|
Sigmoidoscopy Flx with Band Ligation(s) 45350
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
5430717
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.17 |
| Max. Negotiated Rate |
$1,499.78 |
| Rate for Payer: Aetna Commercial |
$1,499.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,357.70
|
| Rate for Payer: Aetna Managed Medicare |
$89.17
|
| Rate for Payer: Anthem Medicare Advantage |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.17
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna Commercial |
$1,499.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.17
|
| Rate for Payer: Health EOS Commercial |
$1,436.64
|
| Rate for Payer: HFN Commercial |
$1,499.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$348.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.17
|
| Rate for Payer: Multiplan Commercial |
$1,262.98
|
| Rate for Payer: NAPHCARE Commercial |
$133.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.78
|
| Rate for Payer: Quartz Beloit One Network |
$694.64
|
| Rate for Payer: Quartz Commercial |
$899.87
|
| Rate for Payer: Quartz Medicare Advantage |
$89.17
|
| Rate for Payer: The Alliance Commercial |
$378.97
|
| Rate for Payer: United Healthcare Medicaid |
$136.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.17
|
| Rate for Payer: WEA Trust Commercial |
$868.30
|
| Rate for Payer: WPS Commercial |
$401.26
|
|
|
SIGMOIDOSCOPY W/ABLATE TUMR 45339
|
Professional
|
Both
|
$1,362.00
|
|
| Hospital Charge Code |
3014802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$623.25 |
| Max. Negotiated Rate |
$1,345.66 |
| Rate for Payer: Aetna Commercial |
$1,345.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,218.17
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$1,345.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$708.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$849.89
|
| Rate for Payer: Health EOS Commercial |
$1,289.00
|
| Rate for Payer: HFN Commercial |
$1,345.66
|
| Rate for Payer: Multiplan Commercial |
$1,133.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.66
|
| Rate for Payer: Quartz Beloit One Network |
$623.25
|
| Rate for Payer: Quartz Commercial |
$807.39
|
| Rate for Payer: The Alliance Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$779.06
|
| Rate for Payer: WPS Commercial |
$1,049.15
|
|
|
SIGMOIDOSCOPY W/FB REMOVAL 45332
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
CPT 45332
|
| Hospital Charge Code |
3014797
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.05 |
| Max. Negotiated Rate |
$608.61 |
| Rate for Payer: Aetna Commercial |
$608.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Aetna Managed Medicare |
$93.05
|
| Rate for Payer: Anthem Medicare Advantage |
$93.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.05
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$608.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.05
|
| Rate for Payer: Health EOS Commercial |
$582.98
|
| Rate for Payer: HFN Commercial |
$608.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$362.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$362.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.05
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: NAPHCARE Commercial |
$139.57
|
| Rate for Payer: Preferred Network Access Commercial |
$608.61
|
| Rate for Payer: Quartz Beloit One Network |
$281.88
|
| Rate for Payer: Quartz Commercial |
$365.16
|
| Rate for Payer: Quartz Medicare Advantage |
$93.05
|
| Rate for Payer: The Alliance Commercial |
$395.46
|
| Rate for Payer: United Healthcare Medicaid |
$116.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.05
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$418.72
|
|
|
SIGMOIDOSCOPY W/SUBMUC INJ 45335
|
Professional
|
Both
|
$1,627.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
3014800
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.54 |
| Max. Negotiated Rate |
$1,607.48 |
| Rate for Payer: Aetna Commercial |
$1,607.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.19
|
| Rate for Payer: Aetna Managed Medicare |
$60.54
|
| Rate for Payer: Anthem Medicare Advantage |
$60.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.54
|
| Rate for Payer: Cash Price |
$488.10
|
| Rate for Payer: Cash Price |
$488.10
|
| Rate for Payer: Cash Price |
$488.10
|
| Rate for Payer: Cigna Commercial |
$1,607.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.54
|
| Rate for Payer: Health EOS Commercial |
$1,539.79
|
| Rate for Payer: HFN Commercial |
$1,607.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.54
|
| Rate for Payer: Multiplan Commercial |
$1,353.66
|
| Rate for Payer: NAPHCARE Commercial |
$90.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.48
|
| Rate for Payer: Quartz Beloit One Network |
$744.52
|
| Rate for Payer: Quartz Commercial |
$964.49
|
| Rate for Payer: Quartz Medicare Advantage |
$60.54
|
| Rate for Payer: The Alliance Commercial |
$257.29
|
| Rate for Payer: United Healthcare Medicaid |
$161.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.54
|
| Rate for Payer: WEA Trust Commercial |
$930.64
|
| Rate for Payer: WPS Commercial |
$272.42
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$39,014.56
|
|
|
Service Code
|
MSDRG 555
|
| Min. Negotiated Rate |
$10,629.38 |
| Max. Negotiated Rate |
$39,014.56 |
| Rate for Payer: Aetna Managed Medicare |
$10,629.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,840.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,106.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,002.24
|
| Rate for Payer: Anthem Medicare Advantage |
$10,629.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,629.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,629.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,629.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,314.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,629.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,371.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,629.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,629.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,629.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,629.38
|
| Rate for Payer: NAPHCARE Commercial |
$15,944.07
|
| Rate for Payer: Quartz Medicare Advantage |
$10,629.38
|
| Rate for Payer: The Alliance Commercial |
$39,014.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,629.38
|
| Rate for Payer: United Healthcare PPO |
$22,087.75
|
| Rate for Payer: Wellcare Medicare |
$10,629.38
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC
|
Facility
|
IP
|
$23,127.52
|
|
|
Service Code
|
MSDRG 556
|
| Min. Negotiated Rate |
$6,867.69 |
| Max. Negotiated Rate |
$23,127.52 |
| Rate for Payer: Aetna Managed Medicare |
$6,867.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,123.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,891.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,197.50
|
| Rate for Payer: Anthem Medicare Advantage |
$6,867.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,867.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,867.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,867.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,650.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,867.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,718.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,867.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,867.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,867.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,867.69
|
| Rate for Payer: NAPHCARE Commercial |
$10,301.54
|
| Rate for Payer: Quartz Medicare Advantage |
$6,867.69
|
| Rate for Payer: The Alliance Commercial |
$23,127.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,867.69
|
| Rate for Payer: United Healthcare PPO |
$13,015.83
|
| Rate for Payer: Wellcare Medicare |
$6,867.69
|
|
|
SIGNS AND SYMPTOMS WITH MCC
|
Facility
|
IP
|
$34,938.80
|
|
|
Service Code
|
MSDRG 947
|
| Min. Negotiated Rate |
$10,228.09 |
| Max. Negotiated Rate |
$34,938.80 |
| Rate for Payer: Aetna Managed Medicare |
$10,228.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,697.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,229.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,169.65
|
| Rate for Payer: Anthem Medicare Advantage |
$10,228.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,228.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,228.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,228.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,390.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,228.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,382.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,228.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,228.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,228.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,228.09
|
| Rate for Payer: NAPHCARE Commercial |
$15,342.13
|
| Rate for Payer: Quartz Medicare Advantage |
$10,228.09
|
| Rate for Payer: The Alliance Commercial |
$34,938.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,228.09
|
| Rate for Payer: United Healthcare PPO |
$19,760.56
|
| Rate for Payer: Wellcare Medicare |
$10,228.09
|
|
|
SIGNS AND SYMPTOMS WITHOUT MCC
|
Facility
|
IP
|
$22,480.64
|
|
|
Service Code
|
MSDRG 948
|
| Min. Negotiated Rate |
$6,637.18 |
| Max. Negotiated Rate |
$22,480.64 |
| Rate for Payer: Aetna Managed Medicare |
$6,637.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,466.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,387.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,719.24
|
| Rate for Payer: Anthem Medicare Advantage |
$6,637.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,637.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,637.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,637.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,119.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,637.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,244.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,637.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,637.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,637.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,637.18
|
| Rate for Payer: NAPHCARE Commercial |
$9,955.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6,637.18
|
| Rate for Payer: The Alliance Commercial |
$22,480.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,637.18
|
| Rate for Payer: United Healthcare PPO |
$12,646.38
|
| Rate for Payer: Wellcare Medicare |
$6,637.18
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$6,137.82
|
|
|
Service Code
|
APR-DRG 8612
|
| Min. Negotiated Rate |
$5,451.99 |
| Max. Negotiated Rate |
$6,137.82 |
| Rate for Payer: Anthem Medicaid |
$5,877.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,877.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,877.30
|
| Rate for Payer: Dean Health Medicaid |
$5,877.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,451.99
|
| Rate for Payer: Managed Health Services Medicaid |
$6,137.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,877.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,877.30
|
| Rate for Payer: United Healthcare Medicaid |
$5,877.30
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$8,943.68
|
|
|
Service Code
|
APR-DRG 8613
|
| Min. Negotiated Rate |
$7,944.33 |
| Max. Negotiated Rate |
$8,943.68 |
| Rate for Payer: Molina Healthcare Medicaid |
$8,564.06
|
| Rate for Payer: Anthem Medicaid |
$8,564.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,564.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,564.06
|
| Rate for Payer: Dean Health Medicaid |
$8,564.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,944.33
|
| Rate for Payer: Managed Health Services Medicaid |
$8,943.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,564.06
|
| Rate for Payer: United Healthcare Medicaid |
$8,564.06
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$14,643.08
|
|
|
Service Code
|
APR-DRG 8614
|
| Min. Negotiated Rate |
$13,006.90 |
| Max. Negotiated Rate |
$14,643.08 |
| Rate for Payer: Anthem Medicaid |
$14,021.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,021.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,021.55
|
| Rate for Payer: Dean Health Medicaid |
$14,021.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,006.90
|
| Rate for Payer: Managed Health Services Medicaid |
$14,643.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,021.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,021.55
|
| Rate for Payer: United Healthcare Medicaid |
$14,021.55
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
OP
|
$37.57
|
|
|
Service Code
|
EAPG 00871
|
| Min. Negotiated Rate |
$36.13 |
| Max. Negotiated Rate |
$37.57 |
| Rate for Payer: Anthem Medicaid |
$36.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.13
|
| Rate for Payer: Dean Health Medicaid |
$36.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.13
|
| Rate for Payer: Managed Health Services Medicaid |
$37.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$36.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.13
|
| Rate for Payer: United Healthcare Medicaid |
$36.13
|
|
|
SIGNS, SYMPTOMS AND OTHER FACTORS INFLUENCING HEALTH STATUS
|
Facility
|
IP
|
$4,647.20
|
|
|
Service Code
|
APR-DRG 8611
|
| Min. Negotiated Rate |
$4,127.94 |
| Max. Negotiated Rate |
$4,647.20 |
| Rate for Payer: Anthem Medicaid |
$4,449.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,449.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,449.95
|
| Rate for Payer: Dean Health Medicaid |
$4,449.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,127.94
|
| Rate for Payer: Managed Health Services Medicaid |
$4,647.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,449.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,449.95
|
| Rate for Payer: United Healthcare Medicaid |
$4,449.95
|
|
|
SIG W/BALLOON DILATION 45340
|
Professional
|
Both
|
$742.00
|
|
|
Service Code
|
CPT 45340
|
| Hospital Charge Code |
3014803
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.16 |
| Max. Negotiated Rate |
$733.10 |
| Rate for Payer: Aetna Commercial |
$733.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$663.64
|
| Rate for Payer: Aetna Managed Medicare |
$70.16
|
| Rate for Payer: Anthem Medicare Advantage |
$70.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.16
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$733.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$276.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.16
|
| Rate for Payer: Health EOS Commercial |
$702.23
|
| Rate for Payer: HFN Commercial |
$733.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$268.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.16
|
| Rate for Payer: Multiplan Commercial |
$617.34
|
| Rate for Payer: NAPHCARE Commercial |
$105.24
|
| Rate for Payer: Preferred Network Access Commercial |
$733.10
|
| Rate for Payer: Quartz Beloit One Network |
$339.54
|
| Rate for Payer: Quartz Commercial |
$439.86
|
| Rate for Payer: Quartz Medicare Advantage |
$70.16
|
| Rate for Payer: The Alliance Commercial |
$298.17
|
| Rate for Payer: United Healthcare Medicaid |
$276.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.16
|
| Rate for Payer: WEA Trust Commercial |
$424.42
|
| Rate for Payer: WPS Commercial |
$315.71
|
|
|
Silicon Level to Mayo
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 84285
|
| Hospital Charge Code |
5198610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$26.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.52
|
| Rate for Payer: Anthem Medicare Advantage |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.22
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.22
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$39.33
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$26.22
|
| Rate for Payer: The Alliance Commercial |
$104.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.22
|
| Rate for Payer: United Healthcare PPO |
$134.94
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: Wellcare Medicare |
$26.22
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Silicon Level to Mayo
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 84285
|
| Hospital Charge Code |
5198610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.22 |
| Max. Negotiated Rate |
$170.92 |
| Rate for Payer: Aetna Commercial |
$170.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$26.22
|
| Rate for Payer: Anthem Medicare Advantage |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.22
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$170.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.22
|
| Rate for Payer: Health EOS Commercial |
$163.73
|
| Rate for Payer: HFN Commercial |
$170.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$92.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.22
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$39.33
|
| Rate for Payer: Preferred Network Access Commercial |
$170.92
|
| Rate for Payer: Quartz Beloit One Network |
$79.16
|
| Rate for Payer: Quartz Commercial |
$102.55
|
| Rate for Payer: Quartz Medicare Advantage |
$26.22
|
| Rate for Payer: The Alliance Commercial |
$103.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.22
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$115.36
|
|
|
Silicon Level to Mayo
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 84285
|
| Hospital Charge Code |
5198610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Silver Nitrate Sticks [Med]
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
2974978
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Silver Nitrate Sticks [Med]
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
2974978
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.49
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Silver Sulfadiazine Cream 50gm [Med]
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
2974979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Silver Sulfadiazine Cream 50gm [Med]
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
2974979
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Simple Dressing - Incision, Wound Dressing:
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3003560
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.28 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$30.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.12
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$64.90
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Simple Dressing - Incision, Wound Dressing:
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3003560
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITH CC
|
Facility
|
IP
|
$23,066.16
|
|
|
Service Code
|
MSDRG 194
|
| Min. Negotiated Rate |
$6,678.52 |
| Max. Negotiated Rate |
$23,066.16 |
| Rate for Payer: Aetna Managed Medicare |
$6,678.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,584.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,478.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,805.04
|
| Rate for Payer: Anthem Medicare Advantage |
$6,678.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,678.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,678.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,678.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,214.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,678.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,674.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,678.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,678.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,678.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,678.52
|
| Rate for Payer: NAPHCARE Commercial |
$10,017.77
|
| Rate for Payer: Quartz Medicare Advantage |
$6,678.52
|
| Rate for Payer: The Alliance Commercial |
$23,066.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,678.52
|
| Rate for Payer: United Healthcare PPO |
$12,981.09
|
| Rate for Payer: Wellcare Medicare |
$6,678.52
|
|
|
SIMPLE PNEUMONIA AND PLEURISY WITH MCC
|
Facility
|
IP
|
$37,012.56
|
|
|
Service Code
|
MSDRG 193
|
| Min. Negotiated Rate |
$10,572.71 |
| Max. Negotiated Rate |
$37,012.56 |
| Rate for Payer: Aetna Managed Medicare |
$10,572.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,679.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,982.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,884.66
|
| Rate for Payer: Anthem Medicare Advantage |
$10,572.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,572.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,572.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,572.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,183.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,572.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,903.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,572.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,572.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,572.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,572.71
|
| Rate for Payer: NAPHCARE Commercial |
$15,859.07
|
| Rate for Payer: Quartz Medicare Advantage |
$10,572.71
|
| Rate for Payer: The Alliance Commercial |
$37,012.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,572.71
|
| Rate for Payer: United Healthcare PPO |
$20,944.67
|
| Rate for Payer: Wellcare Medicare |
$10,572.71
|
|
