006.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,958.90
|
| Rate for Payer: Anthem Medicare Advantage |
$24,512.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,512.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,512.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,512.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,247.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,512.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49,746.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,512.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,512.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,512.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,512.18
|
| Rate for Payer: NAPHCARE Commercial |
$36,768.27
|
| Rate for Payer: Quartz Medicare Advantage |
$24,512.18
|
| Rate for Payer: The Alliance Commercial |
$68,144.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,512.18
|
| Rate for Payer: United Healthcare PPO |
$38,728.25
|
| Rate for Payer: Wellcare Medicare |
$24,512.18
|
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
|
IP
|
$89,484.00
|
|
|
Service Code
|
MSDRG 252
|
| Min. Negotiated Rate |
$32,188.64 |
| Max. Negotiated Rate |
$89,484.00 |
| Rate for Payer: United Healthcare PPO |
$50,914.04
|
| Rate for Payer: Wellcare Medicare |
$32,188.64
|
| Rate for Payer: Aetna Managed Medicare |
$32,188.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,283.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,871.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,181.30
|
| Rate for Payer: Anthem Medicare Advantage |
$32,188.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,188.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,188.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,188.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,815.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,188.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65,399.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,188.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,188.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,188.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,188.64
|
| Rate for Payer: NAPHCARE Commercial |
$48,282.96
|
| Rate for Payer: Quartz Medicare Advantage |
$32,188.64
|
| Rate for Payer: The Alliance Commercial |
$89,484.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,188.64
|
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$46,450.00
|
|
|
Service Code
|
MSDRG 254
|
| Min. Negotiated Rate |
$16,708.54 |
| Max. Negotiated Rate |
$46,450.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,708.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,505.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,980.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,583.72
|
| Rate for Payer: Anthem Medicare Advantage |
$16,708.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,708.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,708.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,708.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,510.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,708.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,834.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,708.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,708.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,708.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,708.54
|
| Rate for Payer: NAPHCARE Commercial |
$25,062.81
|
| Rate for Payer: Quartz Medicare Advantage |
$16,708.54
|
| Rate for Payer: The Alliance Commercial |
$46,450.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,708.54
|
| Rate for Payer: United Healthcare PPO |
$26,340.55
|
| Rate for Payer: Wellcare Medicare |
$16,708.54
|
|
|
OT Iontophoresis Charges
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
2468806
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$282.44 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$184.20
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
OT Iontophoresis Charges
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
2468806
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$1,228.00 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Aetna Managed Medicare |
$85.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.80
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$199.55
|
| Rate for Payer: Quartz Medicare Advantage |
$184.20
|
| Rate for Payer: The Alliance Commercial |
$1,228.00
|
| Rate for Payer: United Healthcare PPO |
$230.25
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
OTITIS MEDIA AND URI WITH MCC
|
Facility
|
IP
|
$31,910.00
|
|
|
Service Code
|
MSDRG 152
|
| Min. Negotiated Rate |
$11,478.37 |
| Max. Negotiated Rate |
$31,910.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,478.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,966.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,136.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,180.82
|
| Rate for Payer: Anthem Medicare Advantage |
$11,478.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,478.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,478.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,478.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,182.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,478.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,169.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,478.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,478.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,478.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,478.37
|
| Rate for Payer: NAPHCARE Commercial |
$17,217.56
|
| Rate for Payer: Quartz Medicare Advantage |
$11,478.37
|
| Rate for Payer: The Alliance Commercial |
$31,910.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,478.37
|
| Rate for Payer: United Healthcare PPO |
$18,038.06
|
| Rate for Payer: Wellcare Medicare |
$11,478.37
|
|
