|
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
|
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
|
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, 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
|
|
|
Orchiectomy, simple (including subcapsular), with or without testicular prosthesis, scrotal or inguinal approach
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 54520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| 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 |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,709.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,799.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,709.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,709.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,709.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,709.65
|
| Rate for Payer: NAPHCARE Commercial |
$5,564.47
|
| Rate for Payer: Quartz Medicare Advantage |
$3,709.65
|
| Rate for Payer: The Alliance Commercial |
$14,838.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,709.65
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
ORCHIOPEXY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960260
|
|
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
|
|
|
ORCHIOPEXY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960260
|
|
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
|
|
|
Orchiopexy, inguinal or scrotal approach
|
Facility
|
OP
|
$15,071.89
|
|
|
Service Code
|
CPT 54640
|
|
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
|
|
|
Organic Acids, Full Panel, Urine
|
Facility
|
OP
|
$969.00
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
978030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$927.14 |
| Rate for Payer: Aetna Commercial |
$906.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.67
|
| Rate for Payer: Aetna Managed Medicare |
$24.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.74
|
| Rate for Payer: Anthem Medicare Advantage |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.54
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna Commercial |
$927.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.54
|
| Rate for Payer: Health EOS Commercial |
$896.91
|
| Rate for Payer: HFN Commercial |
$927.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.54
|
| Rate for Payer: Multiplan Commercial |
$806.21
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$927.14
|
| Rate for Payer: Quartz Beloit One Network |
$493.80
|
| Rate for Payer: Quartz Commercial |
$655.04
|
| Rate for Payer: Quartz Medicare Advantage |
$24.54
|
| Rate for Payer: The Alliance Commercial |
$98.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.54
|
| Rate for Payer: United Healthcare PPO |
$755.82
|
| Rate for Payer: WEA Trust Commercial |
$554.27
|
| Rate for Payer: Wellcare Medicare |
$24.54
|
| Rate for Payer: WPS Commercial |
$746.42
|
|
|
Organic Acids, Full Panel, Urine
|
Facility
|
IP
|
$969.00
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
978030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$493.80 |
| Max. Negotiated Rate |
$927.14 |
| Rate for Payer: Aetna Commercial |
$906.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$534.11
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna Commercial |
$927.14
|
| Rate for Payer: Health EOS Commercial |
$896.91
|
| Rate for Payer: HFN Commercial |
$927.14
|
| Rate for Payer: Multiplan Commercial |
$806.21
|
| Rate for Payer: Preferred Network Access Commercial |
$927.14
|
| Rate for Payer: Quartz Beloit One Network |
$493.80
|
| Rate for Payer: Quartz Commercial |
$604.66
|
| Rate for Payer: WEA Trust Commercial |
$554.27
|
| Rate for Payer: WPS Commercial |
$746.42
|
|
|
Organic Acids, Full Panel, Urine
|
Professional
|
Both
|
$969.00
|
|
|
Service Code
|
CPT 83918
|
| Hospital Charge Code |
978030
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.54 |
| Max. Negotiated Rate |
$957.37 |
| Rate for Payer: Aetna Commercial |
$957.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$866.67
|
| Rate for Payer: Aetna Managed Medicare |
$24.54
|
| Rate for Payer: Anthem Medicare Advantage |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.54
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cash Price |
$290.70
|
| Rate for Payer: Cigna Commercial |
$957.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$503.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.54
|
| Rate for Payer: Health EOS Commercial |
$917.06
|
| Rate for Payer: HFN Commercial |
$957.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.54
|
| Rate for Payer: Multiplan Commercial |
$806.21
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$957.37
|
| Rate for Payer: Quartz Beloit One Network |
$443.41
|
| Rate for Payer: Quartz Commercial |
$574.42
|
| Rate for Payer: Quartz Medicare Advantage |
$24.54
|
| Rate for Payer: The Alliance Commercial |
$96.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.54
|
| Rate for Payer: WEA Trust Commercial |
$554.27
|
| Rate for Payer: WPS Commercial |
$107.99
|
|
|
ORGANIC BEHAVIORAL HEALTH DISTURBANCES
|
Facility
|
OP
|
$31.50
|
|
|
Service Code
|
EAPG 00827
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$31.50 |
| Rate for Payer: Anthem Medicaid |
$30.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$30.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.28
|
| Rate for Payer: Dean Health Medicaid |
$30.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30.28
|
| Rate for Payer: Managed Health Services Medicaid |
$31.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$30.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.28
|
| Rate for Payer: United Healthcare Medicaid |
$30.28
|
|
|
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY
|
Facility
|
IP
|
$48,910.16
|
|
|
Service Code
|
MSDRG 884
|
| Min. Negotiated Rate |
$12,828.06 |
| Max. Negotiated Rate |
$48,910.16 |
| Rate for Payer: Aetna Managed Medicare |
$12,828.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,104.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,907.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,564.01
|
| Rate for Payer: Anthem Medicare Advantage |
$12,828.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,828.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,828.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,828.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,378.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,828.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,828.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,828.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,828.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,828.06
|
| Rate for Payer: NAPHCARE Commercial |
$19,242.09
|
| Rate for Payer: Quartz Medicare Advantage |
$12,828.06
|
| Rate for Payer: The Alliance Commercial |
$48,910.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,828.06
|
| Rate for Payer: United Healthcare PPO |
$27,738.36
|
| Rate for Payer: Wellcare Medicare |
$12,828.06
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$7,190.01
|
|
|
Service Code
|
APR-DRG 7572
|
| Min. Negotiated Rate |
$6,386.62 |
| Max. Negotiated Rate |
$7,190.01 |
| Rate for Payer: Anthem Medicaid |
$6,884.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,884.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,884.83
|
| Rate for Payer: Dean Health Medicaid |
$6,884.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,386.62
|
| Rate for Payer: Managed Health Services Medicaid |
$7,190.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,884.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,884.83
|
| Rate for Payer: United Healthcare Medicaid |
$6,884.83
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$4,822.57
|
|
|
Service Code
|
APR-DRG 7571
|
| Min. Negotiated Rate |
$4,283.71 |
| Max. Negotiated Rate |
$4,822.57 |
| Rate for Payer: Anthem Medicaid |
$4,617.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,617.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,617.88
|
| Rate for Payer: Dean Health Medicaid |
$4,617.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,283.71
|
| Rate for Payer: Managed Health Services Medicaid |
$4,822.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,617.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,617.88
|
| Rate for Payer: United Healthcare Medicaid |
$4,617.88
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$25,428.10
|
|
|
Service Code
|
APR-DRG 7574
|
| Min. Negotiated Rate |
$22,586.82 |
| Max. Negotiated Rate |
$25,428.10 |
| Rate for Payer: Anthem Medicaid |
$24,348.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$24,348.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24,348.81
|
| Rate for Payer: Dean Health Medicaid |
$24,348.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22,586.82
|
| Rate for Payer: Managed Health Services Medicaid |
$25,428.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,348.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24,348.81
|
| Rate for Payer: United Healthcare Medicaid |
$24,348.81
|
|
|
ORGANIC MENTAL HEALTH CONDITIONS AND DISTURBANCES
|
Facility
|
IP
|
$10,346.61
|
|
|
Service Code
|
APR-DRG 7573
|
| Min. Negotiated Rate |
$9,190.50 |
| Max. Negotiated Rate |
$10,346.61 |
| Rate for Payer: Anthem Medicaid |
$9,907.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,907.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,907.45
|
| Rate for Payer: Dean Health Medicaid |
$9,907.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$10,346.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,907.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,907.45
|
| Rate for Payer: United Healthcare Medicaid |
$9,907.45
|
|
|
ORGAN OR DISEASE ORIENTED PANELS
|
Facility
|
OP
|
$1.61
|
|
|
Service Code
|
EAPG 00403
|
| Min. Negotiated Rate |
$1.54 |
| Max. Negotiated Rate |
$1.61 |
| Rate for Payer: Anthem Medicaid |
$1.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.54
|
| Rate for Payer: Dean Health Medicaid |
$1.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1.54
|
| Rate for Payer: Managed Health Services Medicaid |
$1.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$1.54
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1.54
|
| Rate for Payer: United Healthcare Medicaid |
$1.54
|
|
|
ORGAN PROCUREMENT
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
ORGAN PROCUREMENT
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960261
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
ORISE GEL M00519201
|
Facility
|
OP
|
$1,466.00
|
|
| Hospital Charge Code |
5520803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.90 |
| Max. Negotiated Rate |
$1,402.67 |
| Rate for Payer: Aetna Commercial |
$1,372.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.19
|
| Rate for Payer: Aetna Managed Medicare |
$426.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$731.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.06
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,402.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.21
|
| Rate for Payer: Health EOS Commercial |
$1,356.93
|
| Rate for Payer: HFN Commercial |
$1,402.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.48
|
| Rate for Payer: Multiplan Commercial |
$1,219.71
|
| Rate for Payer: NAPHCARE Commercial |
$914.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.67
|
| Rate for Payer: Quartz Beloit One Network |
$747.07
|
| Rate for Payer: Quartz Commercial |
$991.02
|
| Rate for Payer: Quartz Medicare Advantage |
$914.78
|
| Rate for Payer: The Alliance Commercial |
$762.32
|
| Rate for Payer: WEA Trust Commercial |
$838.55
|
| Rate for Payer: WPS Commercial |
$1,129.26
|
|
|
ORISE GEL M00519201
|
Facility
|
IP
|
$1,466.00
|
|
| Hospital Charge Code |
5520803
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$747.07 |
| Max. Negotiated Rate |
$1,402.67 |
| Rate for Payer: Aetna Commercial |
$1,372.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.06
|
| Rate for Payer: Cash Price |
$439.80
|
| Rate for Payer: Cigna Commercial |
$1,402.67
|
| Rate for Payer: Health EOS Commercial |
$1,356.93
|
| Rate for Payer: HFN Commercial |
$1,402.67
|
| Rate for Payer: Multiplan Commercial |
$1,219.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.67
|
| Rate for Payer: Quartz Beloit One Network |
$747.07
|
| Rate for Payer: Quartz Commercial |
$914.78
|
| Rate for Payer: WEA Trust Commercial |
$838.55
|
| Rate for Payer: WPS Commercial |
$1,129.26
|
|
|
Oropharyngeal Airway
|
Facility
|
IP
|
$2.00
|
|
| Hospital Charge Code |
3149566
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
