|
RESPIRATORY MALIGNANCY
|
Facility
|
IP
|
$11,837.22
|
|
|
Service Code
|
APR-DRG 1363
|
| Min. Negotiated Rate |
$10,514.56 |
| Max. Negotiated Rate |
$11,837.22 |
| Rate for Payer: Anthem Medicaid |
$11,334.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,334.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,334.79
|
| Rate for Payer: Dean Health Medicaid |
$11,334.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,514.56
|
| Rate for Payer: Managed Health Services Medicaid |
$11,837.22
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,334.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,334.79
|
| Rate for Payer: United Healthcare Medicaid |
$11,334.79
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
|
OP
|
$90.41
|
|
|
Service Code
|
EAPG 00571
|
| Min. Negotiated Rate |
$86.93 |
| Max. Negotiated Rate |
$90.41 |
| Rate for Payer: Anthem Medicaid |
$86.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$86.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.93
|
| Rate for Payer: Dean Health Medicaid |
$86.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$86.93
|
| Rate for Payer: Managed Health Services Medicaid |
$90.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$86.93
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$86.93
|
| Rate for Payer: United Healthcare Medicaid |
$86.93
|
|
|
RESPIRATORY MALIGNANCY
|
Facility
|
IP
|
$18,150.40
|
|
|
Service Code
|
APR-DRG 1364
|
| Min. Negotiated Rate |
$16,122.32 |
| Max. Negotiated Rate |
$18,150.40 |
| Rate for Payer: Anthem Medicaid |
$17,380.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,380.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,380.01
|
| Rate for Payer: Dean Health Medicaid |
$17,380.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,122.32
|
| Rate for Payer: Managed Health Services Medicaid |
$18,150.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,380.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,380.01
|
| Rate for Payer: United Healthcare Medicaid |
$17,380.01
|
|
|
Respiratory Motion Management Simulation
|
Facility
|
OP
|
$3,137.00
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
3970754
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$913.49 |
| Max. Negotiated Rate |
$3,001.48 |
| Rate for Payer: Aetna Commercial |
$2,936.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,805.73
|
| Rate for Payer: Aetna Managed Medicare |
$913.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,120.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,631.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,565.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,729.11
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$3,001.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,825.73
|
| Rate for Payer: Health EOS Commercial |
$2,903.61
|
| Rate for Payer: HFN Commercial |
$3,001.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,446.86
|
| Rate for Payer: Multiplan Commercial |
$2,609.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,957.49
|
| Rate for Payer: Preferred Network Access Commercial |
$3,001.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,598.62
|
| Rate for Payer: Quartz Commercial |
$2,120.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,957.49
|
| Rate for Payer: The Alliance Commercial |
$1,603.68
|
| Rate for Payer: United Healthcare PPO |
$2,446.86
|
| Rate for Payer: WEA Trust Commercial |
$1,794.36
|
| Rate for Payer: WPS Commercial |
$2,416.43
|
|
|
Respiratory Motion Management Simulation
|
Facility
|
IP
|
$3,137.00
|
|
|
Service Code
|
CPT 77293
|
| Hospital Charge Code |
3970754
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,598.62 |
| Max. Negotiated Rate |
$3,001.48 |
| Rate for Payer: Aetna Commercial |
$2,936.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,805.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,729.11
|
| Rate for Payer: Cash Price |
$941.10
|
| Rate for Payer: Cigna Commercial |
$3,001.48
|
| Rate for Payer: Health EOS Commercial |
$2,903.61
|
| Rate for Payer: HFN Commercial |
$3,001.48
|
| Rate for Payer: Multiplan Commercial |
$2,609.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,001.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,598.62
|
| Rate for Payer: Quartz Commercial |
$1,957.49
|
| Rate for Payer: WEA Trust Commercial |
$1,794.36
|
| Rate for Payer: WPS Commercial |
$2,416.43
|
|
|
Respiratory Motion Management Simulation 7729326
|
Professional
|
Both
|
$859.00
|
|
|
Service Code
|
CPT 77293 26
|
| Hospital Charge Code |
5518682
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.09 |
| Max. Negotiated Rate |
$848.69 |
| Rate for Payer: Aetna Commercial |
$848.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$768.29
|
| Rate for Payer: Aetna Managed Medicare |
$105.09
|
| Rate for Payer: Anthem Medicare Advantage |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$105.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$105.09
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cash Price |
$257.70
|
| Rate for Payer: Cigna Commercial |
$848.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$446.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.09
|
| Rate for Payer: Health EOS Commercial |
$812.96
|
| Rate for Payer: HFN Commercial |
$848.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$375.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$105.09
|
| Rate for Payer: Multiplan Commercial |
$714.69
|
| Rate for Payer: NAPHCARE Commercial |
$157.64
|
| Rate for Payer: Preferred Network Access Commercial |
$848.69
|
| Rate for Payer: Quartz Beloit One Network |
$393.08
|
| Rate for Payer: Quartz Commercial |
$509.22
|
| Rate for Payer: Quartz Medicare Advantage |
$105.09
|
| Rate for Payer: The Alliance Commercial |
$399.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.09
|
| Rate for Payer: WEA Trust Commercial |
$491.35
|
| Rate for Payer: WPS Commercial |
$525.46
|
|
|
RESPIRATORY NEOPLASMS WITH CC
|
Facility
|
IP
|
$30,777.76
|
|
|
Service Code
|
MSDRG 181
|
| Min. Negotiated Rate |
$8,708.71 |
| Max. Negotiated Rate |
$30,777.76 |
| Rate for Payer: Aetna Managed Medicare |
$8,708.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,368.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,911.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,017.25
|
| Rate for Payer: Anthem Medicare Advantage |
$8,708.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,708.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,708.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,708.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,890.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,708.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,330.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,708.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,708.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,708.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,708.71
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.07
|
| Rate for Payer: Quartz Medicare Advantage |
$8,708.71
|
| Rate for Payer: The Alliance Commercial |
$30,777.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,708.71
|
| Rate for Payer: United Healthcare PPO |
$17,384.43
|
| Rate for Payer: Wellcare Medicare |
$8,708.71
|
|
|
RESPIRATORY NEOPLASMS WITH MCC
|
Facility
|
IP
|
$48,393.28
|
|
|
Service Code
|
MSDRG 180
|
| Min. Negotiated Rate |
$14,031.16 |
| Max. Negotiated Rate |
$48,393.28 |
| Rate for Payer: Aetna Managed Medicare |
$14,031.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,532.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,535.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,060.19
|
| Rate for Payer: Anthem Medicare Advantage |
$14,031.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,031.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,031.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,031.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,149.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,031.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,250.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,031.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,031.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,031.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,031.16
|
| Rate for Payer: NAPHCARE Commercial |
$21,046.74
|
| Rate for Payer: Quartz Medicare Advantage |
$14,031.16
|
| Rate for Payer: The Alliance Commercial |
$48,393.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,031.16
|
| Rate for Payer: United Healthcare PPO |
$27,443.11
|
| Rate for Payer: Wellcare Medicare |
$14,031.16
|
|
|
RESPIRATORY NEOPLASMS WITHOUT CC/MCC
|
Facility
|
IP
|
$22,419.28
|
|
|
Service Code
|
MSDRG 182
|
| Min. Negotiated Rate |
$6,279.53 |
| Max. Negotiated Rate |
$22,419.28 |
| Rate for Payer: Aetna Managed Medicare |
$6,279.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,233.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,442.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,821.51
|
| Rate for Payer: Anthem Medicare Advantage |
$6,279.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,279.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,279.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,279.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,122.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,279.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,392.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,279.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,279.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,279.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,279.53
|
| Rate for Payer: NAPHCARE Commercial |
$9,419.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6,279.53
|
| Rate for Payer: The Alliance Commercial |
$22,419.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,279.53
|
| Rate for Payer: United Healthcare PPO |
$11,983.28
|
| Rate for Payer: Wellcare Medicare |
$6,279.53
|
|
|
RESPIRATORY SIGNS AND SYMPTOMS
|
Facility
|
IP
|
$23,085.92
|
|
|
Service Code
|
MSDRG 204
|
| Min. Negotiated Rate |
$6,690.01 |
| Max. Negotiated Rate |
$23,085.92 |
| Rate for Payer: Aetna Managed Medicare |
$6,690.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,616.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,503.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,828.88
|
| Rate for Payer: Anthem Medicare Advantage |
$6,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,690.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,690.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,690.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,241.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,690.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,688.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,690.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,690.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,690.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,690.01
|
| Rate for Payer: NAPHCARE Commercial |
$10,035.01
|
| Rate for Payer: Quartz Medicare Advantage |
$6,690.01
|
| Rate for Payer: The Alliance Commercial |
$23,085.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,690.01
|
| Rate for Payer: United Healthcare PPO |
$12,992.14
|
| Rate for Payer: Wellcare Medicare |
$6,690.01
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
|
IP
|
$16,221.37
|
|
|
Service Code
|
APR-DRG 1444
|
| Min. Negotiated Rate |
$14,408.84 |
| Max. Negotiated Rate |
$16,221.37 |
| Rate for Payer: Anthem Medicaid |
$15,532.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,532.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,532.86
|
| Rate for Payer: Dean Health Medicaid |
$15,532.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,408.84
|
| Rate for Payer: Managed Health Services Medicaid |
$16,221.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,532.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,532.86
|
| Rate for Payer: United Healthcare Medicaid |
$15,532.86
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
|
IP
|
$10,171.24
|
|
|
Service Code
|
APR-DRG 1443
|
| Min. Negotiated Rate |
$9,034.73 |
| Max. Negotiated Rate |
$10,171.24 |
| Rate for Payer: Anthem Medicaid |
$9,739.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,739.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,739.52
|
| Rate for Payer: Dean Health Medicaid |
$9,739.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,034.73
|
| Rate for Payer: Managed Health Services Medicaid |
$10,171.24
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,739.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,739.52
|
| Rate for Payer: United Healthcare Medicaid |
$9,739.52
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
|
IP
|
$5,085.62
|
|
|
Service Code
|
APR-DRG 1441
|
| Min. Negotiated Rate |
$4,517.36 |
| Max. Negotiated Rate |
$5,085.62 |
| Rate for Payer: Anthem Medicaid |
$4,869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,869.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,869.76
|
| Rate for Payer: Dean Health Medicaid |
$4,869.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,517.36
|
| Rate for Payer: Managed Health Services Medicaid |
$5,085.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,869.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,869.76
|
| Rate for Payer: United Healthcare Medicaid |
$4,869.76
|
|
|
RESPIRATORY SIGNS, SYMPTOMS AND MISCELLANEOUS DIAGNOSES
|
Facility
|
IP
|
$7,190.01
|
|
|
Service Code
|
APR-DRG 1442
|
| Min. Negotiated Rate |
$6,386.62 |
| Max. Negotiated Rate |
$7,190.01 |
| Rate for Payer: Anthem Medicaid |
$6,884.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,884.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,884.83
|
| Rate for Payer: Dean Health Medicaid |
$6,884.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,386.62
|
| Rate for Payer: Managed Health Services Medicaid |
$7,190.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,884.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,884.83
|
| Rate for Payer: United Healthcare Medicaid |
$6,884.83
|
|
|
Respiratory Syncytial Virus Antibody
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 86756
|
| Hospital Charge Code |
978059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$154.75
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
Respiratory Syncytial Virus Antibody
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 86756
|
| Hospital Charge Code |
978059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$16.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.43
|
| Rate for Payer: Anthem Medicare Advantage |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.53
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.53
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.53
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$24.79
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$167.65
|
| Rate for Payer: Quartz Medicare Advantage |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$66.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare PPO |
$193.44
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: Wellcare Medicare |
$16.53
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
Respiratory Syncytial Virus Antibody
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
CPT 86756
|
| Hospital Charge Code |
978059
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$245.02 |
| Rate for Payer: Aetna Commercial |
$245.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$16.53
|
| Rate for Payer: Anthem Medicare Advantage |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.53
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$245.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.53
|
| Rate for Payer: Health EOS Commercial |
$234.71
|
| Rate for Payer: HFN Commercial |
$245.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.53
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$24.79
|
| Rate for Payer: Preferred Network Access Commercial |
$245.02
|
| Rate for Payer: Quartz Beloit One Network |
$113.48
|
| Rate for Payer: Quartz Commercial |
$147.01
|
| Rate for Payer: Quartz Medicare Advantage |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$65.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$72.71
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS
|
Facility
|
IP
|
$75,092.16
|
|
|
Service Code
|
MSDRG 208
|
| Min. Negotiated Rate |
$21,556.88 |
| Max. Negotiated Rate |
$75,092.16 |
| Rate for Payer: Aetna Managed Medicare |
$21,556.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59,974.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,969.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,674.42
|
| Rate for Payer: Anthem Medicare Advantage |
$21,556.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,556.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,556.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,556.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48,482.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,556.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54,833.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,556.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,556.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,556.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,556.88
|
| Rate for Payer: NAPHCARE Commercial |
$32,335.32
|
| Rate for Payer: Quartz Medicare Advantage |
$21,556.88
|
| Rate for Payer: The Alliance Commercial |
$75,092.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,556.88
|
| Rate for Payer: United Healthcare PPO |
$42,688.25
|
| Rate for Payer: Wellcare Medicare |
$21,556.88
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$47,962.66
|
|
|
Service Code
|
APR-DRG 1304
|
| Min. Negotiated Rate |
$42,603.42 |
| Max. Negotiated Rate |
$47,962.66 |
| Rate for Payer: Anthem Medicaid |
$45,926.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$45,926.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45,926.89
|
| Rate for Payer: Dean Health Medicaid |
$45,926.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$42,603.42
|
| Rate for Payer: Managed Health Services Medicaid |
$47,962.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,926.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$45,926.89
|
| Rate for Payer: United Healthcare Medicaid |
$45,926.89
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$36,213.12
|
|
|
Service Code
|
APR-DRG 1303
|
| Min. Negotiated Rate |
$32,166.75 |
| Max. Negotiated Rate |
$36,213.12 |
| Rate for Payer: Anthem Medicaid |
$34,676.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$34,676.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34,676.06
|
| Rate for Payer: Dean Health Medicaid |
$34,676.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32,166.75
|
| Rate for Payer: Managed Health Services Medicaid |
$36,213.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$34,676.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$34,676.06
|
| Rate for Payer: United Healthcare Medicaid |
$34,676.06
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$24,551.27
|
|
|
Service Code
|
APR-DRG 1301
|
| Min. Negotiated Rate |
$21,807.97 |
| Max. Negotiated Rate |
$24,551.27 |
| Rate for Payer: Anthem Medicaid |
$23,509.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,509.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,509.19
|
| Rate for Payer: Dean Health Medicaid |
$23,509.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,807.97
|
| Rate for Payer: Managed Health Services Medicaid |
$24,551.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,509.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,509.19
|
| Rate for Payer: United Healthcare Medicaid |
$23,509.19
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT > 96 HOURS
|
Facility
|
IP
|
$29,636.89
|
|
|
Service Code
|
APR-DRG 1302
|
| Min. Negotiated Rate |
$26,325.33 |
| Max. Negotiated Rate |
$29,636.89 |
| Rate for Payer: Anthem Medicaid |
$28,378.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$28,378.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28,378.95
|
| Rate for Payer: Dean Health Medicaid |
$28,378.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,325.33
|
| Rate for Payer: Managed Health Services Medicaid |
$29,636.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$28,378.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28,378.95
|
| Rate for Payer: United Healthcare Medicaid |
$28,378.95
|
|
|
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS
|
Facility
|
IP
|
$191,335.04
|
|
|
Service Code
|
MSDRG 207
|
| Min. Negotiated Rate |
$49,784.99 |
| Max. Negotiated Rate |
$191,335.04 |
| Rate for Payer: Aetna Managed Medicare |
$49,784.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$140,400.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107,615.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102,241.72
|
| Rate for Payer: Anthem Medicare Advantage |
$49,784.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49,784.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49,784.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$49,784.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113,497.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$49,784.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140,094.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49,784.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49,784.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$49,784.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$49,784.99
|
| Rate for Payer: NAPHCARE Commercial |
$74,677.48
|
| Rate for Payer: Quartz Medicare Advantage |
$49,784.99
|
| Rate for Payer: The Alliance Commercial |
$191,335.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49,784.99
|
| Rate for Payer: United Healthcare PPO |
$109,065.16
|
| Rate for Payer: Wellcare Medicare |
$49,784.99
|
|
|
RESPONSE BOOKLET 1 WAIS IV
|
Facility
|
IP
|
$1,354.00
|
|
| Hospital Charge Code |
2972200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$690.00 |
| Max. Negotiated Rate |
$1,295.51 |
| Rate for Payer: Aetna Commercial |
$1,267.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.32
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$1,295.51
|
| Rate for Payer: Health EOS Commercial |
$1,253.26
|
| Rate for Payer: HFN Commercial |
$1,295.51
|
| Rate for Payer: Multiplan Commercial |
$1,126.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.51
|
| Rate for Payer: Quartz Beloit One Network |
$690.00
|
| Rate for Payer: Quartz Commercial |
$844.90
|
| Rate for Payer: WEA Trust Commercial |
$774.49
|
| Rate for Payer: WPS Commercial |
$1,042.99
|
|
|
RESPONSE BOOKLET 1 WAIS IV
|
Facility
|
OP
|
$1,354.00
|
|
| Hospital Charge Code |
2972200
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$394.28 |
| Max. Negotiated Rate |
$1,295.51 |
| Rate for Payer: Aetna Commercial |
$1,267.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,211.02
|
| Rate for Payer: Aetna Managed Medicare |
$394.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$915.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$704.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$746.32
|
| Rate for Payer: Cash Price |
$406.20
|
| Rate for Payer: Cigna Commercial |
$1,295.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$788.03
|
| Rate for Payer: Health EOS Commercial |
$1,253.26
|
| Rate for Payer: HFN Commercial |
$1,295.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,056.12
|
| Rate for Payer: Multiplan Commercial |
$1,126.53
|
| Rate for Payer: NAPHCARE Commercial |
$844.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,295.51
|
| Rate for Payer: Quartz Beloit One Network |
$690.00
|
| Rate for Payer: Quartz Commercial |
$915.30
|
| Rate for Payer: Quartz Medicare Advantage |
$844.90
|
| Rate for Payer: The Alliance Commercial |
$704.08
|
| Rate for Payer: WEA Trust Commercial |
$774.49
|
| Rate for Payer: WPS Commercial |
$1,042.99
|
|
