|
SHOULDER, UPPER ARM AND FOREARM PROCEDURES EXCEPT JOINT REPLACEMENT
|
Facility
|
IP
|
$34,108.73
|
|
|
Service Code
|
APR-DRG 3154
|
| Min. Negotiated Rate |
$30,297.50 |
| Max. Negotiated Rate |
$34,108.73 |
| Rate for Payer: Anthem Medicaid |
$32,660.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,660.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,660.98
|
| Rate for Payer: Dean Health Medicaid |
$32,660.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,297.50
|
| Rate for Payer: Managed Health Services Medicaid |
$34,108.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,660.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,660.98
|
| Rate for Payer: United Healthcare Medicaid |
$32,660.98
|
|
|
SHUNT AHMED FP7-10-0029
|
Facility
|
IP
|
$4,918.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
6174991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.21 |
| Max. Negotiated Rate |
$4,705.54 |
| Rate for Payer: Aetna Commercial |
$4,603.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,398.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,710.80
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,705.54
|
| Rate for Payer: Health EOS Commercial |
$4,552.10
|
| Rate for Payer: HFN Commercial |
$4,705.54
|
| Rate for Payer: Multiplan Commercial |
$4,091.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,705.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,506.21
|
| Rate for Payer: Quartz Commercial |
$3,068.83
|
| Rate for Payer: WEA Trust Commercial |
$2,813.10
|
| Rate for Payer: WPS Commercial |
$3,788.34
|
|
|
SHUNT AHMED FP7-10-0029
|
Facility
|
OP
|
$4,918.00
|
|
|
Service Code
|
HCPCS C1783
|
| Hospital Charge Code |
6174991
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,432.12 |
| Max. Negotiated Rate |
$4,705.54 |
| Rate for Payer: Aetna Commercial |
$4,603.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,398.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,432.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,324.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,557.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,455.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,710.80
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,705.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,862.28
|
| Rate for Payer: Health EOS Commercial |
$4,552.10
|
| Rate for Payer: HFN Commercial |
$4,705.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,836.04
|
| Rate for Payer: Multiplan Commercial |
$4,091.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,068.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,705.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,506.21
|
| Rate for Payer: Quartz Commercial |
$3,324.57
|
| Rate for Payer: Quartz Medicare Advantage |
$3,068.83
|
| Rate for Payer: The Alliance Commercial |
$2,557.36
|
| Rate for Payer: WEA Trust Commercial |
$2,813.10
|
| Rate for Payer: WPS Commercial |
$3,788.34
|
|
|
SHUNT CLEARVIEW INTRACORONARY 1.5MM 31150
|
Facility
|
OP
|
$1,374.00
|
|
| Hospital Charge Code |
4017906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.11 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Aetna Managed Medicare |
$400.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.72
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: NAPHCARE Commercial |
$857.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$928.82
|
| Rate for Payer: Quartz Medicare Advantage |
$857.38
|
| Rate for Payer: The Alliance Commercial |
$714.48
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
SHUNT CLEARVIEW INTRACORONARY 1.5MM 31150
|
Facility
|
IP
|
$1,374.00
|
|
| Hospital Charge Code |
4017906
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$700.19 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$857.38
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
SHUNT CLEARVIEW INTRACORONARY 1MM 31100
|
Facility
|
IP
|
$1,374.00
|
|
| Hospital Charge Code |
4017905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$700.19 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$857.38
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
SHUNT CLEARVIEW INTRACORONARY 1MM 31100
|
Facility
|
OP
|
$1,374.00
|
|
| Hospital Charge Code |
4017905
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.11 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Aetna Managed Medicare |
$400.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.72
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: NAPHCARE Commercial |
$857.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$928.82
|
| Rate for Payer: Quartz Medicare Advantage |
$857.38
|
| Rate for Payer: The Alliance Commercial |
$714.48
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
SHUNT CLEARVIEW INTRACORONARY 2MM 31200
|
Facility
|
OP
|
$1,374.00
|
|
| Hospital Charge Code |
4017907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$400.11 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Aetna Managed Medicare |
$400.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.67
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.72
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: NAPHCARE Commercial |
$857.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$928.82
|
| Rate for Payer: Quartz Medicare Advantage |
$857.38
|
| Rate for Payer: The Alliance Commercial |
$714.48
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
SHUNT CLEARVIEW INTRACORONARY 2MM 31200
|
Facility
|
IP
|
$1,374.00
|
|
| Hospital Charge Code |
4017907
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$700.19 |
| Max. Negotiated Rate |
$1,314.64 |
| Rate for Payer: Aetna Commercial |
$1,286.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$757.35
|
| Rate for Payer: Cash Price |
$412.20
|
| Rate for Payer: Cigna Commercial |
$1,314.64
|
| Rate for Payer: Health EOS Commercial |
$1,271.77
|
| Rate for Payer: HFN Commercial |
$1,314.64
|
| Rate for Payer: Multiplan Commercial |
$1,143.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,314.64
|
| Rate for Payer: Quartz Beloit One Network |
$700.19
|
| Rate for Payer: Quartz Commercial |
$857.38
|
| Rate for Payer: WEA Trust Commercial |
$785.93
|
| Rate for Payer: WPS Commercial |
$1,058.39
|
|
|
SHUNT KIT ARGYLE CAROTID ARTERY 8888577775
|
Facility
|
IP
|
$701.00
|
|
| Hospital Charge Code |
5179006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.23 |
| Max. Negotiated Rate |
$670.72 |
| Rate for Payer: Aetna Commercial |
$656.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.39
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$670.72
|
| Rate for Payer: Health EOS Commercial |
$648.85
|
| Rate for Payer: HFN Commercial |
$670.72
|
| Rate for Payer: Multiplan Commercial |
$583.23
|
| Rate for Payer: Preferred Network Access Commercial |
$670.72
|
| Rate for Payer: Quartz Beloit One Network |
$357.23
|
| Rate for Payer: Quartz Commercial |
$437.42
|
| Rate for Payer: WEA Trust Commercial |
$400.97
|
| Rate for Payer: WPS Commercial |
$539.98
|
|
|
SHUNT KIT ARGYLE CAROTID ARTERY 8888577775
|
Facility
|
OP
|
$701.00
|
|
| Hospital Charge Code |
5179006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.13 |
| Max. Negotiated Rate |
$670.72 |
| Rate for Payer: Aetna Commercial |
$656.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.97
|
| Rate for Payer: Aetna Managed Medicare |
$204.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$473.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$364.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$349.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.39
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$670.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$407.98
|
| Rate for Payer: Health EOS Commercial |
$648.85
|
| Rate for Payer: HFN Commercial |
$670.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.78
|
| Rate for Payer: Multiplan Commercial |
$583.23
|
| Rate for Payer: NAPHCARE Commercial |
$437.42
|
| Rate for Payer: Preferred Network Access Commercial |
$670.72
|
| Rate for Payer: Quartz Beloit One Network |
$357.23
|
| Rate for Payer: Quartz Commercial |
$473.88
|
| Rate for Payer: Quartz Medicare Advantage |
$437.42
|
| Rate for Payer: The Alliance Commercial |
$364.52
|
| Rate for Payer: WEA Trust Commercial |
$400.97
|
| Rate for Payer: WPS Commercial |
$539.98
|
|
|
SHUNT PRUITT-INAHARA CAROTID e2012-10
|
Facility
|
OP
|
$3,406.00
|
|
| Hospital Charge Code |
2965262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$991.83 |
| Max. Negotiated Rate |
$3,258.86 |
| Rate for Payer: Aetna Commercial |
$3,188.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,046.33
|
| Rate for Payer: Aetna Managed Medicare |
$991.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,302.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,771.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,700.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,877.39
|
| Rate for Payer: Cash Price |
$1,021.80
|
| Rate for Payer: Cigna Commercial |
$3,258.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,982.29
|
| Rate for Payer: Health EOS Commercial |
$3,152.59
|
| Rate for Payer: HFN Commercial |
$3,258.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,656.68
|
| Rate for Payer: Multiplan Commercial |
$2,833.79
|
| Rate for Payer: NAPHCARE Commercial |
$2,125.34
|
| Rate for Payer: Preferred Network Access Commercial |
$3,258.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,735.70
|
| Rate for Payer: Quartz Commercial |
$2,302.46
|
| Rate for Payer: Quartz Medicare Advantage |
$2,125.34
|
| Rate for Payer: The Alliance Commercial |
$1,771.12
|
| Rate for Payer: WEA Trust Commercial |
$1,948.23
|
| Rate for Payer: WPS Commercial |
$2,623.64
|
|
|
SHUNT PRUITT-INAHARA CAROTID e2012-10
|
Facility
|
IP
|
$3,406.00
|
|
| Hospital Charge Code |
2965262
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,735.70 |
| Max. Negotiated Rate |
$3,258.86 |
| Rate for Payer: Aetna Commercial |
$3,188.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,046.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,877.39
|
| Rate for Payer: Cash Price |
$1,021.80
|
| Rate for Payer: Cigna Commercial |
$3,258.86
|
| Rate for Payer: Health EOS Commercial |
$3,152.59
|
| Rate for Payer: HFN Commercial |
$3,258.86
|
| Rate for Payer: Multiplan Commercial |
$2,833.79
|
| Rate for Payer: Preferred Network Access Commercial |
$3,258.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,735.70
|
| Rate for Payer: Quartz Commercial |
$2,125.34
|
| Rate for Payer: WEA Trust Commercial |
$1,948.23
|
| Rate for Payer: WPS Commercial |
$2,623.64
|
|
|
Sickle Cell
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
979865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Sickle Cell
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
979865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$5.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.51
|
| Rate for Payer: Anthem Medicare Advantage |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.73
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.73
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.73
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$8.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$5.73
|
| Rate for Payer: The Alliance Commercial |
$22.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.73
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: Wellcare Medicare |
$5.73
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Sickle Cell
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
979865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$5.73
|
| Rate for Payer: Anthem Medicare Advantage |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.73
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$90.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.73
|
| Rate for Payer: Health EOS Commercial |
$87.07
|
| Rate for Payer: HFN Commercial |
$90.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.73
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$8.60
|
| Rate for Payer: Preferred Network Access Commercial |
$90.90
|
| Rate for Payer: Quartz Beloit One Network |
$42.10
|
| Rate for Payer: Quartz Commercial |
$54.54
|
| Rate for Payer: Quartz Medicare Advantage |
$5.73
|
| Rate for Payer: The Alliance Commercial |
$22.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.73
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$25.21
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$11,749.54
|
|
|
Service Code
|
APR-DRG 6623
|
| Min. Negotiated Rate |
$10,436.67 |
| Max. Negotiated Rate |
$11,749.54 |
| Rate for Payer: Anthem Medicaid |
$11,250.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,250.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,250.83
|
| Rate for Payer: Dean Health Medicaid |
$11,250.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,436.67
|
| Rate for Payer: Managed Health Services Medicaid |
$11,749.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,250.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,250.83
|
| Rate for Payer: United Healthcare Medicaid |
$11,250.83
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
OP
|
$227.99
|
|
|
Service Code
|
EAPG 00783
|
| Min. Negotiated Rate |
$219.22 |
| Max. Negotiated Rate |
$227.99 |
| Rate for Payer: Anthem Medicaid |
$219.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$219.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.22
|
| Rate for Payer: Dean Health Medicaid |
$219.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$219.22
|
| Rate for Payer: Managed Health Services Medicaid |
$227.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$219.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$219.22
|
| Rate for Payer: United Healthcare Medicaid |
$219.22
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$21,306.99
|
|
|
Service Code
|
APR-DRG 6624
|
| Min. Negotiated Rate |
$18,926.20 |
| Max. Negotiated Rate |
$21,306.99 |
| Rate for Payer: Anthem Medicaid |
$20,402.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,402.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,402.62
|
| Rate for Payer: Dean Health Medicaid |
$20,402.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,926.20
|
| Rate for Payer: Managed Health Services Medicaid |
$21,306.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,402.62
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,402.62
|
| Rate for Payer: United Healthcare Medicaid |
$20,402.62
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$7,365.38
|
|
|
Service Code
|
APR-DRG 6622
|
| Min. Negotiated Rate |
$6,542.39 |
| Max. Negotiated Rate |
$7,365.38 |
| Rate for Payer: Anthem Medicaid |
$7,052.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,052.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,052.76
|
| Rate for Payer: Dean Health Medicaid |
$7,052.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,542.39
|
| Rate for Payer: Managed Health Services Medicaid |
$7,365.38
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,052.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,052.76
|
| Rate for Payer: United Healthcare Medicaid |
$7,052.76
|
|
|
SICKLE CELL ANEMIA CRISIS
|
Facility
|
IP
|
$5,348.67
|
|
|
Service Code
|
APR-DRG 6621
|
| Min. Negotiated Rate |
$4,751.02 |
| Max. Negotiated Rate |
$5,348.67 |
| Rate for Payer: Anthem Medicaid |
$5,121.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,121.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,121.65
|
| Rate for Payer: Dean Health Medicaid |
$5,121.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,751.02
|
| Rate for Payer: Managed Health Services Medicaid |
$5,348.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,121.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,121.65
|
| Rate for Payer: United Healthcare Medicaid |
$5,121.65
|
|
|
.Sickle Cell Screen
|
Facility
|
OP
|
$18.68
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
6238138
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$22.92 |
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.71
|
| Rate for Payer: Aetna Managed Medicare |
$5.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.51
|
| Rate for Payer: Anthem Medicare Advantage |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.73
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cigna Commercial |
$17.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.73
|
| Rate for Payer: Health EOS Commercial |
$17.29
|
| Rate for Payer: HFN Commercial |
$17.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.73
|
| Rate for Payer: Multiplan Commercial |
$15.54
|
| Rate for Payer: NAPHCARE Commercial |
$8.60
|
| Rate for Payer: Preferred Network Access Commercial |
$17.87
|
| Rate for Payer: Quartz Beloit One Network |
$9.52
|
| Rate for Payer: Quartz Commercial |
$12.63
|
| Rate for Payer: Quartz Medicare Advantage |
$5.73
|
| Rate for Payer: The Alliance Commercial |
$22.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.73
|
| Rate for Payer: United Healthcare PPO |
$14.57
|
| Rate for Payer: WEA Trust Commercial |
$10.68
|
| Rate for Payer: Wellcare Medicare |
$5.73
|
| Rate for Payer: WPS Commercial |
$14.39
|
|
|
.Sickle Cell Screen
|
Facility
|
IP
|
$18.68
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
6238138
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.52 |
| Max. Negotiated Rate |
$17.87 |
| Rate for Payer: Aetna Commercial |
$17.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.30
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cigna Commercial |
$17.87
|
| Rate for Payer: Health EOS Commercial |
$17.29
|
| Rate for Payer: HFN Commercial |
$17.87
|
| Rate for Payer: Multiplan Commercial |
$15.54
|
| Rate for Payer: Preferred Network Access Commercial |
$17.87
|
| Rate for Payer: Quartz Beloit One Network |
$9.52
|
| Rate for Payer: Quartz Commercial |
$11.66
|
| Rate for Payer: WEA Trust Commercial |
$10.68
|
| Rate for Payer: WPS Commercial |
$14.39
|
|
|
.Sickle Cell Screen
|
Professional
|
Both
|
$18.68
|
|
|
Service Code
|
CPT 85660
|
| Hospital Charge Code |
6238138
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.73 |
| Max. Negotiated Rate |
$25.21 |
| Rate for Payer: Aetna Commercial |
$18.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.71
|
| Rate for Payer: Aetna Managed Medicare |
$5.73
|
| Rate for Payer: Anthem Medicare Advantage |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.73
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cash Price |
$5.60
|
| Rate for Payer: Cigna Commercial |
$18.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.73
|
| Rate for Payer: Health EOS Commercial |
$17.68
|
| Rate for Payer: HFN Commercial |
$18.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.73
|
| Rate for Payer: Multiplan Commercial |
$15.54
|
| Rate for Payer: NAPHCARE Commercial |
$8.60
|
| Rate for Payer: Preferred Network Access Commercial |
$18.46
|
| Rate for Payer: Quartz Beloit One Network |
$8.55
|
| Rate for Payer: Quartz Commercial |
$11.07
|
| Rate for Payer: Quartz Medicare Advantage |
$5.73
|
| Rate for Payer: The Alliance Commercial |
$22.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.73
|
| Rate for Payer: WEA Trust Commercial |
$10.68
|
| Rate for Payer: WPS Commercial |
$25.21
|
|
|
S & I Code 74425
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
4125411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$525.91 |
| Max. Negotiated Rate |
$987.42 |
| Rate for Payer: Aetna Commercial |
$965.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.84
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$987.42
|
| Rate for Payer: Health EOS Commercial |
$955.22
|
| Rate for Payer: HFN Commercial |
$987.42
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: Preferred Network Access Commercial |
$987.42
|
| Rate for Payer: Quartz Beloit One Network |
$525.91
|
| Rate for Payer: Quartz Commercial |
$643.97
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$794.95
|
|
