|
Separation by Gel Electrophoresis
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2778824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.30
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Separation by Gel Electrophoresis
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2778824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Separation by Gel Electrophoresis
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2778824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Separation & Identification
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2778820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Separation & Identification
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2778820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.84
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Separation & Identification
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2778820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: United Healthcare PPO |
$222.30
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
SEPARATOR OPTICAL VISIPORT 12MMX100MM 176674P
|
Facility
|
OP
|
$506.00
|
|
| Hospital Charge Code |
2963115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.35 |
| Max. Negotiated Rate |
$484.14 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Aetna Managed Medicare |
$147.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$342.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.49
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$394.68
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: NAPHCARE Commercial |
$315.74
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$342.06
|
| Rate for Payer: Quartz Medicare Advantage |
$315.74
|
| Rate for Payer: The Alliance Commercial |
$263.12
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
SEPARATOR OPTICAL VISIPORT 12MMX100MM 176674P
|
Facility
|
IP
|
$506.00
|
|
| Hospital Charge Code |
2963115
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.86 |
| Max. Negotiated Rate |
$484.14 |
| Rate for Payer: Aetna Commercial |
$473.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$452.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.91
|
| Rate for Payer: Cash Price |
$151.80
|
| Rate for Payer: Cigna Commercial |
$484.14
|
| Rate for Payer: Health EOS Commercial |
$468.35
|
| Rate for Payer: HFN Commercial |
$484.14
|
| Rate for Payer: Multiplan Commercial |
$420.99
|
| Rate for Payer: Preferred Network Access Commercial |
$484.14
|
| Rate for Payer: Quartz Beloit One Network |
$257.86
|
| Rate for Payer: Quartz Commercial |
$315.74
|
| Rate for Payer: WEA Trust Commercial |
$289.43
|
| Rate for Payer: WPS Commercial |
$389.77
|
|
|
SEPRAFILM 3 X 5 [Med]
|
Facility
|
OP
|
$2,901.00
|
|
| Hospital Charge Code |
2974977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$844.77 |
| Max. Negotiated Rate |
$2,775.68 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Aetna Managed Medicare |
$844.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,508.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.38
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,262.78
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,961.08
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.22
|
| Rate for Payer: The Alliance Commercial |
$1,508.52
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
|
SEPRAFILM 3 X 5 [Med]
|
Facility
|
IP
|
$2,901.00
|
|
| Hospital Charge Code |
2974977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1,478.35 |
| Max. Negotiated Rate |
$2,775.68 |
| Rate for Payer: Aetna Commercial |
$2,715.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.03
|
| Rate for Payer: Cash Price |
$870.30
|
| Rate for Payer: Cigna Commercial |
$2,775.68
|
| Rate for Payer: Health EOS Commercial |
$2,685.17
|
| Rate for Payer: HFN Commercial |
$2,775.68
|
| Rate for Payer: Multiplan Commercial |
$2,413.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.35
|
| Rate for Payer: Quartz Commercial |
$1,810.22
|
| Rate for Payer: WEA Trust Commercial |
$1,659.37
|
| Rate for Payer: WPS Commercial |
$2,234.64
|
|
|
SEPTAL STAPLER ENTRIGUE ENTACT 601-00100S
|
Facility
|
IP
|
$2,365.00
|
|
| Hospital Charge Code |
3842759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,205.20 |
| Max. Negotiated Rate |
$2,262.83 |
| Rate for Payer: Aetna Commercial |
$2,213.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,115.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,303.59
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cigna Commercial |
$2,262.83
|
| Rate for Payer: Health EOS Commercial |
$2,189.04
|
| Rate for Payer: HFN Commercial |
$2,262.83
|
| Rate for Payer: Multiplan Commercial |
$1,967.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,262.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,205.20
|
| Rate for Payer: Quartz Commercial |
$1,475.76
|
| Rate for Payer: WEA Trust Commercial |
$1,352.78
|
| Rate for Payer: WPS Commercial |
$1,821.76
|
|
|
SEPTAL STAPLER ENTRIGUE ENTACT 601-00100S
|
Facility
|
OP
|
$2,365.00
|
|
| Hospital Charge Code |
3842759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$688.69 |
| Max. Negotiated Rate |
$2,262.83 |
| Rate for Payer: Aetna Commercial |
$2,213.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,115.26
|
| Rate for Payer: Aetna Managed Medicare |
$688.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,598.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,229.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,180.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,303.59
|
| Rate for Payer: Cash Price |
$709.50
|
| Rate for Payer: Cigna Commercial |
$2,262.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,376.43
|
| Rate for Payer: Health EOS Commercial |
$2,189.04
|
| Rate for Payer: HFN Commercial |
$2,262.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,844.70
|
| Rate for Payer: Multiplan Commercial |
$1,967.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,475.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,262.83
|
| Rate for Payer: Quartz Beloit One Network |
$1,205.20
|
| Rate for Payer: Quartz Commercial |
$1,598.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,475.76
|
| Rate for Payer: The Alliance Commercial |
$1,229.80
|
| Rate for Payer: WEA Trust Commercial |
$1,352.78
|
| Rate for Payer: WPS Commercial |
$1,821.76
|
|
|
SEPTIC ARTHRITIS WITH CC
|
Facility
|
IP
|
$33,683.52
|
|
|
Service Code
|
MSDRG 549
|
| Min. Negotiated Rate |
$9,751.76 |
| Max. Negotiated Rate |
$33,683.52 |
| Rate for Payer: Aetna Managed Medicare |
$9,751.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,340.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,189.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,181.35
|
| Rate for Payer: Anthem Medicare Advantage |
$9,751.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,751.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,751.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,751.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,293.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,751.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,461.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,751.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,751.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,751.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,751.76
|
| Rate for Payer: NAPHCARE Commercial |
$14,627.64
|
| Rate for Payer: Quartz Medicare Advantage |
$9,751.76
|
| Rate for Payer: The Alliance Commercial |
$33,683.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,751.76
|
| Rate for Payer: United Healthcare PPO |
$19,043.77
|
| Rate for Payer: Wellcare Medicare |
$9,751.76
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
|
IP
|
$54,244.32
|
|
|
Service Code
|
MSDRG 548
|
| Min. Negotiated Rate |
$15,293.99 |
| Max. Negotiated Rate |
$54,244.32 |
| Rate for Payer: Aetna Managed Medicare |
$15,293.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,130.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,292.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,680.30
|
| Rate for Payer: Anthem Medicare Advantage |
$15,293.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,293.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,293.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,293.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,057.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,293.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,541.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,293.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,293.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,293.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,293.99
|
| Rate for Payer: NAPHCARE Commercial |
$22,940.99
|
| Rate for Payer: Quartz Medicare Advantage |
$15,293.99
|
| Rate for Payer: The Alliance Commercial |
$54,244.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,293.99
|
| Rate for Payer: United Healthcare PPO |
$30,783.91
|
| Rate for Payer: Wellcare Medicare |
$15,293.99
|
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$26,420.16
|
|
|
Service Code
|
MSDRG 550
|
| Min. Negotiated Rate |
$7,200.81 |
| Max. Negotiated Rate |
$26,420.16 |
| Rate for Payer: Aetna Managed Medicare |
$7,200.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,072.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,618.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,888.68
|
| Rate for Payer: Anthem Medicare Advantage |
$7,200.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,200.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,200.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,200.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,417.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,200.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,673.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,200.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,200.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,200.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,200.81
|
| Rate for Payer: NAPHCARE Commercial |
$10,801.22
|
| Rate for Payer: Quartz Medicare Advantage |
$7,200.81
|
| Rate for Payer: The Alliance Commercial |
$26,420.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,200.81
|
| Rate for Payer: United Healthcare PPO |
$14,537.81
|
| Rate for Payer: Wellcare Medicare |
$7,200.81
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
OP
|
$120.55
|
|
|
Service Code
|
EAPG 00805
|
| Min. Negotiated Rate |
$115.91 |
| Max. Negotiated Rate |
$120.55 |
| Rate for Payer: Anthem Medicaid |
$115.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$115.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.91
|
| Rate for Payer: Dean Health Medicaid |
$115.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$115.91
|
| Rate for Payer: Managed Health Services Medicaid |
$120.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$115.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$115.91
|
| Rate for Payer: United Healthcare Medicaid |
$115.91
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$23,674.44
|
|
|
Service Code
|
APR-DRG 7204
|
| Min. Negotiated Rate |
$21,029.11 |
| Max. Negotiated Rate |
$23,674.44 |
| Rate for Payer: Anthem Medicaid |
$22,669.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,669.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,669.58
|
| Rate for Payer: Dean Health Medicaid |
$22,669.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,029.11
|
| Rate for Payer: Managed Health Services Medicaid |
$23,674.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,669.58
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,669.58
|
| Rate for Payer: United Healthcare Medicaid |
$22,669.58
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$5,787.08
|
|
|
Service Code
|
APR-DRG 7201
|
| Min. Negotiated Rate |
$5,140.45 |
| Max. Negotiated Rate |
$5,787.08 |
| Rate for Payer: Anthem Medicaid |
$5,541.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,541.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,541.45
|
| Rate for Payer: Dean Health Medicaid |
$5,541.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,140.45
|
| Rate for Payer: Managed Health Services Medicaid |
$5,787.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,541.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,541.45
|
| Rate for Payer: United Healthcare Medicaid |
$5,541.45
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$8,066.85
|
|
|
Service Code
|
APR-DRG 7202
|
| Min. Negotiated Rate |
$7,165.48 |
| Max. Negotiated Rate |
$8,066.85 |
| Rate for Payer: Anthem Medicaid |
$7,724.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,724.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,724.45
|
| Rate for Payer: Dean Health Medicaid |
$7,724.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,165.48
|
| Rate for Payer: Managed Health Services Medicaid |
$8,066.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,724.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,724.45
|
| Rate for Payer: United Healthcare Medicaid |
$7,724.45
|
|
|
SEPTICEMIA AND DISSEMINATED INFECTIONS
|
Facility
|
IP
|
$12,801.73
|
|
|
Service Code
|
APR-DRG 7203
|
| Min. Negotiated Rate |
$11,371.30 |
| Max. Negotiated Rate |
$12,801.73 |
| Rate for Payer: Anthem Medicaid |
$12,258.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,258.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,258.36
|
| Rate for Payer: Dean Health Medicaid |
$12,258.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,371.30
|
| Rate for Payer: Managed Health Services Medicaid |
$12,801.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,258.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,258.36
|
| Rate for Payer: United Healthcare Medicaid |
$12,258.36
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$192,908.56
|
|
|
Service Code
|
MSDRG 870
|
| Min. Negotiated Rate |
$53,438.70 |
| Max. Negotiated Rate |
$192,908.56 |
| Rate for Payer: Aetna Managed Medicare |
$53,438.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150,809.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115,594.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109,822.42
|
| Rate for Payer: Anthem Medicare Advantage |
$53,438.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53,438.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53,438.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53,438.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121,912.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53,438.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141,248.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53,438.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53,438.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53,438.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53,438.70
|
| Rate for Payer: NAPHCARE Commercial |
$80,158.06
|
| Rate for Payer: Quartz Medicare Advantage |
$53,438.70
|
| Rate for Payer: The Alliance Commercial |
$192,908.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53,438.70
|
| Rate for Payer: United Healthcare PPO |
$109,963.52
|
| Rate for Payer: Wellcare Medicare |
$53,438.70
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$55,151.20
|
|
|
Service Code
|
MSDRG 871
|
| Min. Negotiated Rate |
$15,382.83 |
| Max. Negotiated Rate |
$55,151.20 |
| Rate for Payer: Aetna Managed Medicare |
$15,382.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,383.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,486.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,864.62
|
| Rate for Payer: Anthem Medicare Advantage |
$15,382.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,382.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,382.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,382.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,262.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,382.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,207.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,382.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,382.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,382.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,382.83
|
| Rate for Payer: NAPHCARE Commercial |
$23,074.24
|
| Rate for Payer: Quartz Medicare Advantage |
$15,382.83
|
| Rate for Payer: The Alliance Commercial |
$55,151.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,382.83
|
| Rate for Payer: United Healthcare PPO |
$31,301.76
|
| Rate for Payer: Wellcare Medicare |
$15,382.83
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$28,809.04
|
|
|
Service Code
|
MSDRG 872
|
| Min. Negotiated Rate |
$8,343.42 |
| Max. Negotiated Rate |
$28,809.04 |
| Rate for Payer: Aetna Managed Medicare |
$8,343.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,327.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,113.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,259.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8,343.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,343.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,343.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,343.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,049.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,343.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,886.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,343.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,343.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,343.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,343.42
|
| Rate for Payer: NAPHCARE Commercial |
$12,515.13
|
| Rate for Payer: Quartz Medicare Advantage |
$8,343.42
|
| Rate for Payer: The Alliance Commercial |
$28,809.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,343.42
|
| Rate for Payer: United Healthcare PPO |
$16,260.31
|
| Rate for Payer: Wellcare Medicare |
$8,343.42
|
|
|
SEPTOPLASTY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
SEPTOPLASTY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
