|
REPLACE G-J TUBE PERC 49452
|
Professional
|
Both
|
$2,016.00
|
|
|
Service Code
|
CPT 49452
|
| Hospital Charge Code |
3014888
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.77 |
| Max. Negotiated Rate |
$1,991.81 |
| Rate for Payer: Aetna Commercial |
$1,991.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,803.11
|
| Rate for Payer: Aetna Managed Medicare |
$113.77
|
| Rate for Payer: Anthem Medicare Advantage |
$113.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.77
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cash Price |
$604.80
|
| Rate for Payer: Cigna Commercial |
$1,991.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$780.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.77
|
| Rate for Payer: Health EOS Commercial |
$1,907.94
|
| Rate for Payer: HFN Commercial |
$1,991.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$479.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$479.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.77
|
| Rate for Payer: Multiplan Commercial |
$1,677.31
|
| Rate for Payer: NAPHCARE Commercial |
$170.65
|
| Rate for Payer: Preferred Network Access Commercial |
$1,991.81
|
| Rate for Payer: Quartz Beloit One Network |
$922.52
|
| Rate for Payer: Quartz Commercial |
$1,195.08
|
| Rate for Payer: Quartz Medicare Advantage |
$113.77
|
| Rate for Payer: The Alliance Commercial |
$483.50
|
| Rate for Payer: United Healthcare Medicaid |
$780.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.77
|
| Rate for Payer: WEA Trust Commercial |
$1,153.15
|
| Rate for Payer: WPS Commercial |
$511.95
|
|
|
REPLACEMENT, CATHETER ONLY, OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION SITE
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 36578
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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 |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP, THROUGH SAME VENOUS ACCESS
|
Facility
|
OP
|
$13,291.62
|
|
|
Service Code
|
CPT 36581
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| 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 |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
|
|
REPLACE TUNNELED CV CATH 36581
|
Professional
|
Both
|
$3,329.00
|
|
|
Service Code
|
CPT 36581
|
| Hospital Charge Code |
3014535
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.94 |
| Max. Negotiated Rate |
$3,289.05 |
| Rate for Payer: Aetna Commercial |
$3,289.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,977.46
|
| Rate for Payer: Aetna Managed Medicare |
$158.94
|
| Rate for Payer: Anthem Medicare Advantage |
$158.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$158.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$158.94
|
| Rate for Payer: Cash Price |
$998.70
|
| Rate for Payer: Cash Price |
$998.70
|
| Rate for Payer: Cash Price |
$998.70
|
| Rate for Payer: Cigna Commercial |
$3,289.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$638.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.94
|
| Rate for Payer: Health EOS Commercial |
$3,150.57
|
| Rate for Payer: HFN Commercial |
$3,289.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$636.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$158.94
|
| Rate for Payer: Multiplan Commercial |
$2,769.73
|
| Rate for Payer: NAPHCARE Commercial |
$238.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,289.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,523.35
|
| Rate for Payer: Quartz Commercial |
$1,973.43
|
| Rate for Payer: Quartz Medicare Advantage |
$158.94
|
| Rate for Payer: The Alliance Commercial |
$675.51
|
| Rate for Payer: United Healthcare Medicaid |
$638.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.94
|
| Rate for Payer: WEA Trust Commercial |
$1,904.19
|
| Rate for Payer: WPS Commercial |
$715.24
|
|
|
Repositioning LVAD-IMPELLA
|
Facility
|
IP
|
$17,436.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
5128681
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,885.39 |
| Max. Negotiated Rate |
$16,682.76 |
| Rate for Payer: Aetna Commercial |
$16,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,594.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,610.72
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,682.76
|
| Rate for Payer: Health EOS Commercial |
$16,138.76
|
| Rate for Payer: HFN Commercial |
$16,682.76
|
| Rate for Payer: Multiplan Commercial |
$14,506.75
|
| Rate for Payer: Preferred Network Access Commercial |
$16,682.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,885.39
|
| Rate for Payer: Quartz Commercial |
$10,880.06
|
| Rate for Payer: WEA Trust Commercial |
$9,973.39
|
| Rate for Payer: WPS Commercial |
$13,430.95
|
|
|
Repositioning LVAD-IMPELLA
|
Facility
|
OP
|
$17,436.00
|
|
|
Service Code
|
CPT 33993
|
| Hospital Charge Code |
5128681
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$532.31 |
| Max. Negotiated Rate |
$16,682.76 |
| Rate for Payer: Aetna Commercial |
$16,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,594.76
|
| Rate for Payer: Aetna Managed Medicare |
$5,077.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,786.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,066.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,704.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,610.72
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cash Price |
$5,230.80
|
| Rate for Payer: Cigna Commercial |
$16,682.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$16,138.76
|
| Rate for Payer: HFN Commercial |
$16,682.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,600.08
|
| Rate for Payer: Multiplan Commercial |
$14,506.75
|
| Rate for Payer: NAPHCARE Commercial |
$10,880.06
|
| Rate for Payer: Preferred Network Access Commercial |
$16,682.76
|
| Rate for Payer: Quartz Beloit One Network |
$8,885.39
|
| Rate for Payer: Quartz Commercial |
$11,786.74
|
| Rate for Payer: Quartz Medicare Advantage |
$10,880.06
|
| Rate for Payer: The Alliance Commercial |
$532.31
|
| Rate for Payer: WEA Trust Commercial |
$9,973.39
|
| Rate for Payer: WPS Commercial |
$13,430.95
|
|
|
RESECT INFERIOR TURBINATE 30140
|
Professional
|
Both
|
$255.00
|
|
|
Service Code
|
CPT 30140
|
| Hospital Charge Code |
3014355
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.69 |
| Max. Negotiated Rate |
$662.92 |
| Rate for Payer: Aetna Commercial |
$251.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.07
|
| Rate for Payer: Aetna Managed Medicare |
$147.32
|
| Rate for Payer: Anthem Medicare Advantage |
$147.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$147.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$147.32
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$251.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.32
|
| Rate for Payer: Health EOS Commercial |
$241.33
|
| Rate for Payer: HFN Commercial |
$251.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$611.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$147.32
|
| Rate for Payer: Multiplan Commercial |
$212.16
|
| Rate for Payer: NAPHCARE Commercial |
$220.97
|
| Rate for Payer: Preferred Network Access Commercial |
$251.94
|
| Rate for Payer: Quartz Beloit One Network |
$116.69
|
| Rate for Payer: Quartz Commercial |
$151.16
|
| Rate for Payer: Quartz Medicare Advantage |
$147.32
|
| Rate for Payer: The Alliance Commercial |
$626.09
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$147.32
|
| Rate for Payer: WEA Trust Commercial |
$145.86
|
| Rate for Payer: WPS Commercial |
$662.92
|
|
|
Resect Inferior Turbinate 3014050
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
CPT 30140 50
|
| Hospital Charge Code |
3165679
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$234.75 |
| Max. Negotiated Rate |
$611.77 |
| Rate for Payer: Aetna Commercial |
$506.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.83
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$506.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.11
|
| Rate for Payer: Health EOS Commercial |
$485.50
|
| Rate for Payer: HFN Commercial |
$506.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$611.77
|
| Rate for Payer: Multiplan Commercial |
$426.82
|
| Rate for Payer: Preferred Network Access Commercial |
$506.84
|
| Rate for Payer: Quartz Beloit One Network |
$234.75
|
| Rate for Payer: Quartz Commercial |
$304.11
|
| Rate for Payer: The Alliance Commercial |
$266.76
|
| Rate for Payer: United Healthcare Medicaid |
$235.04
|
| Rate for Payer: WEA Trust Commercial |
$293.44
|
| Rate for Payer: WPS Commercial |
$395.16
|
|
|
RESECTOR 3.5 FULL RADIUS C9248
|
Facility
|
IP
|
$320.00
|
|
| Hospital Charge Code |
2965529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
RESECTOR 3.5 FULL RADIUS C9248
|
Facility
|
OP
|
$320.00
|
|
| Hospital Charge Code |
2965529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Aetna Managed Medicare |
$93.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.24
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: NAPHCARE Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$216.32
|
| Rate for Payer: Quartz Medicare Advantage |
$199.68
|
| Rate for Payer: The Alliance Commercial |
$166.40
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
RESERVOIR HARD-SHELL 150M CELL SAVER 205 00205-00
|
Facility
|
IP
|
$1,312.00
|
|
| Hospital Charge Code |
2962980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$668.60 |
| Max. Negotiated Rate |
$1,255.32 |
| Rate for Payer: Aetna Commercial |
$1,228.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,173.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$723.17
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$1,255.32
|
| Rate for Payer: Health EOS Commercial |
$1,214.39
|
| Rate for Payer: HFN Commercial |
$1,255.32
|
| Rate for Payer: Multiplan Commercial |
$1,091.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,255.32
|
| Rate for Payer: Quartz Beloit One Network |
$668.60
|
| Rate for Payer: Quartz Commercial |
$818.69
|
| Rate for Payer: WEA Trust Commercial |
$750.46
|
| Rate for Payer: WPS Commercial |
$1,010.63
|
|
|
RESERVOIR HARD-SHELL 150M CELL SAVER 205 00205-00
|
Facility
|
OP
|
$1,312.00
|
|
| Hospital Charge Code |
2962980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.05 |
| Max. Negotiated Rate |
$1,255.32 |
| Rate for Payer: Aetna Commercial |
$1,228.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,173.45
|
| Rate for Payer: Aetna Managed Medicare |
$382.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$886.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$682.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$654.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$723.17
|
| Rate for Payer: Cash Price |
$393.60
|
| Rate for Payer: Cigna Commercial |
$1,255.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$763.58
|
| Rate for Payer: Health EOS Commercial |
$1,214.39
|
| Rate for Payer: HFN Commercial |
$1,255.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,023.36
|
| Rate for Payer: Multiplan Commercial |
$1,091.58
|
| Rate for Payer: NAPHCARE Commercial |
$818.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,255.32
|
| Rate for Payer: Quartz Beloit One Network |
$668.60
|
| Rate for Payer: Quartz Commercial |
$886.91
|
| Rate for Payer: Quartz Medicare Advantage |
$818.69
|
| Rate for Payer: The Alliance Commercial |
$682.24
|
| Rate for Payer: WEA Trust Commercial |
$750.46
|
| Rate for Payer: WPS Commercial |
$1,010.63
|
|
|
Respiratory Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.88
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$8.96
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Respiratory Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.66 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Respiratory Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$39.45
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$5,260.99
|
|
|
Service Code
|
APR-DRG 1331
|
| Min. Negotiated Rate |
$4,673.14 |
| Max. Negotiated Rate |
$5,260.99 |
| Rate for Payer: Anthem Medicaid |
$5,037.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,037.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,037.68
|
| Rate for Payer: Dean Health Medicaid |
$5,037.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,673.14
|
| Rate for Payer: Managed Health Services Medicaid |
$5,260.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,037.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,037.68
|
| Rate for Payer: United Healthcare Medicaid |
$5,037.68
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$10,346.61
|
|
|
Service Code
|
APR-DRG 1333
|
| 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
|
|
|
RESPIRATORY FAILURE
|
Facility
|
OP
|
$100.89
|
|
|
Service Code
|
EAPG 00587
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Anthem Medicaid |
$97.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$97.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.01
|
| Rate for Payer: Dean Health Medicaid |
$97.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.01
|
| Rate for Payer: Managed Health Services Medicaid |
$100.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.01
|
| Rate for Payer: United Healthcare Medicaid |
$97.01
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$16,922.84
|
|
|
Service Code
|
APR-DRG 1334
|
| Min. Negotiated Rate |
$15,031.92 |
| Max. Negotiated Rate |
$16,922.84 |
| Rate for Payer: Anthem Medicaid |
$16,204.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,204.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,204.55
|
| Rate for Payer: Dean Health Medicaid |
$16,204.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,031.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16,922.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,204.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,204.55
|
| Rate for Payer: United Healthcare Medicaid |
$16,204.55
|
|
|
RESPIRATORY FAILURE
|
Facility
|
IP
|
$7,014.65
|
|
|
Service Code
|
APR-DRG 1332
|
| Min. Negotiated Rate |
$6,230.85 |
| Max. Negotiated Rate |
$7,014.65 |
| Rate for Payer: Anthem Medicaid |
$6,716.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,716.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,716.91
|
| Rate for Payer: Dean Health Medicaid |
$6,716.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,230.85
|
| Rate for Payer: Managed Health Services Medicaid |
$7,014.65
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,716.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,716.91
|
| Rate for Payer: United Healthcare Medicaid |
$6,716.91
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC
|
Facility
|
IP
|
$27,615.12
|
|
|
Service Code
|
MSDRG 178
|
| Min. Negotiated Rate |
$7,981.18 |
| Max. Negotiated Rate |
$27,615.12 |
| Rate for Payer: Aetna Managed Medicare |
$7,981.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,295.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,322.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,507.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7,981.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,981.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,981.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,981.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,215.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,981.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,010.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,981.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,981.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,981.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,981.18
|
| Rate for Payer: NAPHCARE Commercial |
$11,971.77
|
| Rate for Payer: Quartz Medicare Advantage |
$7,981.18
|
| Rate for Payer: The Alliance Commercial |
$27,615.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,981.18
|
| Rate for Payer: United Healthcare PPO |
$15,578.25
|
| Rate for Payer: Wellcare Medicare |
$7,981.18
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC
|
Facility
|
IP
|
$47,237.84
|
|
|
Service Code
|
MSDRG 177
|
| Min. Negotiated Rate |
$12,474.25 |
| Max. Negotiated Rate |
$47,237.84 |
| Rate for Payer: Aetna Managed Medicare |
$12,474.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,096.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,134.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,829.93
|
| Rate for Payer: Anthem Medicare Advantage |
$12,474.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,474.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,474.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,474.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,563.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,474.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,402.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,474.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,474.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,474.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,474.25
|
| Rate for Payer: NAPHCARE Commercial |
$18,711.37
|
| Rate for Payer: Quartz Medicare Advantage |
$12,474.25
|
| Rate for Payer: The Alliance Commercial |
$47,237.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,474.25
|
| Rate for Payer: United Healthcare PPO |
$26,783.17
|
| Rate for Payer: Wellcare Medicare |
$12,474.25
|
|
|
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$21,438.56
|
|
|
Service Code
|
MSDRG 179
|
| Min. Negotiated Rate |
$6,288.71 |
| Max. Negotiated Rate |
$21,438.56 |
| Rate for Payer: Aetna Managed Medicare |
$6,288.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,473.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,626.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,996.29
|
| Rate for Payer: Anthem Medicare Advantage |
$6,288.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,288.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,288.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,288.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,316.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,288.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,479.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,288.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,288.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,288.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,288.71
|
| Rate for Payer: NAPHCARE Commercial |
$9,433.07
|
| Rate for Payer: Quartz Medicare Advantage |
$6,288.71
|
| Rate for Payer: The Alliance Commercial |
$21,438.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,288.71
|
| Rate for Payer: United Healthcare PPO |
$12,051.17
|
| Rate for Payer: Wellcare Medicare |
$6,288.71
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
|
IP
|
$8,505.26
|
|
|
Service Code
|
APR-DRG 1362
|
| Min. Negotiated Rate |
$7,554.90 |
| Max. Negotiated Rate |
$8,505.26 |
| Rate for Payer: Anthem Medicaid |
$8,144.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,144.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,144.26
|
| Rate for Payer: Dean Health Medicaid |
$8,144.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,554.90
|
| Rate for Payer: Managed Health Services Medicaid |
$8,505.26
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,144.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,144.26
|
| Rate for Payer: United Healthcare Medicaid |
$8,144.26
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
|
IP
|
$7,102.33
|
|
|
Service Code
|
APR-DRG 1361
|
| 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
|
|
