|
Chemodenervation of 1 extremity; => 5 muscles 64644
|
Professional
|
Both
|
$836.00
|
|
|
Service Code
|
CPT 64644
|
| Hospital Charge Code |
5072637
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.31 |
| Max. Negotiated Rate |
$825.97 |
| Rate for Payer: Aetna Commercial |
$825.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$747.72
|
| Rate for Payer: Aetna Managed Medicare |
$96.71
|
| Rate for Payer: Anthem Medicare Advantage |
$96.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.71
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cash Price |
$250.80
|
| Rate for Payer: Cigna Commercial |
$825.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.71
|
| Rate for Payer: Health EOS Commercial |
$791.19
|
| Rate for Payer: HFN Commercial |
$825.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.71
|
| Rate for Payer: Multiplan Commercial |
$695.55
|
| Rate for Payer: NAPHCARE Commercial |
$145.06
|
| Rate for Payer: Preferred Network Access Commercial |
$825.97
|
| Rate for Payer: Quartz Beloit One Network |
$382.55
|
| Rate for Payer: Quartz Commercial |
$495.58
|
| Rate for Payer: Quartz Medicare Advantage |
$96.71
|
| Rate for Payer: The Alliance Commercial |
$411.02
|
| Rate for Payer: United Healthcare Medicaid |
$88.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.71
|
| Rate for Payer: WEA Trust Commercial |
$478.19
|
| Rate for Payer: WPS Commercial |
$435.19
|
|
|
Chemodenervation of 1 extremity; ea addi'l extremity, 1-4 muscle(s) 64643
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 64643
|
| Hospital Charge Code |
5072638
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.09 |
| Max. Negotiated Rate |
$284.54 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$56.11
|
| Rate for Payer: Anthem Medicare Advantage |
$56.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.11
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$284.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.11
|
| Rate for Payer: Health EOS Commercial |
$272.56
|
| Rate for Payer: HFN Commercial |
$284.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.11
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$84.16
|
| Rate for Payer: Preferred Network Access Commercial |
$284.54
|
| Rate for Payer: Quartz Beloit One Network |
$131.79
|
| Rate for Payer: Quartz Commercial |
$170.73
|
| Rate for Payer: Quartz Medicare Advantage |
$56.11
|
| Rate for Payer: The Alliance Commercial |
$238.46
|
| Rate for Payer: United Healthcare Medicaid |
$54.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.11
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: WPS Commercial |
$252.49
|
|
|
Chemodenervation of 1 extremity; ea add'l extremity, =>5 muscles 64645
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
CPT 64645
|
| Hospital Charge Code |
5072636
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.90 |
| Max. Negotiated Rate |
$521.66 |
| Rate for Payer: Aetna Commercial |
$521.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.24
|
| Rate for Payer: Aetna Managed Medicare |
$64.52
|
| Rate for Payer: Anthem Medicare Advantage |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.52
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$521.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.52
|
| Rate for Payer: Health EOS Commercial |
$499.70
|
| Rate for Payer: HFN Commercial |
$521.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$275.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.52
|
| Rate for Payer: Multiplan Commercial |
$439.30
|
| Rate for Payer: NAPHCARE Commercial |
$96.78
|
| Rate for Payer: Preferred Network Access Commercial |
$521.66
|
| Rate for Payer: Quartz Beloit One Network |
$241.61
|
| Rate for Payer: Quartz Commercial |
$313.00
|
| Rate for Payer: Quartz Medicare Advantage |
$64.52
|
| Rate for Payer: The Alliance Commercial |
$274.22
|
| Rate for Payer: United Healthcare Medicaid |
$61.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.52
|
| Rate for Payer: WEA Trust Commercial |
$302.02
|
| Rate for Payer: WPS Commercial |
$290.35
|
|
|
Chemodenervation of parotid and submandibular salivary glands, bilateral 64611
|
Professional
|
Both
|
$416.00
|
|
|
Service Code
|
CPT 64611
|
| Hospital Charge Code |
5244779
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.29 |
| Max. Negotiated Rate |
$452.13 |
| Rate for Payer: Aetna Commercial |
$411.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.07
|
| Rate for Payer: Aetna Managed Medicare |
$100.47
|
| Rate for Payer: Anthem Medicare Advantage |
$100.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.47
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cash Price |
$124.80
|
| Rate for Payer: Cigna Commercial |
$411.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.47
|
| Rate for Payer: Health EOS Commercial |
$393.70
|
| Rate for Payer: HFN Commercial |
$411.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$362.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$362.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.47
|
| Rate for Payer: Multiplan Commercial |
$346.11
|
| Rate for Payer: NAPHCARE Commercial |
$150.71
|
| Rate for Payer: Preferred Network Access Commercial |
$411.01
|
| Rate for Payer: Quartz Beloit One Network |
$190.36
|
| Rate for Payer: Quartz Commercial |
$246.60
|
| Rate for Payer: Quartz Medicare Advantage |
$100.47
|
| Rate for Payer: The Alliance Commercial |
$427.02
|
| Rate for Payer: United Healthcare Medicaid |
$65.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.47
|
| Rate for Payer: WEA Trust Commercial |
$237.95
|
| Rate for Payer: WPS Commercial |
$452.13
|
|
|
CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES 64647
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
CPT 64647
|
| Hospital Charge Code |
5749666
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$100.99 |
| Max. Negotiated Rate |
$506.84 |
| Rate for Payer: Aetna Commercial |
$506.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.83
|
| Rate for Payer: Aetna Managed Medicare |
$107.53
|
| Rate for Payer: Anthem Medicare Advantage |
$107.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$107.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$107.53
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$506.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.53
|
| Rate for Payer: Health EOS Commercial |
$485.50
|
| Rate for Payer: HFN Commercial |
$506.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$444.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$444.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$107.53
|
| Rate for Payer: Multiplan Commercial |
$426.82
|
| Rate for Payer: NAPHCARE Commercial |
$161.29
|
| Rate for Payer: Preferred Network Access Commercial |
$506.84
|
| Rate for Payer: Quartz Beloit One Network |
$234.75
|
| Rate for Payer: Quartz Commercial |
$304.11
|
| Rate for Payer: Quartz Medicare Advantage |
$107.53
|
| Rate for Payer: The Alliance Commercial |
$456.98
|
| Rate for Payer: United Healthcare Medicaid |
$100.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$107.53
|
| Rate for Payer: WEA Trust Commercial |
$293.44
|
| Rate for Payer: WPS Commercial |
$483.87
|
|
|
Chemodenervation of trunk muscle(s); 1-5 muscle(s) 64616
|
Professional
|
Both
|
$953.00
|
|
|
Service Code
|
CPT 64616
|
| Hospital Charge Code |
5308637
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$79.62 |
| Max. Negotiated Rate |
$941.56 |
| Rate for Payer: Aetna Commercial |
$941.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.36
|
| Rate for Payer: Aetna Managed Medicare |
$90.05
|
| Rate for Payer: Anthem Medicare Advantage |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$90.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$90.05
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cash Price |
$285.90
|
| Rate for Payer: Cigna Commercial |
$941.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.05
|
| Rate for Payer: Health EOS Commercial |
$901.92
|
| Rate for Payer: HFN Commercial |
$941.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$357.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$357.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$90.05
|
| Rate for Payer: Multiplan Commercial |
$792.90
|
| Rate for Payer: NAPHCARE Commercial |
$135.08
|
| Rate for Payer: Preferred Network Access Commercial |
$941.56
|
| Rate for Payer: Quartz Beloit One Network |
$436.09
|
| Rate for Payer: Quartz Commercial |
$564.94
|
| Rate for Payer: Quartz Medicare Advantage |
$90.05
|
| Rate for Payer: The Alliance Commercial |
$382.73
|
| Rate for Payer: United Healthcare Medicaid |
$79.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.05
|
| Rate for Payer: WEA Trust Commercial |
$545.12
|
| Rate for Payer: WPS Commercial |
$405.24
|
|
|
Chemodenervation trunk muscles, 1-5 muscles 64646
|
Professional
|
Both
|
$806.00
|
|
|
Service Code
|
CPT 64646
|
| Hospital Charge Code |
5551848
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.48 |
| Max. Negotiated Rate |
$796.33 |
| Rate for Payer: Aetna Commercial |
$796.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$720.89
|
| Rate for Payer: Aetna Managed Medicare |
$95.22
|
| Rate for Payer: Anthem Medicare Advantage |
$95.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.22
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cash Price |
$241.80
|
| Rate for Payer: Cigna Commercial |
$796.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.22
|
| Rate for Payer: Health EOS Commercial |
$762.80
|
| Rate for Payer: HFN Commercial |
$796.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$386.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$386.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.22
|
| Rate for Payer: Multiplan Commercial |
$670.59
|
| Rate for Payer: NAPHCARE Commercial |
$142.83
|
| Rate for Payer: Preferred Network Access Commercial |
$796.33
|
| Rate for Payer: Quartz Beloit One Network |
$368.83
|
| Rate for Payer: Quartz Commercial |
$477.80
|
| Rate for Payer: Quartz Medicare Advantage |
$95.22
|
| Rate for Payer: The Alliance Commercial |
$404.70
|
| Rate for Payer: United Healthcare Medicaid |
$87.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.22
|
| Rate for Payer: WEA Trust Commercial |
$461.03
|
| Rate for Payer: WPS Commercial |
$428.50
|
|
|
CHEMODENERV ECCRINE GLANDS 64650
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 64650
|
| Hospital Charge Code |
3015200
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.78 |
| Max. Negotiated Rate |
$264.78 |
| Rate for Payer: Aetna Commercial |
$264.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$31.78
|
| Rate for Payer: Anthem Medicare Advantage |
$31.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.78
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$264.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.78
|
| Rate for Payer: Health EOS Commercial |
$253.64
|
| Rate for Payer: HFN Commercial |
$264.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$139.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.78
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$47.67
|
| Rate for Payer: Preferred Network Access Commercial |
$264.78
|
| Rate for Payer: Quartz Beloit One Network |
$122.64
|
| Rate for Payer: Quartz Commercial |
$158.87
|
| Rate for Payer: Quartz Medicare Advantage |
$31.78
|
| Rate for Payer: The Alliance Commercial |
$135.08
|
| Rate for Payer: United Healthcare Medicaid |
$52.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.78
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$143.02
|
|
|
Chemodenerv Musc Migraine 64615
|
Professional
|
Both
|
$876.00
|
|
|
Service Code
|
CPT 64615
|
| Hospital Charge Code |
3587518
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$97.45 |
| Max. Negotiated Rate |
$865.49 |
| Rate for Payer: Aetna Commercial |
$865.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$783.49
|
| Rate for Payer: Aetna Managed Medicare |
$97.45
|
| Rate for Payer: Anthem Medicare Advantage |
$97.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$97.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$97.45
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$865.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.45
|
| Rate for Payer: Health EOS Commercial |
$829.05
|
| Rate for Payer: HFN Commercial |
$865.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$401.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$97.45
|
| Rate for Payer: Multiplan Commercial |
$728.83
|
| Rate for Payer: NAPHCARE Commercial |
$146.17
|
| Rate for Payer: Preferred Network Access Commercial |
$865.49
|
| Rate for Payer: Quartz Beloit One Network |
$400.86
|
| Rate for Payer: Quartz Commercial |
$519.29
|
| Rate for Payer: Quartz Medicare Advantage |
$97.45
|
| Rate for Payer: The Alliance Commercial |
$414.15
|
| Rate for Payer: United Healthcare Medicaid |
$97.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$97.45
|
| Rate for Payer: WEA Trust Commercial |
$501.07
|
| Rate for Payer: WPS Commercial |
$438.52
|
|
|
CHEMO INTRALESIONAL, UP TO 7 96405
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 96405
|
| Hospital Charge Code |
3015503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.71 |
| Max. Negotiated Rate |
$379.39 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.71
|
| Rate for Payer: Anthem Medicare Advantage |
$23.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.71
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.71
|
| Rate for Payer: Health EOS Commercial |
$363.42
|
| Rate for Payer: HFN Commercial |
$379.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$303.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.71
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: NAPHCARE Commercial |
$35.57
|
| Rate for Payer: Preferred Network Access Commercial |
$379.39
|
| Rate for Payer: Quartz Beloit One Network |
$175.72
|
| Rate for Payer: Quartz Commercial |
$227.64
|
| Rate for Payer: Quartz Medicare Advantage |
$23.71
|
| Rate for Payer: The Alliance Commercial |
$59.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$94.85
|
|
|
Chemo IV Infusion 1 Hour
|
Facility
|
IP
|
$1,216.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
4618619
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$619.67 |
| Max. Negotiated Rate |
$1,163.47 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$758.78
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
Chemo IV Infusion 1 Hour
|
Facility
|
OP
|
$1,216.00
|
|
|
Service Code
|
CPT 96413
|
| Hospital Charge Code |
4618619
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$347.61 |
| Max. Negotiated Rate |
$1,390.44 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Aetna Managed Medicare |
$347.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$632.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.03
|
| Rate for Payer: Anthem Medicare Advantage |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$347.61
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,163.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$347.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$707.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$347.61
|
| Rate for Payer: Health EOS Commercial |
$1,125.53
|
| Rate for Payer: HFN Commercial |
$1,163.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$347.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$347.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$347.61
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: NAPHCARE Commercial |
$521.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,163.47
|
| Rate for Payer: Quartz Beloit One Network |
$619.67
|
| Rate for Payer: Quartz Commercial |
$822.02
|
| Rate for Payer: Quartz Medicare Advantage |
$347.61
|
| Rate for Payer: The Alliance Commercial |
$1,390.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$347.61
|
| Rate for Payer: United Healthcare PPO |
$948.48
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: Wellcare Medicare |
$347.61
|
| Rate for Payer: WPS Commercial |
$936.68
|
|
|
Chemo IV Infusion Additional 1-8 Hours
|
Facility
|
IP
|
$398.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
4618620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$202.82 |
| Max. Negotiated Rate |
$380.81 |
| Rate for Payer: Aetna Commercial |
$372.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.38
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$380.81
|
| Rate for Payer: Health EOS Commercial |
$368.39
|
| Rate for Payer: HFN Commercial |
$380.81
|
| Rate for Payer: Multiplan Commercial |
$331.14
|
| Rate for Payer: Preferred Network Access Commercial |
$380.81
|
| Rate for Payer: Quartz Beloit One Network |
$202.82
|
| Rate for Payer: Quartz Commercial |
$248.35
|
| Rate for Payer: WEA Trust Commercial |
$227.66
|
| Rate for Payer: WPS Commercial |
$306.58
|
|
|
Chemo IV Infusion Additional 1-8 Hours
|
Facility
|
OP
|
$398.00
|
|
|
Service Code
|
CPT 96415
|
| Hospital Charge Code |
4618620
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$75.77 |
| Max. Negotiated Rate |
$380.81 |
| Rate for Payer: Aetna Commercial |
$372.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.97
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.68
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.77
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cash Price |
$119.40
|
| Rate for Payer: Cigna Commercial |
$380.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$368.39
|
| Rate for Payer: HFN Commercial |
$380.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.77
|
| Rate for Payer: Multiplan Commercial |
$331.14
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$380.81
|
| Rate for Payer: Quartz Beloit One Network |
$202.82
|
| Rate for Payer: Quartz Commercial |
$269.05
|
| Rate for Payer: Quartz Medicare Advantage |
$75.77
|
| Rate for Payer: The Alliance Commercial |
$303.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.77
|
| Rate for Payer: United Healthcare PPO |
$310.44
|
| Rate for Payer: WEA Trust Commercial |
$227.66
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$306.58
|
|
|
Chemo, IV Push, Addl Drug 96411
|
Facility
|
IP
|
$503.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
3595514
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$256.33 |
| Max. Negotiated Rate |
$481.27 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$313.87
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
|
Chemo, IV Push, Addl Drug 96411
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 96411
|
| Hospital Charge Code |
3595514
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$75.77 |
| Max. Negotiated Rate |
$481.27 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$340.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.10
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.77
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.77
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$340.03
|
| Rate for Payer: Quartz Medicare Advantage |
$75.77
|
| Rate for Payer: The Alliance Commercial |
$303.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.77
|
| Rate for Payer: United Healthcare PPO |
$392.34
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
|
Chemo, IV Push, Sngl Drug
|
Facility
|
IP
|
$697.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
3595513
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$355.19 |
| Max. Negotiated Rate |
$666.89 |
| Rate for Payer: Aetna Commercial |
$652.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.19
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$666.89
|
| Rate for Payer: Health EOS Commercial |
$645.14
|
| Rate for Payer: HFN Commercial |
$666.89
|
| Rate for Payer: Multiplan Commercial |
$579.90
|
| Rate for Payer: Preferred Network Access Commercial |
$666.89
|
| Rate for Payer: Quartz Beloit One Network |
$355.19
|
| Rate for Payer: Quartz Commercial |
$434.93
|
| Rate for Payer: WEA Trust Commercial |
$398.68
|
| Rate for Payer: WPS Commercial |
$536.90
|
|
|
Chemo, IV Push, Sngl Drug
|
Facility
|
OP
|
$697.00
|
|
|
Service Code
|
CPT 96409
|
| Hospital Charge Code |
3595513
|
|
Hospital Revenue Code
|
330
|
| Min. Negotiated Rate |
$347.61 |
| Max. Negotiated Rate |
$1,390.44 |
| Rate for Payer: Aetna Commercial |
$652.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$623.40
|
| Rate for Payer: Aetna Managed Medicare |
$347.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$471.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.94
|
| Rate for Payer: Anthem Medicare Advantage |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$347.61
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cash Price |
$209.10
|
| Rate for Payer: Cigna Commercial |
$666.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$347.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$347.61
|
| Rate for Payer: Health EOS Commercial |
$645.14
|
| Rate for Payer: HFN Commercial |
$666.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$347.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$347.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$347.61
|
| Rate for Payer: Multiplan Commercial |
$579.90
|
| Rate for Payer: NAPHCARE Commercial |
$521.41
|
| Rate for Payer: Preferred Network Access Commercial |
$666.89
|
| Rate for Payer: Quartz Beloit One Network |
$355.19
|
| Rate for Payer: Quartz Commercial |
$471.17
|
| Rate for Payer: Quartz Medicare Advantage |
$347.61
|
| Rate for Payer: The Alliance Commercial |
$1,390.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$347.61
|
| Rate for Payer: United Healthcare PPO |
$543.66
|
| Rate for Payer: WEA Trust Commercial |
$398.68
|
| Rate for Payer: Wellcare Medicare |
$347.61
|
| Rate for Payer: WPS Commercial |
$536.90
|
|
|
CHEMO PORT INSERTION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CHEMO PORT INSERTION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959925
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
CHEMOTHERAPY
|
Facility
|
OP
|
$46.56
|
|
|
Service Code
|
EAPG 00803
|
| Min. Negotiated Rate |
$44.77 |
| Max. Negotiated Rate |
$46.56 |
| Rate for Payer: Anthem Medicaid |
$44.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$44.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.77
|
| Rate for Payer: Dean Health Medicaid |
$44.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.77
|
| Rate for Payer: Managed Health Services Medicaid |
$46.56
|
| Rate for Payer: Molina Healthcare Medicaid |
$44.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.77
|
| Rate for Payer: United Healthcare Medicaid |
$44.77
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$47,699.61
|
|
|
Service Code
|
APR-DRG 6954
|
| Min. Negotiated Rate |
$42,369.77 |
| Max. Negotiated Rate |
$47,699.61 |
| Rate for Payer: Anthem Medicaid |
$45,675.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$45,675.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45,675.00
|
| Rate for Payer: Dean Health Medicaid |
$45,675.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$42,369.77
|
| Rate for Payer: Managed Health Services Medicaid |
$47,699.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$45,675.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$45,675.00
|
| Rate for Payer: United Healthcare Medicaid |
$45,675.00
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$7,540.75
|
|
|
Service Code
|
APR-DRG 6951
|
| Min. Negotiated Rate |
$6,698.16 |
| Max. Negotiated Rate |
$7,540.75 |
| Rate for Payer: Anthem Medicaid |
$7,220.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,220.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,220.68
|
| Rate for Payer: Dean Health Medicaid |
$7,220.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,698.16
|
| Rate for Payer: Managed Health Services Medicaid |
$7,540.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,220.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,220.68
|
| Rate for Payer: United Healthcare Medicaid |
$7,220.68
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$24,112.85
|
|
|
Service Code
|
APR-DRG 6953
|
| Min. Negotiated Rate |
$21,418.54 |
| Max. Negotiated Rate |
$24,112.85 |
| Rate for Payer: Anthem Medicaid |
$23,089.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$23,089.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23,089.38
|
| Rate for Payer: Dean Health Medicaid |
$23,089.38
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,418.54
|
| Rate for Payer: Managed Health Services Medicaid |
$24,112.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$23,089.38
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23,089.38
|
| Rate for Payer: United Healthcare Medicaid |
$23,089.38
|
|
|
CHEMOTHERAPY FOR ACUTE LEUKEMIA
|
Facility
|
IP
|
$12,100.27
|
|
|
Service Code
|
APR-DRG 6952
|
| Min. Negotiated Rate |
$10,748.21 |
| Max. Negotiated Rate |
$12,100.27 |
| Rate for Payer: Anthem Medicaid |
$11,586.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,586.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,586.67
|
| Rate for Payer: Dean Health Medicaid |
$11,586.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,748.21
|
| Rate for Payer: Managed Health Services Medicaid |
$12,100.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,586.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,586.67
|
| Rate for Payer: United Healthcare Medicaid |
$11,586.67
|
|
