|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
IP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2587001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,864.63 |
| Max. Negotiated Rate |
$3,500.93 |
| Rate for Payer: Aetna Commercial |
$3,424.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,272.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,016.84
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,500.93
|
| Rate for Payer: Health EOS Commercial |
$3,386.77
|
| Rate for Payer: HFN Commercial |
$3,500.93
|
| Rate for Payer: Multiplan Commercial |
$3,044.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,500.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.63
|
| Rate for Payer: Quartz Commercial |
$2,283.22
|
| Rate for Payer: WEA Trust Commercial |
$2,092.95
|
| Rate for Payer: WPS Commercial |
$2,818.53
|
|
|
NM Tumor Whole Body Scan - Oncoscint
|
Facility
|
OP
|
$3,659.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2587001
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$3,424.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,272.61
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,473.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,378.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,159.97
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,016.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cash Price |
$1,097.70
|
| Rate for Payer: Cigna Commercial |
$3,500.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,129.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,386.77
|
| Rate for Payer: HFN Commercial |
$3,500.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,125.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.42
|
| Rate for Payer: Multiplan Commercial |
$3,044.29
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,500.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,864.63
|
| Rate for Payer: Quartz Commercial |
$2,473.48
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$2,092.95
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$2,818.53
|
|
|
NM Ureteral Reflux Study
|
Facility
|
IP
|
$1,433.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
631395
|
| Min. Negotiated Rate |
$730.26 |
| Max. Negotiated Rate |
$1,371.09 |
| Rate for Payer: Aetna Commercial |
$1,341.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.87
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,371.09
|
| Rate for Payer: Health EOS Commercial |
$1,326.38
|
| Rate for Payer: HFN Commercial |
$1,371.09
|
| Rate for Payer: Multiplan Commercial |
$1,192.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,371.09
|
| Rate for Payer: Quartz Beloit One Network |
$730.26
|
| Rate for Payer: Quartz Commercial |
$894.19
|
| Rate for Payer: WEA Trust Commercial |
$819.68
|
| Rate for Payer: WPS Commercial |
$1,103.84
|
|
|
NM Ureteral Reflux Study
|
Professional
|
Both
|
$1,490.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
2587003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$219.43 |
| Max. Negotiated Rate |
$1,472.12 |
| Rate for Payer: Aetna Commercial |
$1,472.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,332.66
|
| Rate for Payer: Aetna Managed Medicare |
$219.43
|
| Rate for Payer: Anthem Medicare Advantage |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.43
|
| 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 |
$1,472.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$774.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.43
|
| Rate for Payer: Health EOS Commercial |
$1,410.14
|
| Rate for Payer: HFN Commercial |
$1,472.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.43
|
| Rate for Payer: Multiplan Commercial |
$1,239.68
|
| Rate for Payer: NAPHCARE Commercial |
$329.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,472.12
|
| Rate for Payer: Quartz Beloit One Network |
$681.82
|
| Rate for Payer: Quartz Commercial |
$883.27
|
| Rate for Payer: Quartz Medicare Advantage |
$219.43
|
| Rate for Payer: The Alliance Commercial |
$833.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.43
|
| Rate for Payer: WEA Trust Commercial |
$852.28
|
| Rate for Payer: WPS Commercial |
$1,097.15
|
|
|
NM Ureteral Reflux Study
|
Facility
|
OP
|
$1,433.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
631395
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,682.84 |
| Rate for Payer: Aetna Commercial |
$1,341.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.68
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$968.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$745.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$715.35
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$789.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cash Price |
$429.90
|
| Rate for Payer: Cigna Commercial |
$1,371.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$834.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,326.38
|
| Rate for Payer: HFN Commercial |
$1,371.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,192.26
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,371.09
|
| Rate for Payer: Quartz Beloit One Network |
$730.26
|
| Rate for Payer: Quartz Commercial |
$968.71
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: WEA Trust Commercial |
$819.68
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,103.84
|
|
|
NM Ureteral Reflux Study
|
Facility
|
IP
|
$1,490.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
2587003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$759.30 |
| Max. Negotiated Rate |
$1,425.63 |
| Rate for Payer: Aetna Commercial |
$1,394.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,332.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$821.29
|
| Rate for Payer: Cash Price |
$447.00
|
| Rate for Payer: Cigna Commercial |
$1,425.63
|
| Rate for Payer: Health EOS Commercial |
$1,379.14
|
| Rate for Payer: HFN Commercial |
$1,425.63
|
| Rate for Payer: Multiplan Commercial |
$1,239.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,425.63
|
| Rate for Payer: Quartz Beloit One Network |
$759.30
|
| Rate for Payer: Quartz Commercial |
$929.76
|
| Rate for Payer: WEA Trust Commercial |
$852.28
|
| Rate for Payer: WPS Commercial |
$1,147.75
|
|
|
NM Ureteral Reflux Study
|
Professional
|
Both
|
$1,433.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
631395
|
| Min. Negotiated Rate |
$219.43 |
| Max. Negotiated Rate |
$1,415.80 |
| Rate for Payer: Aetna Commercial |
$1,415.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,281.68
|
| Rate for Payer: Aetna Managed Medicare |
$219.43
|
| Rate for Payer: Anthem Medicare Advantage |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$219.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$219.43
|
| 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 |
$1,415.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$745.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$219.43
|
| Rate for Payer: Health EOS Commercial |
$1,356.19
|
| Rate for Payer: HFN Commercial |
$1,415.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$782.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$219.43
|
| Rate for Payer: Multiplan Commercial |
$1,192.26
|
| Rate for Payer: NAPHCARE Commercial |
$329.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,415.80
|
| Rate for Payer: Quartz Beloit One Network |
$655.74
|
| Rate for Payer: Quartz Commercial |
$849.48
|
| Rate for Payer: Quartz Medicare Advantage |
$219.43
|
| Rate for Payer: The Alliance Commercial |
$833.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$219.43
|
| Rate for Payer: WEA Trust Commercial |
$819.68
|
| Rate for Payer: WPS Commercial |
$1,097.15
|
|
|
NM Ureteral Reflux Study
|
Facility
|
OP
|
$1,490.00
|
|
|
Service Code
|
CPT 78740
|
| Hospital Charge Code |
2587003
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,394.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,332.66
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,589.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,271.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,208.30
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$821.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| 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 |
$1,425.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$867.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,379.14
|
| Rate for Payer: HFN Commercial |
$1,425.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,239.68
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,425.63
|
| Rate for Payer: Quartz Beloit One Network |
$759.30
|
| Rate for Payer: Quartz Commercial |
$1,007.24
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$852.28
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,147.75
|
|
|
NOCTURNAL POLYSOMNOGRAM-SAS
|
Facility
|
OP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3058221
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,462.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$5,183.57
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$5,981.04
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
|
NOCTURNAL POLYSOMNOGRAM-SAS
|
Facility
|
IP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3058221
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,907.61 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$4,784.83
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
|
NOCTURNAL PSG FOLLOW UP
|
Facility
|
OP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3058222
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,462.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$5,183.57
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: United Healthcare PPO |
$5,981.04
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
|
NOCTURNAL PSG FOLLOW UP
|
Facility
|
IP
|
$7,668.00
|
|
|
Service Code
|
CPT 95811
|
| Hospital Charge Code |
3058222
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$3,907.61 |
| Max. Negotiated Rate |
$7,336.74 |
| Rate for Payer: Aetna Commercial |
$7,177.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,858.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,226.60
|
| Rate for Payer: Cash Price |
$2,300.40
|
| Rate for Payer: Cigna Commercial |
$7,336.74
|
| Rate for Payer: Health EOS Commercial |
$7,097.50
|
| Rate for Payer: HFN Commercial |
$7,336.74
|
| Rate for Payer: Multiplan Commercial |
$6,379.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,907.61
|
| Rate for Payer: Quartz Commercial |
$4,784.83
|
| Rate for Payer: WEA Trust Commercial |
$4,386.10
|
| Rate for Payer: WPS Commercial |
$5,906.66
|
|
|
Nonadherent dressing charge
|
Facility
|
IP
|
$28.00
|
|
| Hospital Charge Code |
2844892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Nonadherent dressing charge
|
Facility
|
OP
|
$28.00
|
|
| Hospital Charge Code |
2844892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$14.56
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
Nonadhesive wrap charge
|
Facility
|
OP
|
$62.00
|
|
| Hospital Charge Code |
2844903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.36
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$38.69
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$38.69
|
| Rate for Payer: The Alliance Commercial |
$32.24
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
Nonadhesive wrap charge
|
Facility
|
IP
|
$62.00
|
|
| Hospital Charge Code |
2844903
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
NON-BACTERIAL GASTROENTERITIS, NAUSEA AND VOMITING
|
Facility
|
OP
|
$45.91
|
|
|
Service Code
|
EAPG 00627
|
| Min. Negotiated Rate |
$44.14 |
| Max. Negotiated Rate |
$45.91 |
| Rate for Payer: Anthem Medicaid |
$44.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$44.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.14
|
| Rate for Payer: Dean Health Medicaid |
$44.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.14
|
| Rate for Payer: Managed Health Services Medicaid |
$45.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.14
|
| Rate for Payer: United Healthcare Medicaid |
$44.14
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC
|
Facility
|
IP
|
$59,904.00
|
|
|
Service Code
|
MSDRG 098
|
| Min. Negotiated Rate |
$18,081.58 |
| Max. Negotiated Rate |
$59,904.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,081.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50,072.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,380.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,463.94
|
| Rate for Payer: Anthem Medicare Advantage |
$18,081.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,081.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,081.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,081.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,478.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,081.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,693.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,081.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,081.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,081.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,081.58
|
| Rate for Payer: NAPHCARE Commercial |
$27,122.36
|
| Rate for Payer: Quartz Medicare Advantage |
$18,081.58
|
| Rate for Payer: The Alliance Commercial |
$59,904.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,081.58
|
| Rate for Payer: United Healthcare PPO |
$34,015.76
|
| Rate for Payer: Wellcare Medicare |
$18,081.58
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC
|
Facility
|
IP
|
$100,891.44
|
|
|
Service Code
|
MSDRG 097
|
| Min. Negotiated Rate |
$28,166.66 |
| Max. Negotiated Rate |
$100,891.44 |
| Rate for Payer: Aetna Managed Medicare |
$28,166.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78,806.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60,404.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57,388.32
|
| Rate for Payer: Anthem Medicare Advantage |
$28,166.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,166.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,166.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,166.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63,706.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,166.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73,756.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,166.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,166.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,166.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,166.66
|
| Rate for Payer: NAPHCARE Commercial |
$42,249.99
|
| Rate for Payer: Quartz Medicare Advantage |
$28,166.66
|
| Rate for Payer: The Alliance Commercial |
$100,891.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,166.66
|
| Rate for Payer: United Healthcare PPO |
$57,420.25
|
| Rate for Payer: Wellcare Medicare |
$28,166.66
|
|
|
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$36,835.76
|
|
|
Service Code
|
MSDRG 099
|
| Min. Negotiated Rate |
$10,940.30 |
| Max. Negotiated Rate |
$36,835.76 |
| Rate for Payer: Aetna Managed Medicare |
$10,940.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,726.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,785.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,647.34
|
| Rate for Payer: Anthem Medicare Advantage |
$10,940.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,940.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,940.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,940.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,030.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,940.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,773.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,940.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,940.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,940.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,940.30
|
| Rate for Payer: NAPHCARE Commercial |
$16,410.45
|
| Rate for Payer: Quartz Medicare Advantage |
$10,940.30
|
| Rate for Payer: The Alliance Commercial |
$36,835.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,940.30
|
| Rate for Payer: United Healthcare PPO |
$20,843.64
|
| Rate for Payer: Wellcare Medicare |
$10,940.30
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
OP
|
$29.24
|
|
|
Service Code
|
EAPG 00519
|
| Min. Negotiated Rate |
$28.11 |
| Max. Negotiated Rate |
$29.24 |
| Rate for Payer: Anthem Medicaid |
$28.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.11
|
| Rate for Payer: Dean Health Medicaid |
$28.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.11
|
| Rate for Payer: Managed Health Services Medicaid |
$29.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$28.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.11
|
| Rate for Payer: United Healthcare Medicaid |
$28.11
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$12,801.73
|
|
|
Service Code
|
APR-DRG 0502
|
| Min. Negotiated Rate |
$11,371.30 |
| Max. Negotiated Rate |
$12,801.73 |
| Rate for Payer: Anthem Medicaid |
$12,258.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,258.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,258.36
|
| Rate for Payer: Dean Health Medicaid |
$12,258.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,371.30
|
| Rate for Payer: Managed Health Services Medicaid |
$12,801.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,258.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,258.36
|
| Rate for Payer: United Healthcare Medicaid |
$12,258.36
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$19,465.65
|
|
|
Service Code
|
APR-DRG 0503
|
| Min. Negotiated Rate |
$17,290.60 |
| Max. Negotiated Rate |
$19,465.65 |
| Rate for Payer: Anthem Medicaid |
$18,639.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,639.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,639.43
|
| Rate for Payer: Dean Health Medicaid |
$18,639.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,290.60
|
| Rate for Payer: Managed Health Services Medicaid |
$19,465.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,639.43
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,639.43
|
| Rate for Payer: United Healthcare Medicaid |
$18,639.43
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$7,102.33
|
|
|
Service Code
|
APR-DRG 0501
|
| Min. Negotiated Rate |
$6,308.73 |
| Max. Negotiated Rate |
$7,102.33 |
| Rate for Payer: Anthem Medicaid |
$6,800.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,800.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,800.87
|
| Rate for Payer: Dean Health Medicaid |
$6,800.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,308.73
|
| Rate for Payer: Managed Health Services Medicaid |
$7,102.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,800.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,800.87
|
| Rate for Payer: United Healthcare Medicaid |
$6,800.87
|
|
|
NON-BACTERIAL INFECTIONS OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS
|
Facility
|
IP
|
$33,407.26
|
|
|
Service Code
|
APR-DRG 0504
|
| Min. Negotiated Rate |
$29,674.41 |
| Max. Negotiated Rate |
$33,407.26 |
| Rate for Payer: Anthem Medicaid |
$31,989.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31,989.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31,989.29
|
| Rate for Payer: Dean Health Medicaid |
$31,989.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,674.41
|
| Rate for Payer: Managed Health Services Medicaid |
$33,407.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,989.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31,989.29
|
| Rate for Payer: United Healthcare Medicaid |
$31,989.29
|
|
