|
Opiates serum
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
CPT 80361
|
| Hospital Charge Code |
5144621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$83.26 |
| Rate for Payer: Aetna Commercial |
$58.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$58.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.82
|
| Rate for Payer: Health EOS Commercial |
$55.84
|
| Rate for Payer: HFN Commercial |
$58.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$58.29
|
| Rate for Payer: Quartz Beloit One Network |
$27.00
|
| Rate for Payer: Quartz Commercial |
$34.98
|
| Rate for Payer: The Alliance Commercial |
$30.68
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
OP
|
$104.82
|
|
|
Service Code
|
EAPG 00840
|
| Min. Negotiated Rate |
$100.79 |
| Max. Negotiated Rate |
$104.82 |
| Rate for Payer: Anthem Medicaid |
$100.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$100.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.79
|
| Rate for Payer: Dean Health Medicaid |
$100.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$100.79
|
| Rate for Payer: Managed Health Services Medicaid |
$104.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$100.79
|
| Rate for Payer: United Healthcare Medicaid |
$100.79
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$7,979.16
|
|
|
Service Code
|
APR-DRG 7733
|
| Min. Negotiated Rate |
$7,087.59 |
| Max. Negotiated Rate |
$7,979.16 |
| Rate for Payer: Anthem Medicaid |
$7,640.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,640.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,640.49
|
| Rate for Payer: Dean Health Medicaid |
$7,640.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,087.59
|
| Rate for Payer: Managed Health Services Medicaid |
$7,979.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,640.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,640.49
|
| Rate for Payer: United Healthcare Medicaid |
$7,640.49
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,121.11
|
|
|
Service Code
|
APR-DRG 7732
|
| Min. Negotiated Rate |
$3,660.62 |
| Max. Negotiated Rate |
$4,121.11 |
| Rate for Payer: Anthem Medicaid |
$3,946.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,946.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,946.19
|
| Rate for Payer: Dean Health Medicaid |
$3,946.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,660.62
|
| Rate for Payer: Managed Health Services Medicaid |
$4,121.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,946.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,946.19
|
| Rate for Payer: United Healthcare Medicaid |
$3,946.19
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$2,805.86
|
|
|
Service Code
|
APR-DRG 7731
|
| Min. Negotiated Rate |
$2,492.34 |
| Max. Negotiated Rate |
$2,805.86 |
| Rate for Payer: Anthem Medicaid |
$2,686.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,686.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,686.76
|
| Rate for Payer: Dean Health Medicaid |
$2,686.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,492.34
|
| Rate for Payer: Managed Health Services Medicaid |
$2,805.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,686.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,686.76
|
| Rate for Payer: United Healthcare Medicaid |
$2,686.76
|
|
|
OPIOID ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$17,010.52
|
|
|
Service Code
|
APR-DRG 7734
|
| Min. Negotiated Rate |
$15,109.81 |
| Max. Negotiated Rate |
$17,010.52 |
| Rate for Payer: Anthem Medicaid |
$16,288.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,288.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,288.51
|
| Rate for Payer: Dean Health Medicaid |
$16,288.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,109.81
|
| Rate for Payer: Managed Health Services Medicaid |
$17,010.52
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,288.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,288.51
|
| Rate for Payer: United Healthcare Medicaid |
$16,288.51
|
|
|
OPTION ELITE IVC FILTER
|
Facility
|
IP
|
$7,260.00
|
|
| Hospital Charge Code |
6175145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,699.70 |
| Max. Negotiated Rate |
$6,946.37 |
| Rate for Payer: Aetna Commercial |
$6,795.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,493.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,001.71
|
| Rate for Payer: Cash Price |
$2,178.00
|
| Rate for Payer: Cigna Commercial |
$6,946.37
|
| Rate for Payer: Health EOS Commercial |
$6,719.86
|
| Rate for Payer: HFN Commercial |
$6,946.37
|
| Rate for Payer: Multiplan Commercial |
$6,040.32
|
| Rate for Payer: Preferred Network Access Commercial |
$6,946.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,699.70
|
| Rate for Payer: Quartz Commercial |
$4,530.24
|
| Rate for Payer: WEA Trust Commercial |
$4,152.72
|
| Rate for Payer: WPS Commercial |
$5,592.38
|
|
|
OPTION ELITE IVC FILTER
|
Facility
|
OP
|
$7,260.00
|
|
| Hospital Charge Code |
6175145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,114.11 |
| Max. Negotiated Rate |
$6,946.37 |
| Rate for Payer: Aetna Commercial |
$6,795.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,493.34
|
| Rate for Payer: Aetna Managed Medicare |
$2,114.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,907.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,775.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,624.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,001.71
|
| Rate for Payer: Cash Price |
$2,178.00
|
| Rate for Payer: Cigna Commercial |
$6,946.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,225.32
|
| Rate for Payer: Health EOS Commercial |
$6,719.86
|
| Rate for Payer: HFN Commercial |
$6,946.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,662.80
|
| Rate for Payer: Multiplan Commercial |
$6,040.32
|
| Rate for Payer: NAPHCARE Commercial |
$4,530.24
|
| Rate for Payer: Preferred Network Access Commercial |
$6,946.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,699.70
|
| Rate for Payer: Quartz Commercial |
$4,907.76
|
| Rate for Payer: Quartz Medicare Advantage |
$4,530.24
|
| Rate for Payer: The Alliance Commercial |
$3,775.20
|
| Rate for Payer: WEA Trust Commercial |
$4,152.72
|
| Rate for Payer: WPS Commercial |
$5,592.38
|
|
|
OPTOKINETIC NYSTAGMUS TEST 92544
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 92544
|
| Hospital Charge Code |
3015334
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.57 |
| Max. Negotiated Rate |
$70.26 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.57
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.57
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.57
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$26.35
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$17.57
|
| Rate for Payer: The Alliance Commercial |
$43.91
|
| Rate for Payer: United Healthcare Medicaid |
$25.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.57
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$70.26
|
|
|
Orange (prong O.D.: 4.0mm) - RAM Cannula
|
Facility
|
OP
|
$223.00
|
|
| Hospital Charge Code |
5983678
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$64.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.94
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$139.15
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$139.15
|
| Rate for Payer: The Alliance Commercial |
$115.96
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Orange (prong O.D.: 4.0mm) - RAM Cannula
|
Facility
|
IP
|
$223.00
|
|
| Hospital Charge Code |
5983678
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
OraRisk HPV
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
3710842
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$294.42 |
| Rate for Payer: Aetna Commercial |
$294.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$294.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$282.03
|
| Rate for Payer: HFN Commercial |
$294.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$294.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.36
|
| Rate for Payer: Quartz Commercial |
$176.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
OraRisk HPV
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
3710842
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$285.13 |
| Rate for Payer: Aetna Commercial |
$278.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.26
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$285.13
|
| Rate for Payer: Health EOS Commercial |
$275.83
|
| Rate for Payer: HFN Commercial |
$285.13
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: Preferred Network Access Commercial |
$285.13
|
| Rate for Payer: Quartz Beloit One Network |
$151.86
|
| Rate for Payer: Quartz Commercial |
$185.95
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: WPS Commercial |
$229.55
|
|
|
OraRisk HPV
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
3710842
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$285.13 |
| Rate for Payer: Aetna Commercial |
$278.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$285.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$173.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$275.83
|
| Rate for Payer: HFN Commercial |
$285.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$285.13
|
| Rate for Payer: Quartz Beloit One Network |
$151.86
|
| Rate for Payer: Quartz Commercial |
$201.45
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$232.44
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$229.55
|
|
|
ORBITAL BLOWOUT FRACTURE
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959853
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
ORBITAL BLOWOUT FRACTURE
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959853
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
ORBITAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$69,658.16
|
|
|
Service Code
|
MSDRG 113
|
| Min. Negotiated Rate |
$18,511.97 |
| Max. Negotiated Rate |
$69,658.16 |
| Rate for Payer: Aetna Managed Medicare |
$18,511.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51,299.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39,320.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37,356.91
|
| Rate for Payer: Anthem Medicare Advantage |
$18,511.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,511.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,511.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,511.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41,469.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,511.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,848.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,511.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,511.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,511.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,511.97
|
| Rate for Payer: NAPHCARE Commercial |
$27,767.95
|
| Rate for Payer: Quartz Medicare Advantage |
$18,511.97
|
| Rate for Payer: The Alliance Commercial |
$69,658.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,511.97
|
| Rate for Payer: United Healthcare PPO |
$39,585.85
|
| Rate for Payer: Wellcare Medicare |
$18,511.97
|
|
|
ORBITAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,391.76
|
|
|
Service Code
|
MSDRG 114
|
| Min. Negotiated Rate |
$10,868.33 |
| Max. Negotiated Rate |
$34,391.76 |
| Rate for Payer: Aetna Managed Medicare |
$10,868.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,521.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,627.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,497.98
|
| Rate for Payer: Anthem Medicare Advantage |
$10,868.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,868.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,868.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,868.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,864.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,868.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,980.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,868.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,868.33
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,868.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,868.33
|
| Rate for Payer: NAPHCARE Commercial |
$16,302.50
|
| Rate for Payer: Quartz Medicare Advantage |
$10,868.33
|
| Rate for Payer: The Alliance Commercial |
$34,391.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,868.33
|
| Rate for Payer: United Healthcare PPO |
$19,447.96
|
| Rate for Payer: Wellcare Medicare |
$10,868.33
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$9,031.36
|
|
|
Service Code
|
APR-DRG 0731
|
| Min. Negotiated Rate |
$8,022.22 |
| Max. Negotiated Rate |
$9,031.36 |
| Rate for Payer: Anthem Medicaid |
$8,648.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,648.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,648.02
|
| Rate for Payer: Dean Health Medicaid |
$8,648.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,022.22
|
| Rate for Payer: Managed Health Services Medicaid |
$9,031.36
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,648.02
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,648.02
|
| Rate for Payer: United Healthcare Medicaid |
$8,648.02
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$12,187.95
|
|
|
Service Code
|
APR-DRG 0732
|
| Min. Negotiated Rate |
$10,826.10 |
| Max. Negotiated Rate |
$12,187.95 |
| Rate for Payer: Anthem Medicaid |
$11,670.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,670.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,670.63
|
| Rate for Payer: Dean Health Medicaid |
$11,670.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,826.10
|
| Rate for Payer: Managed Health Services Medicaid |
$12,187.95
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,670.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,670.63
|
| Rate for Payer: United Healthcare Medicaid |
$11,670.63
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$32,355.06
|
|
|
Service Code
|
APR-DRG 0734
|
| Min. Negotiated Rate |
$28,739.79 |
| Max. Negotiated Rate |
$32,355.06 |
| Rate for Payer: Anthem Medicaid |
$30,981.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$30,981.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30,981.76
|
| Rate for Payer: Dean Health Medicaid |
$30,981.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28,739.79
|
| Rate for Payer: Managed Health Services Medicaid |
$32,355.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$30,981.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30,981.76
|
| Rate for Payer: United Healthcare Medicaid |
$30,981.76
|
|
|
ORBIT AND EYE PROCEDURES
|
Facility
|
IP
|
$18,238.08
|
|
|
Service Code
|
APR-DRG 0733
|
| Min. Negotiated Rate |
$16,200.20 |
| Max. Negotiated Rate |
$18,238.08 |
| Rate for Payer: Anthem Medicaid |
$17,463.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,463.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,463.97
|
| Rate for Payer: Dean Health Medicaid |
$17,463.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,200.20
|
| Rate for Payer: Managed Health Services Medicaid |
$18,238.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,463.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,463.97
|
| Rate for Payer: United Healthcare Medicaid |
$17,463.97
|
|
|
ORCHIECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
ORCHIECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 54530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,767.97 |
| Max. Negotiated Rate |
$15,071.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,767.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,767.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,767.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,767.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,767.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,016.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,767.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,767.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,767.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,767.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,651.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,767.97
|
| Rate for Payer: The Alliance Commercial |
$15,071.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,767.97
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,767.97
|
|
