|
BRONCHIOLITIS AND RSV PNEUMONIA
|
Facility
|
IP
|
$2,981.23
|
|
|
Service Code
|
APR-DRG 1381
|
| Min. Negotiated Rate |
$2,648.11 |
| Max. Negotiated Rate |
$2,981.23 |
| Rate for Payer: Anthem Medicaid |
$2,854.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,854.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,854.69
|
| Rate for Payer: Dean Health Medicaid |
$2,854.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,648.11
|
| Rate for Payer: Managed Health Services Medicaid |
$2,981.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,854.69
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,854.69
|
| Rate for Payer: United Healthcare Medicaid |
$2,854.69
|
|
|
BRONCHITIS AND ASTHMA WITH CC/MCC
|
Facility
|
IP
|
$26,807.04
|
|
|
Service Code
|
MSDRG 202
|
| Min. Negotiated Rate |
$7,944.42 |
| Max. Negotiated Rate |
$26,807.04 |
| Rate for Payer: Aetna Managed Medicare |
$7,944.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,190.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,242.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,431.51
|
| Rate for Payer: Anthem Medicare Advantage |
$7,944.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,944.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,944.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,944.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,130.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,944.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,418.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,944.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,944.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,944.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,944.42
|
| Rate for Payer: NAPHCARE Commercial |
$11,916.64
|
| Rate for Payer: Quartz Medicare Advantage |
$7,944.42
|
| Rate for Payer: The Alliance Commercial |
$26,807.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,944.42
|
| Rate for Payer: United Healthcare PPO |
$15,117.24
|
| Rate for Payer: Wellcare Medicare |
$7,944.42
|
|
|
BRONCHITIS AND ASTHMA WITHOUT CC/MCC
|
Facility
|
IP
|
$19,546.80
|
|
|
Service Code
|
MSDRG 203
|
| Min. Negotiated Rate |
$5,637.77 |
| Max. Negotiated Rate |
$19,546.80 |
| Rate for Payer: Aetna Managed Medicare |
$5,637.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,618.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,205.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,645.71
|
| Rate for Payer: Anthem Medicare Advantage |
$5,637.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,637.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,637.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,637.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,817.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,637.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,092.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,637.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,637.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,637.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,637.77
|
| Rate for Payer: NAPHCARE Commercial |
$8,456.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,637.77
|
| Rate for Payer: The Alliance Commercial |
$19,546.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,637.77
|
| Rate for Payer: United Healthcare PPO |
$10,971.25
|
| Rate for Payer: Wellcare Medicare |
$5,637.77
|
|
|
BRONCHO/LARYNGO/NASOPHANGO/ESOPHAGOSCOPY
|
Facility
|
OP
|
$2,051.00
|
|
| Hospital Charge Code |
2960333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$597.25 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Aetna Managed Medicare |
$597.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,386.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,066.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,023.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,193.68
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,599.78
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,279.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,386.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,279.82
|
| Rate for Payer: The Alliance Commercial |
$1,066.52
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
BRONCHO/LARYNGO/NASOPHANGO/ESOPHAGOSCOPY
|
Facility
|
IP
|
$2,051.00
|
|
| Hospital Charge Code |
2960333
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,045.19 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,279.82
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
BRONCHOSCOPE GLIDESCOPE BFLEX 2.8MM SINGLE-USE 0570-0447
|
Facility
|
OP
|
$3,215.00
|
|
| Hospital Charge Code |
6178757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$936.21 |
| Max. Negotiated Rate |
$3,076.11 |
| Rate for Payer: Aetna Commercial |
$3,009.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,875.50
|
| Rate for Payer: Aetna Managed Medicare |
$936.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,173.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,671.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,604.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,772.11
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$3,076.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,871.13
|
| Rate for Payer: Health EOS Commercial |
$2,975.80
|
| Rate for Payer: HFN Commercial |
$3,076.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,507.70
|
| Rate for Payer: Multiplan Commercial |
$2,674.88
|
| Rate for Payer: NAPHCARE Commercial |
$2,006.16
|
| Rate for Payer: Preferred Network Access Commercial |
$3,076.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,638.36
|
| Rate for Payer: Quartz Commercial |
$2,173.34
|
| Rate for Payer: Quartz Medicare Advantage |
$2,006.16
|
| Rate for Payer: The Alliance Commercial |
$1,671.80
|
| Rate for Payer: WEA Trust Commercial |
$1,838.98
|
| Rate for Payer: WPS Commercial |
$2,476.51
|
|
|
BRONCHOSCOPE GLIDESCOPE BFLEX 2.8MM SINGLE-USE 0570-0447
|
Facility
|
IP
|
$3,215.00
|
|
| Hospital Charge Code |
6178757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,638.36 |
| Max. Negotiated Rate |
$3,076.11 |
| Rate for Payer: Aetna Commercial |
$3,009.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,875.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,772.11
|
| Rate for Payer: Cash Price |
$964.50
|
| Rate for Payer: Cigna Commercial |
$3,076.11
|
| Rate for Payer: Health EOS Commercial |
$2,975.80
|
| Rate for Payer: HFN Commercial |
$3,076.11
|
| Rate for Payer: Multiplan Commercial |
$2,674.88
|
| Rate for Payer: Preferred Network Access Commercial |
$3,076.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,638.36
|
| Rate for Payer: Quartz Commercial |
$2,006.16
|
| Rate for Payer: WEA Trust Commercial |
$1,838.98
|
| Rate for Payer: WPS Commercial |
$2,476.51
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 3.8MM SINGLE-USE 0570-0380
|
Facility
|
OP
|
$2,302.00
|
|
| Hospital Charge Code |
5685759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.34 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Aetna Managed Medicare |
$670.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,556.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,197.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,149.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,339.76
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,795.56
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: NAPHCARE Commercial |
$1,436.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,556.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,436.45
|
| Rate for Payer: The Alliance Commercial |
$1,197.04
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 3.8MM SINGLE-USE 0570-0380
|
Facility
|
IP
|
$2,302.00
|
|
| Hospital Charge Code |
5685759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,173.10 |
| Max. Negotiated Rate |
$2,202.55 |
| Rate for Payer: Aetna Commercial |
$2,154.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,058.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,268.86
|
| Rate for Payer: Cash Price |
$690.60
|
| Rate for Payer: Cigna Commercial |
$2,202.55
|
| Rate for Payer: Health EOS Commercial |
$2,130.73
|
| Rate for Payer: HFN Commercial |
$2,202.55
|
| Rate for Payer: Multiplan Commercial |
$1,915.26
|
| Rate for Payer: Preferred Network Access Commercial |
$2,202.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,173.10
|
| Rate for Payer: Quartz Commercial |
$1,436.45
|
| Rate for Payer: WEA Trust Commercial |
$1,316.74
|
| Rate for Payer: WPS Commercial |
$1,773.23
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 3.8MM SINGLE-USE 0570-0448
|
Facility
|
IP
|
$3,018.00
|
|
| Hospital Charge Code |
5611694
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,537.97 |
| Max. Negotiated Rate |
$2,887.62 |
| Rate for Payer: Aetna Commercial |
$2,824.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.52
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$2,887.62
|
| Rate for Payer: Health EOS Commercial |
$2,793.46
|
| Rate for Payer: HFN Commercial |
$2,887.62
|
| Rate for Payer: Multiplan Commercial |
$2,510.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.97
|
| Rate for Payer: Quartz Commercial |
$1,883.23
|
| Rate for Payer: WEA Trust Commercial |
$1,726.30
|
| Rate for Payer: WPS Commercial |
$2,324.77
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 3.8MM SINGLE-USE 0570-0448
|
Facility
|
OP
|
$3,018.00
|
|
| Hospital Charge Code |
5611694
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$878.84 |
| Max. Negotiated Rate |
$2,887.62 |
| Rate for Payer: Aetna Commercial |
$2,824.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,699.30
|
| Rate for Payer: Aetna Managed Medicare |
$878.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,040.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,569.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,663.52
|
| Rate for Payer: Cash Price |
$905.40
|
| Rate for Payer: Cigna Commercial |
$2,887.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,756.48
|
| Rate for Payer: Health EOS Commercial |
$2,793.46
|
| Rate for Payer: HFN Commercial |
$2,887.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.04
|
| Rate for Payer: Multiplan Commercial |
$2,510.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,883.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,887.62
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.97
|
| Rate for Payer: Quartz Commercial |
$2,040.17
|
| Rate for Payer: Quartz Medicare Advantage |
$1,883.23
|
| Rate for Payer: The Alliance Commercial |
$1,569.36
|
| Rate for Payer: WEA Trust Commercial |
$1,726.30
|
| Rate for Payer: WPS Commercial |
$2,324.77
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 5.0MM SINGLE-USE 0570-0449
|
Facility
|
IP
|
$3,265.00
|
|
| Hospital Charge Code |
5459378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,663.84 |
| Max. Negotiated Rate |
$3,123.95 |
| Rate for Payer: Aetna Commercial |
$3,056.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.67
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,123.95
|
| Rate for Payer: Health EOS Commercial |
$3,022.08
|
| Rate for Payer: HFN Commercial |
$3,123.95
|
| Rate for Payer: Multiplan Commercial |
$2,716.48
|
| Rate for Payer: Preferred Network Access Commercial |
$3,123.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,663.84
|
| Rate for Payer: Quartz Commercial |
$2,037.36
|
| Rate for Payer: WEA Trust Commercial |
$1,867.58
|
| Rate for Payer: WPS Commercial |
$2,515.03
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 5.0MM SINGLE-USE 0570-0449
|
Facility
|
OP
|
$3,265.00
|
|
| Hospital Charge Code |
5459378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$950.77 |
| Max. Negotiated Rate |
$3,123.95 |
| Rate for Payer: Aetna Commercial |
$3,056.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,920.22
|
| Rate for Payer: Aetna Managed Medicare |
$950.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,207.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,697.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,629.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,799.67
|
| Rate for Payer: Cash Price |
$979.50
|
| Rate for Payer: Cigna Commercial |
$3,123.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,900.23
|
| Rate for Payer: Health EOS Commercial |
$3,022.08
|
| Rate for Payer: HFN Commercial |
$3,123.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,546.70
|
| Rate for Payer: Multiplan Commercial |
$2,716.48
|
| Rate for Payer: NAPHCARE Commercial |
$2,037.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,123.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,663.84
|
| Rate for Payer: Quartz Commercial |
$2,207.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,037.36
|
| Rate for Payer: The Alliance Commercial |
$1,697.80
|
| Rate for Payer: WEA Trust Commercial |
$1,867.58
|
| Rate for Payer: WPS Commercial |
$2,515.03
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 5.8MM SINGLE-USE 0570-0450
|
Facility
|
OP
|
$3,344.00
|
|
| Hospital Charge Code |
5520938
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$973.77 |
| Max. Negotiated Rate |
$3,199.54 |
| Rate for Payer: Aetna Commercial |
$3,129.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,990.87
|
| Rate for Payer: Aetna Managed Medicare |
$973.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,260.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,738.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,669.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,843.21
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,199.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,946.21
|
| Rate for Payer: Health EOS Commercial |
$3,095.21
|
| Rate for Payer: HFN Commercial |
$3,199.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,608.32
|
| Rate for Payer: Multiplan Commercial |
$2,782.21
|
| Rate for Payer: NAPHCARE Commercial |
$2,086.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,199.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,704.10
|
| Rate for Payer: Quartz Commercial |
$2,260.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,086.66
|
| Rate for Payer: The Alliance Commercial |
$1,738.88
|
| Rate for Payer: WEA Trust Commercial |
$1,912.77
|
| Rate for Payer: WPS Commercial |
$2,575.88
|
|
|
BRONCHOSCOPE GLIDESCOPE BIFLEX 5.8MM SINGLE-USE 0570-0450
|
Facility
|
IP
|
$3,344.00
|
|
| Hospital Charge Code |
5520938
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,704.10 |
| Max. Negotiated Rate |
$3,199.54 |
| Rate for Payer: Aetna Commercial |
$3,129.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,990.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,843.21
|
| Rate for Payer: Cash Price |
$1,003.20
|
| Rate for Payer: Cigna Commercial |
$3,199.54
|
| Rate for Payer: Health EOS Commercial |
$3,095.21
|
| Rate for Payer: HFN Commercial |
$3,199.54
|
| Rate for Payer: Multiplan Commercial |
$2,782.21
|
| Rate for Payer: Preferred Network Access Commercial |
$3,199.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,704.10
|
| Rate for Payer: Quartz Commercial |
$2,086.66
|
| Rate for Payer: WEA Trust Commercial |
$1,912.77
|
| Rate for Payer: WPS Commercial |
$2,575.88
|
|
|
BRONCHOSCOPY
|
Facility
|
OP
|
$2,051.00
|
|
| Hospital Charge Code |
1186826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$597.25 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Aetna Managed Medicare |
$597.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,386.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,066.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,023.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,193.68
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,599.78
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,279.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,386.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,279.82
|
| Rate for Payer: The Alliance Commercial |
$1,066.52
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
BRONCHOSCOPY
|
Facility
|
IP
|
$2,051.00
|
|
| Hospital Charge Code |
1186826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,045.19 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,279.82
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
BRONCHOSCOPY, CLEAR AIRWAYS 31645
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
CPT 31645
|
| Hospital Charge Code |
3014402
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.33 |
| Max. Negotiated Rate |
$1,783.34 |
| Rate for Payer: Aetna Commercial |
$1,783.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$130.33
|
| Rate for Payer: Anthem Medicare Advantage |
$130.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.33
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,783.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.33
|
| Rate for Payer: Health EOS Commercial |
$1,708.25
|
| Rate for Payer: HFN Commercial |
$1,783.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$515.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$515.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.33
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$195.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,783.34
|
| Rate for Payer: Quartz Beloit One Network |
$825.97
|
| Rate for Payer: Quartz Commercial |
$1,070.00
|
| Rate for Payer: Quartz Medicare Advantage |
$130.33
|
| Rate for Payer: The Alliance Commercial |
$553.91
|
| Rate for Payer: United Healthcare Medicaid |
$284.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.33
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$586.50
|
|
|
BRONCHOSCOPY/LUNG BX, EACH 31628
|
Professional
|
Both
|
$1,919.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
3014400
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$155.67 |
| Max. Negotiated Rate |
$1,895.97 |
| Rate for Payer: Aetna Commercial |
$1,895.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,716.35
|
| Rate for Payer: Aetna Managed Medicare |
$155.67
|
| Rate for Payer: Anthem Medicare Advantage |
$155.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.67
|
| Rate for Payer: Cash Price |
$575.70
|
| Rate for Payer: Cash Price |
$575.70
|
| Rate for Payer: Cash Price |
$575.70
|
| Rate for Payer: Cigna Commercial |
$1,895.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$380.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.67
|
| Rate for Payer: Health EOS Commercial |
$1,816.14
|
| Rate for Payer: HFN Commercial |
$1,895.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$621.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$621.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.67
|
| Rate for Payer: Multiplan Commercial |
$1,596.61
|
| Rate for Payer: NAPHCARE Commercial |
$233.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,895.97
|
| Rate for Payer: Quartz Beloit One Network |
$878.13
|
| Rate for Payer: Quartz Commercial |
$1,137.58
|
| Rate for Payer: Quartz Medicare Advantage |
$155.67
|
| Rate for Payer: The Alliance Commercial |
$661.59
|
| Rate for Payer: United Healthcare Medicaid |
$380.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.67
|
| Rate for Payer: WEA Trust Commercial |
$1,097.67
|
| Rate for Payer: WPS Commercial |
$700.50
|
|
|
BRONCHOSCOPY W/FB REMOVAL 31635
|
Professional
|
Both
|
$2,129.00
|
|
|
Service Code
|
CPT 31635
|
| Hospital Charge Code |
3014401
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$154.47 |
| Max. Negotiated Rate |
$2,103.45 |
| Rate for Payer: Aetna Commercial |
$2,103.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,904.18
|
| Rate for Payer: Aetna Managed Medicare |
$154.47
|
| Rate for Payer: Anthem Medicare Advantage |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.47
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cash Price |
$638.70
|
| Rate for Payer: Cigna Commercial |
$2,103.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$582.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.47
|
| Rate for Payer: Health EOS Commercial |
$2,014.89
|
| Rate for Payer: HFN Commercial |
$2,103.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$612.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.47
|
| Rate for Payer: Multiplan Commercial |
$1,771.33
|
| Rate for Payer: NAPHCARE Commercial |
$231.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,103.45
|
| Rate for Payer: Quartz Beloit One Network |
$974.23
|
| Rate for Payer: Quartz Commercial |
$1,262.07
|
| Rate for Payer: Quartz Medicare Advantage |
$154.47
|
| Rate for Payer: The Alliance Commercial |
$656.50
|
| Rate for Payer: United Healthcare Medicaid |
$582.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.47
|
| Rate for Payer: WEA Trust Commercial |
$1,217.79
|
| Rate for Payer: WPS Commercial |
$695.12
|
|
|
BROW LIFT
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959882
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
BROW LIFT
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959882
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Brucella Antibodies (IgG, IgM), EIA
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
5383334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$86.94 |
| Rate for Payer: Aetna Commercial |
$86.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$9.29
|
| Rate for Payer: Anthem Medicare Advantage |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.29
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$86.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.29
|
| Rate for Payer: Health EOS Commercial |
$83.28
|
| Rate for Payer: HFN Commercial |
$86.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.29
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$13.93
|
| Rate for Payer: Preferred Network Access Commercial |
$86.94
|
| Rate for Payer: Quartz Beloit One Network |
$40.27
|
| Rate for Payer: Quartz Commercial |
$52.17
|
| Rate for Payer: Quartz Medicare Advantage |
$9.29
|
| Rate for Payer: The Alliance Commercial |
$36.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.29
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$40.86
|
|
|
Brucella Antibodies (IgG, IgM), EIA
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
5383334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
Brucella Antibodies (IgG, IgM), EIA
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86622
|
| Hospital Charge Code |
5383334
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.29 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$9.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.42
|
| Rate for Payer: Anthem Medicare Advantage |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.29
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.29
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.29
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$13.93
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$9.29
|
| Rate for Payer: The Alliance Commercial |
$37.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.29
|
| Rate for Payer: United Healthcare PPO |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: Wellcare Medicare |
$9.29
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
