|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$7,365.38
|
|
|
Service Code
|
APR-DRG 3641
|
| Min. Negotiated Rate |
$6,542.39 |
| Max. Negotiated Rate |
$7,365.38 |
| Rate for Payer: Anthem Medicaid |
$7,052.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,052.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,052.76
|
| Rate for Payer: Dean Health Medicaid |
$7,052.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,542.39
|
| Rate for Payer: Managed Health Services Medicaid |
$7,365.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,052.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,052.76
|
| Rate for Payer: United Healthcare Medicaid |
$7,052.76
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$9,732.82
|
|
|
Service Code
|
APR-DRG 3642
|
| Min. Negotiated Rate |
$8,645.30 |
| Max. Negotiated Rate |
$9,732.82 |
| Rate for Payer: Anthem Medicaid |
$9,319.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,319.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,319.72
|
| Rate for Payer: Dean Health Medicaid |
$9,319.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,645.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9,732.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,319.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,319.72
|
| Rate for Payer: United Healthcare Medicaid |
$9,319.72
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$16,046.01
|
|
|
Service Code
|
APR-DRG 3643
|
| Min. Negotiated Rate |
$14,253.06 |
| Max. Negotiated Rate |
$16,046.01 |
| Rate for Payer: Anthem Medicaid |
$15,364.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,364.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,364.94
|
| Rate for Payer: Dean Health Medicaid |
$15,364.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,253.06
|
| Rate for Payer: Managed Health Services Medicaid |
$16,046.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,364.94
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,364.94
|
| Rate for Payer: United Healthcare Medicaid |
$15,364.94
|
|
|
OTHER SKIN, SUBCUTANEOUS TISSUE AND RELATED PROCEDURES
|
Facility
|
IP
|
$27,006.39
|
|
|
Service Code
|
APR-DRG 3644
|
| Min. Negotiated Rate |
$23,988.76 |
| Max. Negotiated Rate |
$27,006.39 |
| Rate for Payer: Anthem Medicaid |
$25,860.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$25,860.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25,860.11
|
| Rate for Payer: Dean Health Medicaid |
$25,860.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23,988.76
|
| Rate for Payer: Managed Health Services Medicaid |
$27,006.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$25,860.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$25,860.11
|
| Rate for Payer: United Healthcare Medicaid |
$25,860.11
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$33,845.68
|
|
|
Service Code
|
APR-DRG 2234
|
| Min. Negotiated Rate |
$30,063.84 |
| Max. Negotiated Rate |
$33,845.68 |
| Rate for Payer: Anthem Medicaid |
$32,409.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,409.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,409.10
|
| Rate for Payer: Dean Health Medicaid |
$32,409.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,063.84
|
| Rate for Payer: Managed Health Services Medicaid |
$33,845.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,409.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,409.10
|
| Rate for Payer: United Healthcare Medicaid |
$32,409.10
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$18,851.87
|
|
|
Service Code
|
APR-DRG 2233
|
| Min. Negotiated Rate |
$16,745.40 |
| Max. Negotiated Rate |
$18,851.87 |
| Rate for Payer: Anthem Medicaid |
$18,051.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,051.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,051.70
|
| Rate for Payer: Dean Health Medicaid |
$18,051.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,745.40
|
| Rate for Payer: Managed Health Services Medicaid |
$18,851.87
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,051.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,051.70
|
| Rate for Payer: United Healthcare Medicaid |
$18,051.70
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$13,415.51
|
|
|
Service Code
|
APR-DRG 2232
|
| Min. Negotiated Rate |
$11,916.50 |
| Max. Negotiated Rate |
$13,415.51 |
| Rate for Payer: Anthem Medicaid |
$12,846.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,846.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,846.09
|
| Rate for Payer: Dean Health Medicaid |
$12,846.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,916.50
|
| Rate for Payer: Managed Health Services Medicaid |
$13,415.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,846.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,846.09
|
| Rate for Payer: United Healthcare Medicaid |
$12,846.09
|
|
|
OTHER SMALL AND LARGE BOWEL PROCEDURES
|
Facility
|
IP
|
$10,521.97
|
|
|
Service Code
|
APR-DRG 2231
|
| Min. Negotiated Rate |
$9,346.27 |
| Max. Negotiated Rate |
$10,521.97 |
| Rate for Payer: Anthem Medicaid |
$10,075.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,075.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,075.37
|
| Rate for Payer: Dean Health Medicaid |
$10,075.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,346.27
|
| Rate for Payer: Managed Health Services Medicaid |
$10,521.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,075.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,075.37
|
| Rate for Payer: United Healthcare Medicaid |
$10,075.37
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$7,453.06
|
|
|
Service Code
|
APR-DRG 2221
|
| Min. Negotiated Rate |
$6,620.28 |
| Max. Negotiated Rate |
$7,453.06 |
| Rate for Payer: Anthem Medicaid |
$7,136.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,136.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,136.72
|
| Rate for Payer: Dean Health Medicaid |
$7,136.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,620.28
|
| Rate for Payer: Managed Health Services Medicaid |
$7,453.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,136.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,136.72
|
| Rate for Payer: United Healthcare Medicaid |
$7,136.72
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$35,423.97
|
|
|
Service Code
|
APR-DRG 2224
|
| Min. Negotiated Rate |
$31,465.78 |
| Max. Negotiated Rate |
$35,423.97 |
| Rate for Payer: Anthem Medicaid |
$33,920.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$33,920.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33,920.41
|
| Rate for Payer: Dean Health Medicaid |
$33,920.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$31,465.78
|
| Rate for Payer: Managed Health Services Medicaid |
$35,423.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$33,920.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$33,920.41
|
| Rate for Payer: United Healthcare Medicaid |
$33,920.41
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$20,868.58
|
|
|
Service Code
|
APR-DRG 2223
|
| Min. Negotiated Rate |
$18,536.77 |
| Max. Negotiated Rate |
$20,868.58 |
| Rate for Payer: Anthem Medicaid |
$19,982.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,982.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,982.81
|
| Rate for Payer: Dean Health Medicaid |
$19,982.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,536.77
|
| Rate for Payer: Managed Health Services Medicaid |
$20,868.58
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,982.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,982.81
|
| Rate for Payer: United Healthcare Medicaid |
$19,982.81
|
|
|
OTHER STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES
|
Facility
|
IP
|
$13,064.78
|
|
|
Service Code
|
APR-DRG 2222
|
| Min. Negotiated Rate |
$11,604.95 |
| Max. Negotiated Rate |
$13,064.78 |
| Rate for Payer: Anthem Medicaid |
$12,510.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,510.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,510.25
|
| Rate for Payer: Dean Health Medicaid |
$12,510.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,604.95
|
| Rate for Payer: Managed Health Services Medicaid |
$13,064.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,510.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,510.25
|
| Rate for Payer: United Healthcare Medicaid |
$12,510.25
|
|
|
OTHER VASCULAR PROCEDURES WITH CC
|
Facility
|
IP
|
$70,869.76
|
|
|
Service Code
|
MSDRG 253
|
| Min. Negotiated Rate |
$20,384.38 |
| Max. Negotiated Rate |
$70,869.76 |
| Rate for Payer: Aetna Managed Medicare |
$20,384.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56,633.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43,409.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41,241.80
|
| Rate for Payer: Anthem Medicare Advantage |
$20,384.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,384.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,384.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,384.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45,782.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,384.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51,736.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,384.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,384.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,384.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,384.38
|
| Rate for Payer: NAPHCARE Commercial |
$30,576.58
|
| Rate for Payer: Quartz Medicare Advantage |
$20,384.38
|
| Rate for Payer: The Alliance Commercial |
$70,869.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,384.38
|
| Rate for Payer: United Healthcare PPO |
$40,277.38
|
| Rate for Payer: Wellcare Medicare |
$20,384.38
|
|
|
OTHER VASCULAR PROCEDURES WITH MCC
|
Facility
|
IP
|
$93,063.36
|
|
|
Service Code
|
MSDRG 252
|
| Min. Negotiated Rate |
$27,220.87 |
| Max. Negotiated Rate |
$93,063.36 |
| Rate for Payer: Aetna Managed Medicare |
$27,220.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,111.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,339.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,426.02
|
| Rate for Payer: Anthem Medicare Advantage |
$27,220.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,220.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,220.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,220.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61,527.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,220.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68,015.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,220.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,220.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,220.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,220.87
|
| Rate for Payer: NAPHCARE Commercial |
$40,831.30
|
| Rate for Payer: Quartz Medicare Advantage |
$27,220.87
|
| Rate for Payer: The Alliance Commercial |
$93,063.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,220.87
|
| Rate for Payer: United Healthcare PPO |
$52,950.60
|
| Rate for Payer: Wellcare Medicare |
$27,220.87
|
|
|
OTHER VASCULAR PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$48,308.00
|
|
|
Service Code
|
MSDRG 254
|
| Min. Negotiated Rate |
$14,151.38 |
| Max. Negotiated Rate |
$48,308.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,151.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,875.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,797.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,309.65
|
| Rate for Payer: Anthem Medicare Advantage |
$14,151.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,151.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,151.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,151.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,426.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,151.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,187.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,151.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,151.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,151.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,151.38
|
| Rate for Payer: NAPHCARE Commercial |
$21,227.08
|
| Rate for Payer: Quartz Medicare Advantage |
$14,151.38
|
| Rate for Payer: The Alliance Commercial |
$48,308.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,151.38
|
| Rate for Payer: United Healthcare PPO |
$27,394.17
|
| Rate for Payer: Wellcare Medicare |
$14,151.38
|
|
|
OT Iontophoresis Charges
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
2468806
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Aetna Managed Medicare |
$89.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.67
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: NAPHCARE Commercial |
$191.57
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$207.53
|
| Rate for Payer: Quartz Medicare Advantage |
$191.57
|
| Rate for Payer: The Alliance Commercial |
$159.64
|
| Rate for Payer: United Healthcare PPO |
$239.46
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
OT Iontophoresis Charges
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
CPT 97033 GO
|
| Hospital Charge Code |
2468806
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$156.45 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$191.57
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
OTITIS MEDIA AND URI WITH MCC
|
Facility
|
IP
|
$33,186.40
|
|
|
Service Code
|
MSDRG 152
|
| Min. Negotiated Rate |
$9,560.30 |
| Max. Negotiated Rate |
$33,186.40 |
| Rate for Payer: Aetna Managed Medicare |
$9,560.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,794.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,771.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,784.12
|
| Rate for Payer: Anthem Medicare Advantage |
$9,560.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,560.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,560.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,560.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,852.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,560.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,096.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,560.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,560.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,560.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,560.30
|
| Rate for Payer: NAPHCARE Commercial |
$14,340.46
|
| Rate for Payer: Quartz Medicare Advantage |
$9,560.30
|
| Rate for Payer: The Alliance Commercial |
$33,186.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,560.30
|
| Rate for Payer: United Healthcare PPO |
$18,759.58
|
| Rate for Payer: Wellcare Medicare |
$9,560.30
|
|
|
OTITIS MEDIA AND URI WITHOUT MCC
|
Facility
|
IP
|
$20,650.24
|
|
|
Service Code
|
MSDRG 153
|
| Min. Negotiated Rate |
$6,160.07 |
| Max. Negotiated Rate |
$20,650.24 |
| Rate for Payer: Aetna Managed Medicare |
$6,160.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,106.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,345.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,729.35
|
| Rate for Payer: Anthem Medicare Advantage |
$6,160.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,160.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,160.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,160.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,020.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,160.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,901.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,160.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,160.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,160.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,160.07
|
| Rate for Payer: NAPHCARE Commercial |
$9,240.10
|
| Rate for Payer: Quartz Medicare Advantage |
$6,160.07
|
| Rate for Payer: The Alliance Commercial |
$20,650.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,160.07
|
| Rate for Payer: United Healthcare PPO |
$11,601.20
|
| Rate for Payer: Wellcare Medicare |
$6,160.07
|
|
|
OT Manual Therapy Charge Units
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
5247099
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$68.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$146.02
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$146.02
|
| Rate for Payer: The Alliance Commercial |
$112.07
|
| Rate for Payer: United Healthcare PPO |
$182.52
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
OT Manual Therapy Charge Units
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
750909
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$68.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$146.02
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$146.02
|
| Rate for Payer: The Alliance Commercial |
$121.68
|
| Rate for Payer: United Healthcare PPO |
$182.52
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
OT Manual Therapy Charge Units
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
750909
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
OT Manual Therapy Charge Units
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 97140 GO
|
| Hospital Charge Code |
750909
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$98.06 |
| Max. Negotiated Rate |
$231.19 |
| Rate for Payer: Aetna Commercial |
$231.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$231.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.02
|
| Rate for Payer: Health EOS Commercial |
$221.46
|
| Rate for Payer: HFN Commercial |
$231.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.06
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$231.19
|
| Rate for Payer: Quartz Beloit One Network |
$107.08
|
| Rate for Payer: Quartz Commercial |
$138.72
|
| Rate for Payer: The Alliance Commercial |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
OT Manual Therapy Charge Units
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 97140
|
| Hospital Charge Code |
5247099
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
OT Massage Charge Units
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 97124 GO
|
| Hospital Charge Code |
2468807
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$26.21 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$26.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.38
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$56.16
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$60.84
|
| Rate for Payer: Quartz Medicare Advantage |
$56.16
|
| Rate for Payer: The Alliance Commercial |
$46.80
|
| Rate for Payer: United Healthcare PPO |
$70.20
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
