|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR
|
Facility
|
IP
|
$101,303.28
|
|
|
Service Code
|
MSDRG 518
|
| Min. Negotiated Rate |
$29,127.76 |
| Max. Negotiated Rate |
$101,303.28 |
| Rate for Payer: Aetna Managed Medicare |
$29,127.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81,544.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62,503.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59,382.41
|
| Rate for Payer: Anthem Medicare Advantage |
$29,127.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29,127.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29,127.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29,127.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65,919.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29,127.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74,058.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29,127.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29,127.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29,127.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29,127.76
|
| Rate for Payer: NAPHCARE Commercial |
$43,691.64
|
| Rate for Payer: Quartz Medicare Advantage |
$29,127.76
|
| Rate for Payer: The Alliance Commercial |
$101,303.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,127.76
|
| Rate for Payer: United Healthcare PPO |
$57,655.50
|
| Rate for Payer: Wellcare Medicare |
$29,127.76
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$39,913.12
|
|
|
Service Code
|
MSDRG 520
|
| Min. Negotiated Rate |
$11,947.35 |
| Max. Negotiated Rate |
$39,913.12 |
| Rate for Payer: Aetna Managed Medicare |
$11,947.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,595.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,984.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,736.76
|
| Rate for Payer: Anthem Medicare Advantage |
$11,947.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,947.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,947.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,947.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,349.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,947.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,030.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,947.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,947.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,947.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,947.35
|
| Rate for Payer: NAPHCARE Commercial |
$17,921.03
|
| Rate for Payer: Quartz Medicare Advantage |
$11,947.35
|
| Rate for Payer: The Alliance Commercial |
$39,913.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,947.35
|
| Rate for Payer: United Healthcare PPO |
$22,600.86
|
| Rate for Payer: Wellcare Medicare |
$11,947.35
|
|
|
Bacteria ID, Aerobic / 34118
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4624617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Bacteria ID, Aerobic / 34118
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4624617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$36.97 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$21.77
|
| Rate for Payer: HFN Commercial |
$22.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$10.52
|
| Rate for Payer: Quartz Commercial |
$13.63
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Bacteria ID, Aerobic / 34118
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4624617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$33.61 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.95
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: United Healthcare PPO |
$17.94
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: Wellcare Medicare |
$8.40
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$12,889.42
|
|
|
Service Code
|
APR-DRG 0492
|
| Min. Negotiated Rate |
$11,449.18 |
| Max. Negotiated Rate |
$12,889.42 |
| Rate for Payer: Anthem Medicaid |
$12,342.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,342.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,342.33
|
| Rate for Payer: Dean Health Medicaid |
$12,342.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,449.18
|
| Rate for Payer: Managed Health Services Medicaid |
$12,889.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,342.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,342.33
|
| Rate for Payer: United Healthcare Medicaid |
$12,342.33
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$28,760.06
|
|
|
Service Code
|
APR-DRG 0494
|
| Min. Negotiated Rate |
$25,546.48 |
| Max. Negotiated Rate |
$28,760.06 |
| Rate for Payer: Anthem Medicaid |
$27,539.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$27,539.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27,539.34
|
| Rate for Payer: Dean Health Medicaid |
$27,539.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25,546.48
|
| Rate for Payer: Managed Health Services Medicaid |
$28,760.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,539.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27,539.34
|
| Rate for Payer: United Healthcare Medicaid |
$27,539.34
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$18,588.82
|
|
|
Service Code
|
APR-DRG 0493
|
| Min. Negotiated Rate |
$16,511.75 |
| Max. Negotiated Rate |
$18,588.82 |
| Rate for Payer: Anthem Medicaid |
$17,799.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,799.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,799.82
|
| Rate for Payer: Dean Health Medicaid |
$17,799.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,511.75
|
| Rate for Payer: Managed Health Services Medicaid |
$18,588.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,799.82
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,799.82
|
| Rate for Payer: United Healthcare Medicaid |
$17,799.82
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
IP
|
$10,521.97
|
|
|
Service Code
|
APR-DRG 0491
|
| Min. Negotiated Rate |
$9,346.27 |
| Max. Negotiated Rate |
$10,521.97 |
| Rate for Payer: Anthem Medicaid |
$10,075.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,075.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,075.37
|
| Rate for Payer: Dean Health Medicaid |
$10,075.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,346.27
|
| Rate for Payer: Managed Health Services Medicaid |
$10,521.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,075.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,075.37
|
| Rate for Payer: United Healthcare Medicaid |
$10,075.37
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM
|
Facility
|
OP
|
$102.20
|
|
|
Service Code
|
EAPG 00518
|
| Min. Negotiated Rate |
$98.27 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Anthem Medicaid |
$98.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$98.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.27
|
| Rate for Payer: Dean Health Medicaid |
$98.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$98.27
|
| Rate for Payer: Managed Health Services Medicaid |
$102.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.27
|
| Rate for Payer: United Healthcare Medicaid |
$98.27
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
|
IP
|
$66,255.28
|
|
|
Service Code
|
MSDRG 095
|
| Min. Negotiated Rate |
$20,258.80 |
| Max. Negotiated Rate |
$66,255.28 |
| Rate for Payer: Aetna Managed Medicare |
$20,258.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56,276.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43,135.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40,981.22
|
| Rate for Payer: Anthem Medicare Advantage |
$20,258.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,258.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,258.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,258.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45,492.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,258.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48,351.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,258.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,258.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,258.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,258.80
|
| Rate for Payer: NAPHCARE Commercial |
$30,388.21
|
| Rate for Payer: Quartz Medicare Advantage |
$20,258.80
|
| Rate for Payer: The Alliance Commercial |
$66,255.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,258.80
|
| Rate for Payer: United Healthcare PPO |
$37,642.32
|
| Rate for Payer: Wellcare Medicare |
$20,258.80
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
|
IP
|
$100,498.32
|
|
|
Service Code
|
MSDRG 094
|
| Min. Negotiated Rate |
$27,459.05 |
| Max. Negotiated Rate |
$100,498.32 |
| Rate for Payer: Aetna Managed Medicare |
$27,459.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,790.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,859.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,920.17
|
| Rate for Payer: Anthem Medicare Advantage |
$27,459.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,459.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,459.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,459.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62,076.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,459.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73,468.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,459.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,459.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,459.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,459.05
|
| Rate for Payer: NAPHCARE Commercial |
$41,188.57
|
| Rate for Payer: Quartz Medicare Advantage |
$27,459.05
|
| Rate for Payer: The Alliance Commercial |
$100,498.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,459.05
|
| Rate for Payer: United Healthcare PPO |
$57,196.06
|
| Rate for Payer: Wellcare Medicare |
$27,459.05
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
|
IP
|
$60,600.80
|
|
|
Service Code
|
MSDRG 096
|
| Min. Negotiated Rate |
$20,258.80 |
| Max. Negotiated Rate |
$60,600.80 |
| Rate for Payer: Aetna Managed Medicare |
$20,258.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56,276.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43,135.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40,981.22
|
| Rate for Payer: Anthem Medicare Advantage |
$20,258.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,258.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,258.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,258.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45,492.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,258.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44,204.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,258.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,258.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,258.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,258.80
|
| Rate for Payer: NAPHCARE Commercial |
$30,388.21
|
| Rate for Payer: Quartz Medicare Advantage |
$20,258.80
|
| Rate for Payer: The Alliance Commercial |
$60,600.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,258.80
|
| Rate for Payer: United Healthcare PPO |
$34,413.63
|
| Rate for Payer: Wellcare Medicare |
$20,258.80
|
|
|
Bacterial Antigen
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
2770816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Bacterial Antigen
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
2770816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$52.81 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$29.34
|
| Rate for Payer: HFN Commercial |
$30.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$30.63
|
| Rate for Payer: Quartz Beloit One Network |
$14.19
|
| Rate for Payer: Quartz Commercial |
$18.38
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$47.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$52.81
|
|
|
Bacterial Antigen
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
2770816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.00 |
| Max. Negotiated Rate |
$48.01 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$12.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.92
|
| Rate for Payer: Anthem Medicare Advantage |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.00
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.00
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.00
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$12.00
|
| Rate for Payer: The Alliance Commercial |
$48.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.00
|
| Rate for Payer: United Healthcare PPO |
$24.18
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: Wellcare Medicare |
$12.00
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Bacterial DNA detection by 16S to UW
|
Facility
|
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
4732612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$509.60 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$624.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
Bacterial DNA detection by 16S to UW
|
Facility
|
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
4732612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$956.80 |
| Rate for Payer: Aetna Commercial |
$936.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$119.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$449.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$209.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.16
|
| Rate for Payer: Anthem Medicare Advantage |
$119.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$551.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.97
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$956.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$119.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$582.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$119.97
|
| Rate for Payer: Health EOS Commercial |
$925.60
|
| Rate for Payer: HFN Commercial |
$956.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$119.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$119.97
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$179.96
|
| Rate for Payer: Preferred Network Access Commercial |
$956.80
|
| Rate for Payer: Quartz Beloit One Network |
$509.60
|
| Rate for Payer: Quartz Commercial |
$676.00
|
| Rate for Payer: Quartz Medicare Advantage |
$119.97
|
| Rate for Payer: The Alliance Commercial |
$479.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.97
|
| Rate for Payer: United Healthcare PPO |
$780.00
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: Wellcare Medicare |
$119.97
|
| Rate for Payer: WPS Commercial |
$770.30
|
|
|
Bacterial DNA detection by 16S to UW
|
Professional
|
Both
|
$1,000.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
4732612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$988.00 |
| Rate for Payer: Aetna Commercial |
$988.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$894.40
|
| Rate for Payer: Aetna Managed Medicare |
$119.97
|
| Rate for Payer: Anthem Medicare Advantage |
$119.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$119.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$119.97
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$988.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$520.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.97
|
| Rate for Payer: Health EOS Commercial |
$946.40
|
| Rate for Payer: HFN Commercial |
$988.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$423.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$119.97
|
| Rate for Payer: Multiplan Commercial |
$832.00
|
| Rate for Payer: NAPHCARE Commercial |
$179.96
|
| Rate for Payer: Preferred Network Access Commercial |
$988.00
|
| Rate for Payer: Quartz Beloit One Network |
$457.60
|
| Rate for Payer: Quartz Commercial |
$592.80
|
| Rate for Payer: Quartz Medicare Advantage |
$119.97
|
| Rate for Payer: The Alliance Commercial |
$473.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$119.97
|
| Rate for Payer: WEA Trust Commercial |
$572.00
|
| Rate for Payer: WPS Commercial |
$527.89
|
|
|
Bacteriostatic Sodium Chloride 30ml MDV [Med]
|
Facility
|
IP
|
$11.00
|
|
| Hospital Charge Code |
2974981
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.61 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$10.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.06
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: Health EOS Commercial |
$10.18
|
| Rate for Payer: HFN Commercial |
$10.52
|
| Rate for Payer: Multiplan Commercial |
$9.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10.52
|
| Rate for Payer: Quartz Beloit One Network |
$5.61
|
| Rate for Payer: Quartz Commercial |
$6.86
|
| Rate for Payer: WEA Trust Commercial |
$6.29
|
| Rate for Payer: WPS Commercial |
$8.47
|
|
|
Bacteriostatic Sodium Chloride 30ml MDV [Med]
|
Facility
|
OP
|
$11.00
|
|
| Hospital Charge Code |
2974981
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.20 |
| Max. Negotiated Rate |
$10.52 |
| Rate for Payer: Aetna Commercial |
$10.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.84
|
| Rate for Payer: Aetna Managed Medicare |
$3.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.06
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.40
|
| Rate for Payer: Health EOS Commercial |
$10.18
|
| Rate for Payer: HFN Commercial |
$10.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.58
|
| Rate for Payer: Multiplan Commercial |
$9.15
|
| Rate for Payer: NAPHCARE Commercial |
$6.86
|
| Rate for Payer: Preferred Network Access Commercial |
$10.52
|
| Rate for Payer: Quartz Beloit One Network |
$5.61
|
| Rate for Payer: Quartz Commercial |
$7.44
|
| Rate for Payer: Quartz Medicare Advantage |
$6.86
|
| Rate for Payer: The Alliance Commercial |
$5.72
|
| Rate for Payer: WEA Trust Commercial |
$6.29
|
| Rate for Payer: WPS Commercial |
$8.47
|
|
|
BAG 150ML RESERVOIR #1PR-150
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
HCPCS A4627
|
| Hospital Charge Code |
2970379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$132.50 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
BAG 150ML RESERVOIR #1PR-150
|
Facility
|
OP
|
$260.00
|
|
|
Service Code
|
HCPCS A4627
|
| Hospital Charge Code |
2970379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.71 |
| Max. Negotiated Rate |
$248.77 |
| Rate for Payer: Aetna Commercial |
$243.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.54
|
| Rate for Payer: Aetna Managed Medicare |
$75.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.31
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$248.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.32
|
| Rate for Payer: Health EOS Commercial |
$240.66
|
| Rate for Payer: HFN Commercial |
$248.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.80
|
| Rate for Payer: Multiplan Commercial |
$216.32
|
| Rate for Payer: NAPHCARE Commercial |
$162.24
|
| Rate for Payer: Preferred Network Access Commercial |
$248.77
|
| Rate for Payer: Quartz Beloit One Network |
$132.50
|
| Rate for Payer: Quartz Commercial |
$175.76
|
| Rate for Payer: Quartz Medicare Advantage |
$162.24
|
| Rate for Payer: The Alliance Commercial |
$135.20
|
| Rate for Payer: WEA Trust Commercial |
$148.72
|
| Rate for Payer: WPS Commercial |
$200.28
|
|
|
BAG 65ML RESERVOIR #1PR-86/10
|
Facility
|
OP
|
$162.00
|
|
| Hospital Charge Code |
2971992
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.17 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$47.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.28
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.36
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$101.09
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$109.51
|
| Rate for Payer: Quartz Medicare Advantage |
$101.09
|
| Rate for Payer: The Alliance Commercial |
$84.24
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
BAG 65ML RESERVOIR #1PR-86/10
|
Facility
|
IP
|
$162.00
|
|
| Hospital Charge Code |
2971992
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$101.09
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
