|
Activated Protein C Resistance
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
980012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Activated Protein C Resistance
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
980012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.43
|
| Rate for Payer: Anthem Medicaid |
$15.83
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Dean Health Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$22.98
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.83
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$61.28
|
| Rate for Payer: United Healthcare Medicaid |
$15.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare PPO |
$258.75
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: Wellcare Medicare |
$15.32
|
| Rate for Payer: WMAP Medicaid |
$15.83
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Activated Protein C Resistance
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
5749633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.80
|
| Rate for Payer: Health EOS Commercial |
$293.93
|
| Rate for Payer: HFN Commercial |
$306.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.08
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Preferred Network Access Commercial |
$306.85
|
| Rate for Payer: Quartz Beloit One Network |
$142.12
|
| Rate for Payer: Quartz Commercial |
$184.11
|
| Rate for Payer: The Alliance Commercial |
$161.50
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Activated Protein C Resistance
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
980012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna Commercial |
$327.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$327.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$313.95
|
| Rate for Payer: HFN Commercial |
$327.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.08
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$327.75
|
| Rate for Payer: Quartz Beloit One Network |
$151.80
|
| Rate for Payer: Quartz Commercial |
$196.65
|
| Rate for Payer: The Alliance Commercial |
$172.50
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
ACTIVATION TOOL S0457-000
|
Facility
|
IP
|
$1,553.00
|
|
| Hospital Charge Code |
6232145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.97 |
| Max. Negotiated Rate |
$1,428.76 |
| Rate for Payer: Aetna Commercial |
$1,397.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.09
|
| Rate for Payer: Cash Price |
$465.90
|
| Rate for Payer: Cigna Commercial |
$1,428.76
|
| Rate for Payer: Health EOS Commercial |
$1,382.17
|
| Rate for Payer: HFN Commercial |
$1,428.76
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$931.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.76
|
| Rate for Payer: Quartz Beloit One Network |
$760.97
|
| Rate for Payer: Quartz Commercial |
$931.80
|
| Rate for Payer: WEA Trust Commercial |
$854.15
|
| Rate for Payer: WPS Commercial |
$1,150.31
|
|
|
ACTIVATION TOOL S0457-000
|
Facility
|
OP
|
$1,553.00
|
|
| Hospital Charge Code |
6232145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$434.84 |
| Max. Negotiated Rate |
$6,212.00 |
| Rate for Payer: Aetna Commercial |
$1,397.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.58
|
| Rate for Payer: Aetna Managed Medicare |
$434.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.09
|
| Rate for Payer: Cash Price |
$465.90
|
| Rate for Payer: Cigna Commercial |
$1,428.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$869.06
|
| Rate for Payer: Health EOS Commercial |
$1,382.17
|
| Rate for Payer: HFN Commercial |
$1,428.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.75
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$931.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.76
|
| Rate for Payer: Quartz Beloit One Network |
$760.97
|
| Rate for Payer: Quartz Commercial |
$1,009.45
|
| Rate for Payer: Quartz Medicare Advantage |
$931.80
|
| Rate for Payer: The Alliance Commercial |
$6,212.00
|
| Rate for Payer: WEA Trust Commercial |
$854.15
|
| Rate for Payer: WPS Commercial |
$1,150.31
|
|
|
ACT Testing
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
3052459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$4.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.10
|
| Rate for Payer: Anthem Medicaid |
$4.42
|
| Rate for Payer: Anthem Medicare Advantage |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.28
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.62
|
| Rate for Payer: Dean Health Medicaid |
$4.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.28
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.28
|
| Rate for Payer: Managed Health Services Medicaid |
$4.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.28
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$6.42
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.42
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4.28
|
| Rate for Payer: The Alliance Commercial |
$17.12
|
| Rate for Payer: United Healthcare Medicaid |
$4.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.28
|
| Rate for Payer: United Healthcare PPO |
$114.75
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: Wellcare Medicare |
$4.28
|
| Rate for Payer: WMAP Medicaid |
$4.42
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
ACT Testing
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
3052459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$25,699.00
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$9,244.39 |
| Max. Negotiated Rate |
$25,699.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,244.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,931.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,276.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,514.10
|
| Rate for Payer: Anthem Medicare Advantage |
$9,244.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,244.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,244.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,244.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,111.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,244.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,614.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,244.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,244.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,244.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,244.39
|
| Rate for Payer: NAPHCARE Commercial |
$13,866.58
|
| Rate for Payer: Quartz Medicare Advantage |
$9,244.39
|
| Rate for Payer: The Alliance Commercial |
$25,699.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,244.39
|
| Rate for Payer: United Healthcare PPO |
$14,491.78
|
| Rate for Payer: Wellcare Medicare |
$9,244.39
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$39,606.00
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$14,246.94 |
| Max. Negotiated Rate |
$39,606.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,246.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,050.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,799.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,611.44
|
| Rate for Payer: Anthem Medicare Advantage |
$14,246.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,246.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,246.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,246.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,100.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,246.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,815.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,246.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,246.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,246.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,246.94
|
| Rate for Payer: NAPHCARE Commercial |
$21,370.41
|
| Rate for Payer: Quartz Medicare Advantage |
$14,246.94
|
| Rate for Payer: The Alliance Commercial |
$39,606.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,246.94
|
| Rate for Payer: United Healthcare PPO |
$22,432.96
|
| Rate for Payer: Wellcare Medicare |
$14,246.94
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$69,258.00
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$24,912.88 |
| Max. Negotiated Rate |
$69,258.00 |
| Rate for Payer: Aetna Managed Medicare |
$24,912.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54,338.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41,649.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39,570.02
|
| Rate for Payer: Anthem Medicare Advantage |
$24,912.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,912.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,912.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,912.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,926.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,912.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,563.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,912.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,912.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,912.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,912.88
|
| Rate for Payer: NAPHCARE Commercial |
$37,369.32
|
| Rate for Payer: Quartz Medicare Advantage |
$24,912.88
|
| Rate for Payer: The Alliance Commercial |
$69,258.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,912.88
|
| Rate for Payer: United Healthcare PPO |
$39,364.33
|
| Rate for Payer: Wellcare Medicare |
$24,912.88
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$29,169.00
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$10,492.39 |
| Max. Negotiated Rate |
$29,169.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,492.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,563.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,736.34
|
| Rate for Payer: Anthem Medicare Advantage |
$10,492.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,492.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,492.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,492.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,468.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,492.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,991.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,492.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,492.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,492.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,492.39
|
| Rate for Payer: NAPHCARE Commercial |
$15,738.58
|
| Rate for Payer: Quartz Medicare Advantage |
$10,492.39
|
| Rate for Payer: The Alliance Commercial |
$29,169.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,492.39
|
| Rate for Payer: United Healthcare PPO |
$15,563.56
|
| Rate for Payer: Wellcare Medicare |
$10,492.39
|
|
|
Acute Hemodialysis
|
Facility
|
IP
|
$2,195.00
|
|
| Hospital Charge Code |
3005574
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$1,075.55 |
| Max. Negotiated Rate |
$2,019.40 |
| Rate for Payer: Aetna Commercial |
$1,975.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,887.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.35
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,019.40
|
| Rate for Payer: Health EOS Commercial |
$1,953.55
|
| Rate for Payer: HFN Commercial |
$2,019.40
|
| Rate for Payer: Multiplan Commercial |
$1,756.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.55
|
| Rate for Payer: Quartz Commercial |
$1,317.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.25
|
| Rate for Payer: WPS Commercial |
$1,625.84
|
|
|
Acute Hemodialysis
|
Facility
|
OP
|
$2,195.00
|
|
| Hospital Charge Code |
3005574
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$614.60 |
| Max. Negotiated Rate |
$8,780.00 |
| Rate for Payer: Aetna Commercial |
$1,975.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,887.70
|
| Rate for Payer: Aetna Managed Medicare |
$614.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,426.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,097.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,053.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.35
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,019.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.32
|
| Rate for Payer: Health EOS Commercial |
$1,953.55
|
| Rate for Payer: HFN Commercial |
$2,019.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,646.25
|
| Rate for Payer: Multiplan Commercial |
$1,756.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.55
|
| Rate for Payer: Quartz Commercial |
$1,426.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.00
|
| Rate for Payer: The Alliance Commercial |
$8,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.25
|
| Rate for Payer: WPS Commercial |
$1,625.84
|
|
|
Acute Hepatitis Panel
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
633756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$517.96 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Aetna Managed Medicare |
$47.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.07
|
| Rate for Payer: Anthem Medicaid |
$49.22
|
| Rate for Payer: Anthem Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.63
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$47.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.05
|
| Rate for Payer: Dean Health Medicaid |
$49.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$47.63
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$49.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.63
|
| Rate for Payer: Managed Health Services Medicaid |
$51.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$47.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$47.63
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$71.44
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$49.22
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$365.95
|
| Rate for Payer: Quartz Medicare Advantage |
$47.63
|
| Rate for Payer: The Alliance Commercial |
$190.52
|
| Rate for Payer: United Healthcare Medicaid |
$49.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.63
|
| Rate for Payer: United Healthcare PPO |
$422.25
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: Wellcare Medicare |
$47.63
|
| Rate for Payer: WMAP Medicaid |
$49.22
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
Acute Hepatitis Panel
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
633756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.87 |
| Max. Negotiated Rate |
$517.96 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$337.80
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$337.80
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
Acute Hepatitis Panel
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
633756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.13 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna Commercial |
$534.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$534.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.80
|
| Rate for Payer: Health EOS Commercial |
$512.33
|
| Rate for Payer: HFN Commercial |
$534.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.13
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$534.85
|
| Rate for Payer: Quartz Beloit One Network |
$247.72
|
| Rate for Payer: Quartz Commercial |
$320.91
|
| Rate for Payer: The Alliance Commercial |
$281.50
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH CC
|
Facility
|
IP
|
$59,753.00
|
|
|
Service Code
|
MSDRG 835
|
| Min. Negotiated Rate |
$21,494.01 |
| Max. Negotiated Rate |
$59,753.00 |
| Rate for Payer: Aetna Managed Medicare |
$21,494.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,995.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,021.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,222.72
|
| Rate for Payer: Anthem Medicare Advantage |
$21,494.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,494.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,494.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,494.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,990.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,494.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,592.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,494.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,494.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,494.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,494.01
|
| Rate for Payer: NAPHCARE Commercial |
$32,241.02
|
| Rate for Payer: Quartz Medicare Advantage |
$21,494.01
|
| Rate for Payer: The Alliance Commercial |
$59,753.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,494.01
|
| Rate for Payer: United Healthcare PPO |
$33,937.13
|
| Rate for Payer: Wellcare Medicare |
$21,494.01
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITH MCC
|
Facility
|
IP
|
$149,175.00
|
|
|
Service Code
|
MSDRG 834
|
| Min. Negotiated Rate |
$53,660.15 |
| Max. Negotiated Rate |
$149,175.00 |
| Rate for Payer: Aetna Managed Medicare |
$53,660.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$117,488.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$90,053.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85,556.80
|
| Rate for Payer: Anthem Medicare Advantage |
$53,660.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53,660.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53,660.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53,660.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94,975.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53,660.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109,180.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53,660.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53,660.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53,660.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53,660.15
|
| Rate for Payer: NAPHCARE Commercial |
$80,490.22
|
| Rate for Payer: Quartz Medicare Advantage |
$53,660.15
|
| Rate for Payer: The Alliance Commercial |
$149,175.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53,660.15
|
| Rate for Payer: United Healthcare PPO |
$84,998.42
|
| Rate for Payer: Wellcare Medicare |
$53,660.15
|
|
|
ACUTE LEUKEMIA WITHOUT MAJOR O.R. PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$37,857.00
|
|
|
Service Code
|
MSDRG 836
|
| Min. Negotiated Rate |
$13,617.67 |
| Max. Negotiated Rate |
$37,857.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,617.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,176.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,297.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,333.60
|
| Rate for Payer: Anthem Medicare Advantage |
$13,617.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,617.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,617.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,617.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,351.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,617.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,347.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,617.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,617.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,617.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,617.67
|
| Rate for Payer: NAPHCARE Commercial |
$20,426.50
|
| Rate for Payer: Quartz Medicare Advantage |
$13,617.67
|
| Rate for Payer: The Alliance Commercial |
$37,857.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,617.67
|
| Rate for Payer: United Healthcare PPO |
$18,176.21
|
| Rate for Payer: Wellcare Medicare |
$13,617.67
|
|
|
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC
|
Facility
|
IP
|
$34,382.00
|
|
|
Service Code
|
MSDRG 121
|
| Min. Negotiated Rate |
$12,367.76 |
| Max. Negotiated Rate |
$34,382.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,367.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,854.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,583.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,555.84
|
| Rate for Payer: Anthem Medicare Advantage |
$12,367.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,367.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,367.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,367.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,708.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,367.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,983.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,367.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,367.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,367.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,367.76
|
| Rate for Payer: NAPHCARE Commercial |
$18,551.64
|
| Rate for Payer: Quartz Medicare Advantage |
$12,367.76
|
| Rate for Payer: The Alliance Commercial |
$34,382.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,367.76
|
| Rate for Payer: United Healthcare PPO |
$19,449.90
|
| Rate for Payer: Wellcare Medicare |
$12,367.76
|
|
|
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC
|
Facility
|
IP
|
$20,114.00
|
|
|
Service Code
|
MSDRG 122
|
| Min. Negotiated Rate |
$7,235.14 |
| Max. Negotiated Rate |
$20,114.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,235.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,899.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,305.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,235.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,235.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,235.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,235.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,550.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,235.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,517.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,235.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,235.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,235.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,235.14
|
| Rate for Payer: NAPHCARE Commercial |
$10,852.71
|
| Rate for Payer: Quartz Medicare Advantage |
$7,235.14
|
| Rate for Payer: The Alliance Commercial |
$20,114.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,235.14
|
| Rate for Payer: United Healthcare PPO |
$11,302.25
|
| Rate for Payer: Wellcare Medicare |
$7,235.14
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH CC
|
Facility
|
IP
|
$24,593.00
|
|
|
Service Code
|
MSDRG 281
|
| Min. Negotiated Rate |
$8,846.56 |
| Max. Negotiated Rate |
$24,593.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,846.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,091.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,633.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,902.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8,846.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,846.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,846.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,846.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,433.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,846.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,803.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,846.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,846.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,846.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,846.56
|
| Rate for Payer: NAPHCARE Commercial |
$13,269.84
|
| Rate for Payer: Quartz Medicare Advantage |
$8,846.56
|
| Rate for Payer: The Alliance Commercial |
$24,593.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,846.56
|
| Rate for Payer: United Healthcare PPO |
$13,860.25
|
| Rate for Payer: Wellcare Medicare |
$8,846.56
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITH MCC
|
Facility
|
IP
|
$42,499.00
|
|
|
Service Code
|
MSDRG 280
|
| Min. Negotiated Rate |
$15,287.44 |
| Max. Negotiated Rate |
$42,499.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,287.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,358.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,568.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,292.02
|
| Rate for Payer: Anthem Medicare Advantage |
$15,287.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,287.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,287.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,287.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,966.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,287.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,936.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,287.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,287.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,287.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,287.44
|
| Rate for Payer: NAPHCARE Commercial |
$22,931.16
|
| Rate for Payer: Quartz Medicare Advantage |
$15,287.44
|
| Rate for Payer: The Alliance Commercial |
$42,499.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,287.44
|
| Rate for Payer: United Healthcare PPO |
$24,084.66
|
| Rate for Payer: Wellcare Medicare |
$15,287.44
|
|
|
ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE WITHOUT CC/MCC
|
Facility
|
IP
|
$19,412.00
|
|
|
Service Code
|
MSDRG 282
|
| Min. Negotiated Rate |
$6,982.66 |
| Max. Negotiated Rate |
$19,412.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,982.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,105.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,578.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,000.16
|
| Rate for Payer: Anthem Medicare Advantage |
$6,982.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,982.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,982.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,982.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,211.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,982.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,002.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,982.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,982.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,982.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,982.66
|
| Rate for Payer: NAPHCARE Commercial |
$10,473.99
|
| Rate for Payer: Quartz Medicare Advantage |
$6,982.66
|
| Rate for Payer: The Alliance Commercial |
$19,412.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,982.66
|
| Rate for Payer: United Healthcare PPO |
$10,901.48
|
| Rate for Payer: Wellcare Medicare |
$6,982.66
|
|
