|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
|
IP
|
$26,726.96
|
|
|
Service Code
|
MSDRG 880
|
| Min. Negotiated Rate |
$7,860.20 |
| Max. Negotiated Rate |
$26,726.96 |
| Rate for Payer: Aetna Managed Medicare |
$7,860.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,950.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,058.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,256.73
|
| Rate for Payer: Anthem Medicare Advantage |
$7,860.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,860.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,860.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,860.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,936.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,860.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,860.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,860.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,860.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,860.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,790.29
|
| Rate for Payer: Quartz Medicare Advantage |
$7,860.20
|
| Rate for Payer: The Alliance Commercial |
$26,726.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,860.20
|
| Rate for Payer: United Healthcare PPO |
$15,071.45
|
| Rate for Payer: Wellcare Medicare |
$7,860.20
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$10,609.66
|
|
|
Service Code
|
APR-DRG 1932
|
| Min. Negotiated Rate |
$9,424.16 |
| Max. Negotiated Rate |
$10,609.66 |
| Rate for Payer: Anthem Medicaid |
$10,159.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,159.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,159.33
|
| Rate for Payer: Dean Health Medicaid |
$10,159.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,424.16
|
| Rate for Payer: Managed Health Services Medicaid |
$10,609.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,159.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,159.33
|
| Rate for Payer: United Healthcare Medicaid |
$10,159.33
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$9,732.82
|
|
|
Service Code
|
APR-DRG 1931
|
| Min. Negotiated Rate |
$8,645.30 |
| Max. Negotiated Rate |
$9,732.82 |
| Rate for Payer: Anthem Medicaid |
$9,319.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,319.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,319.72
|
| Rate for Payer: Dean Health Medicaid |
$9,319.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,645.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9,732.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,319.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,319.72
|
| Rate for Payer: United Healthcare Medicaid |
$9,319.72
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
OP
|
$93.03
|
|
|
Service Code
|
EAPG 00608
|
| Min. Negotiated Rate |
$89.45 |
| Max. Negotiated Rate |
$93.03 |
| Rate for Payer: Anthem Medicaid |
$89.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$89.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.45
|
| Rate for Payer: Dean Health Medicaid |
$89.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$89.45
|
| Rate for Payer: Managed Health Services Medicaid |
$93.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$89.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$89.45
|
| Rate for Payer: United Healthcare Medicaid |
$89.45
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$21,394.68
|
|
|
Service Code
|
APR-DRG 1934
|
| Min. Negotiated Rate |
$19,004.09 |
| Max. Negotiated Rate |
$21,394.68 |
| Rate for Payer: Anthem Medicaid |
$20,486.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,486.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,486.58
|
| Rate for Payer: Dean Health Medicaid |
$20,486.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,004.09
|
| Rate for Payer: Managed Health Services Medicaid |
$21,394.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,486.58
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,486.58
|
| Rate for Payer: United Healthcare Medicaid |
$20,486.58
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS
|
Facility
|
IP
|
$14,555.39
|
|
|
Service Code
|
APR-DRG 1933
|
| Min. Negotiated Rate |
$12,929.01 |
| Max. Negotiated Rate |
$14,555.39 |
| Rate for Payer: Anthem Medicaid |
$13,937.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,937.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,937.59
|
| Rate for Payer: Dean Health Medicaid |
$13,937.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,929.01
|
| Rate for Payer: Managed Health Services Medicaid |
$14,555.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,937.59
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,937.59
|
| Rate for Payer: United Healthcare Medicaid |
$13,937.59
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
|
IP
|
$41,190.24
|
|
|
Service Code
|
MSDRG 289
|
| Min. Negotiated Rate |
$13,578.57 |
| Max. Negotiated Rate |
$41,190.24 |
| Rate for Payer: Aetna Managed Medicare |
$13,578.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,243.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,546.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,121.14
|
| Rate for Payer: Anthem Medicare Advantage |
$13,578.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,578.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,578.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,578.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,106.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,578.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,967.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,578.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,578.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,578.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,578.57
|
| Rate for Payer: NAPHCARE Commercial |
$20,367.86
|
| Rate for Payer: Quartz Medicare Advantage |
$13,578.57
|
| Rate for Payer: The Alliance Commercial |
$41,190.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,578.57
|
| Rate for Payer: United Healthcare PPO |
$23,330.28
|
| Rate for Payer: Wellcare Medicare |
$13,578.57
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
|
IP
|
$72,028.32
|
|
|
Service Code
|
MSDRG 288
|
| Min. Negotiated Rate |
$21,231.39 |
| Max. Negotiated Rate |
$72,028.32 |
| Rate for Payer: Aetna Managed Medicare |
$21,231.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59,047.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45,259.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42,999.14
|
| Rate for Payer: Anthem Medicare Advantage |
$21,231.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,231.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,231.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,231.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47,732.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,231.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52,586.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,231.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,231.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,231.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,231.39
|
| Rate for Payer: NAPHCARE Commercial |
$31,847.09
|
| Rate for Payer: Quartz Medicare Advantage |
$21,231.39
|
| Rate for Payer: The Alliance Commercial |
$72,028.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,231.39
|
| Rate for Payer: United Healthcare PPO |
$40,938.90
|
| Rate for Payer: Wellcare Medicare |
$21,231.39
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$30,335.76
|
|
|
Service Code
|
MSDRG 290
|
| Min. Negotiated Rate |
$7,626.60 |
| Max. Negotiated Rate |
$30,335.76 |
| Rate for Payer: Aetna Managed Medicare |
$7,626.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,285.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,548.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,772.11
|
| Rate for Payer: Anthem Medicare Advantage |
$7,626.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,626.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,626.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,626.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,398.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,626.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,791.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,626.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,626.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,626.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,626.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,439.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7,626.60
|
| Rate for Payer: The Alliance Commercial |
$30,335.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,626.60
|
| Rate for Payer: United Healthcare PPO |
$16,186.10
|
| Rate for Payer: Wellcare Medicare |
$7,626.60
|
|
|
ACUTE ANXIETY AND DELIRIUM STATES
|
Facility
|
OP
|
$86.48
|
|
|
Service Code
|
EAPG 00826
|
| Min. Negotiated Rate |
$83.15 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Anthem Medicaid |
$83.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$83.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.15
|
| Rate for Payer: Dean Health Medicaid |
$83.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$83.15
|
| Rate for Payer: Managed Health Services Medicaid |
$86.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$83.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$83.15
|
| Rate for Payer: United Healthcare Medicaid |
$83.15
|
|
|
ACUTE ANXIETY AND STRESS SYNDROMES
|
Facility
|
IP
|
$8,592.94
|
|
|
Service Code
|
APR-DRG 7563
|
| Min. Negotiated Rate |
$7,632.79 |
| Max. Negotiated Rate |
$8,592.94 |
| Rate for Payer: Anthem Medicaid |
$8,228.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,228.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,228.22
|
| Rate for Payer: Dean Health Medicaid |
$8,228.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,632.79
|
| Rate for Payer: Managed Health Services Medicaid |
$8,592.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,228.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,228.22
|
| Rate for Payer: United Healthcare Medicaid |
$8,228.22
|
|
|
ACUTE ANXIETY AND STRESS SYNDROMES
|
Facility
|
IP
|
$4,033.42
|
|
|
Service Code
|
APR-DRG 7561
|
| Min. Negotiated Rate |
$3,582.74 |
| Max. Negotiated Rate |
$4,033.42 |
| Rate for Payer: Anthem Medicaid |
$3,862.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,862.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,862.22
|
| Rate for Payer: Dean Health Medicaid |
$3,862.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,582.74
|
| Rate for Payer: Managed Health Services Medicaid |
$4,033.42
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,862.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,862.22
|
| Rate for Payer: United Healthcare Medicaid |
$3,862.22
|
|
|
ACUTE ANXIETY AND STRESS SYNDROMES
|
Facility
|
IP
|
$15,256.86
|
|
|
Service Code
|
APR-DRG 7564
|
| Min. Negotiated Rate |
$13,552.09 |
| Max. Negotiated Rate |
$15,256.86 |
| Rate for Payer: Anthem Medicaid |
$14,609.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,609.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,609.28
|
| Rate for Payer: Dean Health Medicaid |
$14,609.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,552.09
|
| Rate for Payer: Managed Health Services Medicaid |
$15,256.86
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,609.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,609.28
|
| Rate for Payer: United Healthcare Medicaid |
$14,609.28
|
|
|
ACUTE ANXIETY AND STRESS SYNDROMES
|
Facility
|
IP
|
$6,137.82
|
|
|
Service Code
|
APR-DRG 7562
|
| Min. Negotiated Rate |
$5,451.99 |
| Max. Negotiated Rate |
$6,137.82 |
| Rate for Payer: Anthem Medicaid |
$5,877.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,877.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,877.30
|
| Rate for Payer: Dean Health Medicaid |
$5,877.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,451.99
|
| Rate for Payer: Managed Health Services Medicaid |
$6,137.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,877.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,877.30
|
| Rate for Payer: United Healthcare Medicaid |
$5,877.30
|
|
|
ACUTE BRONCHITIS
|
Facility
|
OP
|
$108.75
|
|
|
Service Code
|
EAPG 00584
|
| Min. Negotiated Rate |
$104.57 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Anthem Medicaid |
$104.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$104.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.57
|
| Rate for Payer: Dean Health Medicaid |
$104.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$104.57
|
| Rate for Payer: Managed Health Services Medicaid |
$108.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.57
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$104.57
|
| Rate for Payer: United Healthcare Medicaid |
$104.57
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
|
IP
|
$12,801.73
|
|
|
Service Code
|
APR-DRG 1454
|
| Min. Negotiated Rate |
$11,371.30 |
| Max. Negotiated Rate |
$12,801.73 |
| Rate for Payer: Anthem Medicaid |
$12,258.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,258.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,258.36
|
| Rate for Payer: Dean Health Medicaid |
$12,258.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,371.30
|
| Rate for Payer: Managed Health Services Medicaid |
$12,801.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,258.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,258.36
|
| Rate for Payer: United Healthcare Medicaid |
$12,258.36
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
|
IP
|
$5,699.40
|
|
|
Service Code
|
APR-DRG 1452
|
| Min. Negotiated Rate |
$5,062.56 |
| Max. Negotiated Rate |
$5,699.40 |
| Rate for Payer: Anthem Medicaid |
$5,457.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,457.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,457.49
|
| Rate for Payer: Dean Health Medicaid |
$5,457.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,062.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5,699.40
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,457.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,457.49
|
| Rate for Payer: United Healthcare Medicaid |
$5,457.49
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
|
IP
|
$4,647.20
|
|
|
Service Code
|
APR-DRG 1451
|
| Min. Negotiated Rate |
$4,127.94 |
| Max. Negotiated Rate |
$4,647.20 |
| Rate for Payer: Anthem Medicaid |
$4,449.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,449.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,449.95
|
| Rate for Payer: Dean Health Medicaid |
$4,449.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,127.94
|
| Rate for Payer: Managed Health Services Medicaid |
$4,647.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,449.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,449.95
|
| Rate for Payer: United Healthcare Medicaid |
$4,449.95
|
|
|
ACUTE BRONCHITIS AND RELATED SYMPTOMS
|
Facility
|
IP
|
$7,803.80
|
|
|
Service Code
|
APR-DRG 1453
|
| Min. Negotiated Rate |
$6,931.82 |
| Max. Negotiated Rate |
$7,803.80 |
| Rate for Payer: Anthem Medicaid |
$7,472.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,472.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,472.56
|
| Rate for Payer: Dean Health Medicaid |
$7,472.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,931.82
|
| Rate for Payer: Managed Health Services Medicaid |
$7,803.80
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,472.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,472.56
|
| Rate for Payer: United Healthcare Medicaid |
$7,472.56
|
|
|
Acute Hemodialysis
|
Facility
|
IP
|
$2,195.00
|
|
| Hospital Charge Code |
3005574
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$1,118.57 |
| Max. Negotiated Rate |
$2,100.18 |
| Rate for Payer: Aetna Commercial |
$2,054.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,963.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.88
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,100.18
|
| Rate for Payer: Health EOS Commercial |
$2,031.69
|
| Rate for Payer: HFN Commercial |
$2,100.18
|
| Rate for Payer: Multiplan Commercial |
$1,826.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,100.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.57
|
| Rate for Payer: Quartz Commercial |
$1,369.68
|
| Rate for Payer: WEA Trust Commercial |
$1,255.54
|
| Rate for Payer: WPS Commercial |
$1,690.81
|
|
|
Acute Hemodialysis
|
Facility
|
OP
|
$2,195.00
|
|
| Hospital Charge Code |
3005574
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$639.18 |
| Max. Negotiated Rate |
$2,100.18 |
| Rate for Payer: Aetna Commercial |
$2,054.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,963.21
|
| Rate for Payer: Aetna Managed Medicare |
$639.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,483.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,141.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,095.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,209.88
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,100.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,277.49
|
| Rate for Payer: Health EOS Commercial |
$2,031.69
|
| Rate for Payer: HFN Commercial |
$2,100.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,712.10
|
| Rate for Payer: Multiplan Commercial |
$1,826.24
|
| Rate for Payer: NAPHCARE Commercial |
$1,369.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,100.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,118.57
|
| Rate for Payer: Quartz Commercial |
$1,483.82
|
| Rate for Payer: Quartz Medicare Advantage |
$1,369.68
|
| Rate for Payer: The Alliance Commercial |
$1,141.40
|
| Rate for Payer: WEA Trust Commercial |
$1,255.54
|
| Rate for Payer: WPS Commercial |
$1,690.81
|
|
|
Acute Hepatitis Panel
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
633756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$286.90 |
| Max. Negotiated Rate |
$538.68 |
| Rate for Payer: Aetna Commercial |
$526.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.33
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$538.68
|
| Rate for Payer: Health EOS Commercial |
$521.11
|
| Rate for Payer: HFN Commercial |
$538.68
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: Preferred Network Access Commercial |
$538.68
|
| Rate for Payer: Quartz Beloit One Network |
$286.90
|
| Rate for Payer: Quartz Commercial |
$351.31
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: WPS Commercial |
$433.68
|
|
|
Acute Hepatitis Panel
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
633756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$556.24 |
| Rate for Payer: Aetna Commercial |
$556.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Aetna Managed Medicare |
$49.54
|
| Rate for Payer: Anthem Medicare Advantage |
$49.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.54
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$556.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$292.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.54
|
| Rate for Payer: Health EOS Commercial |
$532.82
|
| Rate for Payer: HFN Commercial |
$556.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$174.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.54
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: NAPHCARE Commercial |
$74.30
|
| Rate for Payer: Preferred Network Access Commercial |
$556.24
|
| Rate for Payer: Quartz Beloit One Network |
$257.63
|
| Rate for Payer: Quartz Commercial |
$333.75
|
| Rate for Payer: Quartz Medicare Advantage |
$49.54
|
| Rate for Payer: The Alliance Commercial |
$195.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.54
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: WPS Commercial |
$217.95
|
|
|
Acute Hepatitis Panel
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
633756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.54 |
| Max. Negotiated Rate |
$538.68 |
| Rate for Payer: Aetna Commercial |
$526.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Aetna Managed Medicare |
$49.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$86.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.23
|
| Rate for Payer: Anthem Medicare Advantage |
$49.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.54
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$538.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$49.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$49.54
|
| Rate for Payer: Health EOS Commercial |
$521.11
|
| Rate for Payer: HFN Commercial |
$538.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$49.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$49.54
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: NAPHCARE Commercial |
$74.30
|
| Rate for Payer: Preferred Network Access Commercial |
$538.68
|
| Rate for Payer: Quartz Beloit One Network |
$286.90
|
| Rate for Payer: Quartz Commercial |
$380.59
|
| Rate for Payer: Quartz Medicare Advantage |
$49.54
|
| Rate for Payer: The Alliance Commercial |
$198.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.54
|
| Rate for Payer: United Healthcare PPO |
$439.14
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: Wellcare Medicare |
$49.54
|
| Rate for Payer: WPS Commercial |
$433.68
|
|
|
ACUTE KIDNEY INJURY
|
Facility
|
OP
|
$87.79
|
|
|
Service Code
|
EAPG 00729
|
| Min. Negotiated Rate |
$84.41 |
| Max. Negotiated Rate |
$87.79 |
| Rate for Payer: Anthem Medicaid |
$84.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$84.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.41
|
| Rate for Payer: Dean Health Medicaid |
$84.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$84.41
|
| Rate for Payer: Managed Health Services Medicaid |
$87.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$84.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$84.41
|
| Rate for Payer: United Healthcare Medicaid |
$84.41
|
|
