|
POST OUTRIGGER STRAIGHT 11MM 390.011
|
Facility
|
OP
|
$1,821.00
|
|
| Hospital Charge Code |
3133479
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$530.28 |
| Max. Negotiated Rate |
$1,742.33 |
| Rate for Payer: Aetna Commercial |
$1,704.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,628.70
|
| Rate for Payer: Aetna Managed Medicare |
$530.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,231.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$946.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$909.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,003.74
|
| Rate for Payer: Cash Price |
$546.30
|
| Rate for Payer: Cigna Commercial |
$1,742.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,059.82
|
| Rate for Payer: Health EOS Commercial |
$1,685.52
|
| Rate for Payer: HFN Commercial |
$1,742.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,420.38
|
| Rate for Payer: Multiplan Commercial |
$1,515.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,136.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,742.33
|
| Rate for Payer: Quartz Beloit One Network |
$927.98
|
| Rate for Payer: Quartz Commercial |
$1,231.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,136.30
|
| Rate for Payer: The Alliance Commercial |
$946.92
|
| Rate for Payer: WEA Trust Commercial |
$1,041.61
|
| Rate for Payer: WPS Commercial |
$1,402.72
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES
|
Facility
|
OP
|
$48.10
|
|
|
Service Code
|
EAPG 00761
|
| Min. Negotiated Rate |
$46.25 |
| Max. Negotiated Rate |
$48.10 |
| Rate for Payer: Anthem Medicaid |
$46.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$46.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.25
|
| Rate for Payer: Dean Health Medicaid |
$46.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$46.25
|
| Rate for Payer: Managed Health Services Medicaid |
$48.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$46.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$46.25
|
| Rate for Payer: United Healthcare Medicaid |
$46.25
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES
|
Facility
|
IP
|
$43,021.68
|
|
|
Service Code
|
MSDRG 769
|
| Min. Negotiated Rate |
$13,447.62 |
| Max. Negotiated Rate |
$43,021.68 |
| Rate for Payer: Aetna Managed Medicare |
$13,447.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,870.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,260.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,849.43
|
| Rate for Payer: Anthem Medicare Advantage |
$13,447.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,447.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,447.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,447.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,805.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,447.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,310.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,447.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,447.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,447.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,447.62
|
| Rate for Payer: NAPHCARE Commercial |
$20,171.42
|
| Rate for Payer: Quartz Medicare Advantage |
$13,447.62
|
| Rate for Payer: The Alliance Commercial |
$43,021.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,447.62
|
| Rate for Payer: United Healthcare PPO |
$24,375.47
|
| Rate for Payer: Wellcare Medicare |
$13,447.62
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES
|
Facility
|
IP
|
$20,150.00
|
|
|
Service Code
|
MSDRG 776
|
| Min. Negotiated Rate |
$5,520.59 |
| Max. Negotiated Rate |
$20,150.00 |
| Rate for Payer: United Healthcare PPO |
$11,315.43
|
| Rate for Payer: Aetna Managed Medicare |
$5,520.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,285.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,949.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,402.61
|
| Rate for Payer: Anthem Medicare Advantage |
$5,520.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,520.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,520.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,520.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,547.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,520.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,534.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,520.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,520.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,520.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,520.59
|
| Rate for Payer: NAPHCARE Commercial |
$8,280.89
|
| Rate for Payer: Quartz Medicare Advantage |
$5,520.59
|
| Rate for Payer: The Alliance Commercial |
$20,150.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,520.59
|
| Rate for Payer: Wellcare Medicare |
$5,520.59
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$2,455.13
|
|
|
Service Code
|
APR-DRG 5611
|
| Min. Negotiated Rate |
$2,180.80 |
| Max. Negotiated Rate |
$2,455.13 |
| Rate for Payer: Anthem Medicaid |
$2,350.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,350.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,350.92
|
| Rate for Payer: Dean Health Medicaid |
$2,350.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,180.80
|
| Rate for Payer: Managed Health Services Medicaid |
$2,455.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,350.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,350.92
|
| Rate for Payer: United Healthcare Medicaid |
$2,350.92
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$14,906.13
|
|
|
Service Code
|
APR-DRG 5614
|
| Min. Negotiated Rate |
$13,240.55 |
| Max. Negotiated Rate |
$14,906.13 |
| Rate for Payer: Anthem Medicaid |
$14,273.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,273.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,273.44
|
| Rate for Payer: Dean Health Medicaid |
$14,273.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,240.55
|
| Rate for Payer: Managed Health Services Medicaid |
$14,906.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,273.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,273.44
|
| Rate for Payer: United Healthcare Medicaid |
$14,273.44
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$3,945.74
|
|
|
Service Code
|
APR-DRG 5612
|
| Min. Negotiated Rate |
$3,504.85 |
| Max. Negotiated Rate |
$3,945.74 |
| Rate for Payer: Anthem Medicaid |
$3,778.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,778.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,778.26
|
| Rate for Payer: Dean Health Medicaid |
$3,778.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,504.85
|
| Rate for Payer: Managed Health Services Medicaid |
$3,945.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,778.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,778.26
|
| Rate for Payer: United Healthcare Medicaid |
$3,778.26
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT PROCEDURE
|
Facility
|
IP
|
$7,102.33
|
|
|
Service Code
|
APR-DRG 5613
|
| 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
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$28,847.74
|
|
|
Service Code
|
APR-DRG 5484
|
| Min. Negotiated Rate |
$25,624.36 |
| Max. Negotiated Rate |
$28,847.74 |
| Rate for Payer: Anthem Medicaid |
$27,623.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$27,623.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27,623.30
|
| Rate for Payer: Dean Health Medicaid |
$27,623.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25,624.36
|
| Rate for Payer: Managed Health Services Medicaid |
$28,847.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,623.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27,623.30
|
| Rate for Payer: United Healthcare Medicaid |
$27,623.30
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$15,169.18
|
|
|
Service Code
|
APR-DRG 5483
|
| Min. Negotiated Rate |
$13,474.21 |
| Max. Negotiated Rate |
$15,169.18 |
| Rate for Payer: Anthem Medicaid |
$14,525.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,525.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,525.32
|
| Rate for Payer: Dean Health Medicaid |
$14,525.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,474.21
|
| Rate for Payer: Managed Health Services Medicaid |
$15,169.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,525.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,525.32
|
| Rate for Payer: United Healthcare Medicaid |
$14,525.32
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$9,645.14
|
|
|
Service Code
|
APR-DRG 5482
|
| Min. Negotiated Rate |
$8,567.42 |
| Max. Negotiated Rate |
$9,645.14 |
| Rate for Payer: Anthem Medicaid |
$9,235.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,235.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,235.75
|
| Rate for Payer: Dean Health Medicaid |
$9,235.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,567.42
|
| Rate for Payer: Managed Health Services Medicaid |
$9,645.14
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,235.75
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,235.75
|
| Rate for Payer: United Healthcare Medicaid |
$9,235.75
|
|
|
POSTPARTUM AND POST ABORTION DIAGNOSIS WITH O.R. PROCEDURE
|
Facility
|
IP
|
$3,945.74
|
|
|
Service Code
|
APR-DRG 5481
|
| Min. Negotiated Rate |
$3,504.85 |
| Max. Negotiated Rate |
$3,945.74 |
| Rate for Payer: Anthem Medicaid |
$3,778.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,778.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,778.26
|
| Rate for Payer: Dean Health Medicaid |
$3,778.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,504.85
|
| Rate for Payer: Managed Health Services Medicaid |
$3,945.74
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,778.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,778.26
|
| Rate for Payer: United Healthcare Medicaid |
$3,778.26
|
|
|
Post pelvic ring fx w/man closed 27198
|
Professional
|
Both
|
$1,834.00
|
|
|
Service Code
|
CPT 27198
|
| Hospital Charge Code |
5184673
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$238.99 |
| Max. Negotiated Rate |
$1,811.99 |
| Rate for Payer: Aetna Commercial |
$1,811.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.33
|
| Rate for Payer: Aetna Managed Medicare |
$267.60
|
| Rate for Payer: Anthem Medicare Advantage |
$267.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.60
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$1,811.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.60
|
| Rate for Payer: Health EOS Commercial |
$1,735.70
|
| Rate for Payer: HFN Commercial |
$1,811.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,092.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.60
|
| Rate for Payer: Multiplan Commercial |
$1,525.89
|
| Rate for Payer: NAPHCARE Commercial |
$401.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,811.99
|
| Rate for Payer: Quartz Beloit One Network |
$839.24
|
| Rate for Payer: Quartz Commercial |
$1,087.20
|
| Rate for Payer: Quartz Medicare Advantage |
$267.60
|
| Rate for Payer: The Alliance Commercial |
$1,137.31
|
| Rate for Payer: United Healthcare Medicaid |
$238.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.60
|
| Rate for Payer: WEA Trust Commercial |
$1,049.05
|
| Rate for Payer: WPS Commercial |
$1,204.21
|
|
|
Post pelvic ring fx w/o man closed 27197
|
Professional
|
Both
|
$721.00
|
|
|
Service Code
|
CPT 27197
|
| Hospital Charge Code |
5184674
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.50 |
| Max. Negotiated Rate |
$712.35 |
| Rate for Payer: Aetna Commercial |
$712.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$644.86
|
| Rate for Payer: Aetna Managed Medicare |
$118.53
|
| Rate for Payer: Anthem Medicare Advantage |
$118.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.53
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$712.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.53
|
| Rate for Payer: Health EOS Commercial |
$682.35
|
| Rate for Payer: HFN Commercial |
$712.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$457.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$457.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.53
|
| Rate for Payer: Multiplan Commercial |
$599.87
|
| Rate for Payer: NAPHCARE Commercial |
$177.79
|
| Rate for Payer: Preferred Network Access Commercial |
$712.35
|
| Rate for Payer: Quartz Beloit One Network |
$329.93
|
| Rate for Payer: Quartz Commercial |
$427.41
|
| Rate for Payer: Quartz Medicare Advantage |
$118.53
|
| Rate for Payer: The Alliance Commercial |
$503.75
|
| Rate for Payer: United Healthcare Medicaid |
$94.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.53
|
| Rate for Payer: WEA Trust Commercial |
$412.41
|
| Rate for Payer: WPS Commercial |
$533.38
|
|
|
Post-TR ABO/Rh
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
973773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Post-TR ABO/Rh
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86900
|
| Hospital Charge Code |
973773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$492.41 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$3.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$492.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$229.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$217.98
|
| Rate for Payer: Anthem Medicare Advantage |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.11
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.11
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$4.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$3.11
|
| Rate for Payer: The Alliance Commercial |
$12.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.11
|
| Rate for Payer: United Healthcare PPO |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$3.11
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Post-Transfusion Reaction ABSC
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
973774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$119.18
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Post-Transfusion Reaction ABSC
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 86850
|
| Hospital Charge Code |
973774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.16 |
| Max. Negotiated Rate |
$208.88 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$10.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.47
|
| Rate for Payer: Anthem Medicare Advantage |
$10.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.16
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.16
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.16
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$15.24
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$129.12
|
| Rate for Payer: Quartz Medicare Advantage |
$10.16
|
| Rate for Payer: The Alliance Commercial |
$40.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.16
|
| Rate for Payer: United Healthcare PPO |
$148.98
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: Wellcare Medicare |
$10.16
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Post-Transfusion Reaction DAT
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
973775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$235.79 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$5.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.38
|
| Rate for Payer: Anthem Medicare Advantage |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.61
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.61
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.61
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$8.41
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.61
|
| Rate for Payer: The Alliance Commercial |
$22.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.61
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$5.61
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Post-Transfusion Reaction DAT
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86880
|
| Hospital Charge Code |
973775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Post-Transfusion Reaction XM
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
973776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$180.84 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$117.94
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Post-Transfusion Reaction XM
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 86922
|
| Hospital Charge Code |
973776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.31 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$176.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.04
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$180.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$174.94
|
| Rate for Payer: HFN Commercial |
$180.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$157.25
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$180.84
|
| Rate for Payer: Quartz Beloit One Network |
$96.31
|
| Rate for Payer: Quartz Commercial |
$127.76
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$147.42
|
| Rate for Payer: WEA Trust Commercial |
$108.11
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$145.59
|
|
|
Postural drainage
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989711
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$108.42
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Postural drainage
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989711
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Potassium, Feces
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
983366
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$37.07
|
|
