|
Chromosomes, DEB Assay for Fanconi Anemia
|
Facility
|
OP
|
$452.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
4125582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.15 |
| Max. Negotiated Rate |
$484.60 |
| Rate for Payer: Aetna Commercial |
$423.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.27
|
| Rate for Payer: Aetna Managed Medicare |
$121.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$454.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$212.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.11
|
| Rate for Payer: Anthem Medicare Advantage |
$121.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.15
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$432.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$121.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$121.15
|
| Rate for Payer: Health EOS Commercial |
$418.37
|
| Rate for Payer: HFN Commercial |
$432.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$121.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$121.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$121.15
|
| Rate for Payer: Multiplan Commercial |
$376.06
|
| Rate for Payer: NAPHCARE Commercial |
$181.72
|
| Rate for Payer: Preferred Network Access Commercial |
$432.47
|
| Rate for Payer: Quartz Beloit One Network |
$230.34
|
| Rate for Payer: Quartz Commercial |
$305.55
|
| Rate for Payer: Quartz Medicare Advantage |
$121.15
|
| Rate for Payer: The Alliance Commercial |
$484.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.15
|
| Rate for Payer: United Healthcare PPO |
$352.56
|
| Rate for Payer: WEA Trust Commercial |
$258.54
|
| Rate for Payer: Wellcare Medicare |
$121.15
|
| Rate for Payer: WPS Commercial |
$348.18
|
|
|
Chromosomes, DEB Assay for Fanconi Anemia
|
Professional
|
Both
|
$452.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
4125582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.15 |
| Max. Negotiated Rate |
$533.06 |
| Rate for Payer: Aetna Commercial |
$446.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.27
|
| Rate for Payer: Aetna Managed Medicare |
$121.15
|
| Rate for Payer: Anthem Medicare Advantage |
$121.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.15
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$446.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.15
|
| Rate for Payer: Health EOS Commercial |
$427.77
|
| Rate for Payer: HFN Commercial |
$446.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$427.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.15
|
| Rate for Payer: Multiplan Commercial |
$376.06
|
| Rate for Payer: NAPHCARE Commercial |
$181.72
|
| Rate for Payer: Preferred Network Access Commercial |
$446.58
|
| Rate for Payer: Quartz Beloit One Network |
$206.84
|
| Rate for Payer: Quartz Commercial |
$267.95
|
| Rate for Payer: Quartz Medicare Advantage |
$121.15
|
| Rate for Payer: The Alliance Commercial |
$478.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.15
|
| Rate for Payer: WEA Trust Commercial |
$258.54
|
| Rate for Payer: WPS Commercial |
$533.06
|
|
|
CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 58350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,386.95 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
Chronic Care Management 20 min 99490
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
4596801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.47 |
| Max. Negotiated Rate |
$133.38 |
| Rate for Payer: Aetna Commercial |
$133.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.74
|
| Rate for Payer: Aetna Managed Medicare |
$43.47
|
| Rate for Payer: Anthem Medicare Advantage |
$43.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.47
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$133.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.47
|
| Rate for Payer: Health EOS Commercial |
$127.76
|
| Rate for Payer: HFN Commercial |
$133.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.47
|
| Rate for Payer: Multiplan Commercial |
$112.32
|
| Rate for Payer: NAPHCARE Commercial |
$65.21
|
| Rate for Payer: Preferred Network Access Commercial |
$133.38
|
| Rate for Payer: Quartz Beloit One Network |
$61.78
|
| Rate for Payer: Quartz Commercial |
$80.03
|
| Rate for Payer: Quartz Medicare Advantage |
$43.47
|
| Rate for Payer: The Alliance Commercial |
$104.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.47
|
| Rate for Payer: WEA Trust Commercial |
$77.22
|
| Rate for Payer: WPS Commercial |
$119.55
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$6,488.55
|
|
|
Service Code
|
APR-DRG 4702
|
| Min. Negotiated Rate |
$5,763.53 |
| Max. Negotiated Rate |
$6,488.55 |
| Rate for Payer: Anthem Medicaid |
$6,213.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,213.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,213.14
|
| Rate for Payer: Dean Health Medicaid |
$6,213.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,763.53
|
| Rate for Payer: Managed Health Services Medicaid |
$6,488.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,213.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,213.14
|
| Rate for Payer: United Healthcare Medicaid |
$6,213.14
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$10,258.92
|
|
|
Service Code
|
APR-DRG 4703
|
| Min. Negotiated Rate |
$9,112.62 |
| Max. Negotiated Rate |
$10,258.92 |
| Rate for Payer: Anthem Medicaid |
$9,823.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,823.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,823.48
|
| Rate for Payer: Dean Health Medicaid |
$9,823.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,112.62
|
| Rate for Payer: Managed Health Services Medicaid |
$10,258.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,823.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,823.48
|
| Rate for Payer: United Healthcare Medicaid |
$9,823.48
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$18,676.50
|
|
|
Service Code
|
APR-DRG 4704
|
| Min. Negotiated Rate |
$16,589.63 |
| Max. Negotiated Rate |
$18,676.50 |
| Rate for Payer: Anthem Medicaid |
$17,883.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,883.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,883.78
|
| Rate for Payer: Dean Health Medicaid |
$17,883.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,589.63
|
| Rate for Payer: Managed Health Services Medicaid |
$18,676.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,883.78
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,883.78
|
| Rate for Payer: United Healthcare Medicaid |
$17,883.78
|
|
|
CHRONIC KIDNEY DISEASE
|
Facility
|
IP
|
$4,734.89
|
|
|
Service Code
|
APR-DRG 4701
|
| Min. Negotiated Rate |
$4,205.82 |
| Max. Negotiated Rate |
$4,734.89 |
| Rate for Payer: Anthem Medicaid |
$4,533.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,533.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,533.92
|
| Rate for Payer: Dean Health Medicaid |
$4,533.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,205.82
|
| Rate for Payer: Managed Health Services Medicaid |
$4,734.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,533.92
|
| Rate for Payer: United Healthcare Medicaid |
$4,533.92
|
|
|
Chronic Lymphocytic Leukemia Panel, FISH
|
Facility
|
IP
|
$476.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5432849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$242.57 |
| Max. Negotiated Rate |
$455.44 |
| Rate for Payer: Aetna Commercial |
$445.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$425.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.37
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$455.44
|
| Rate for Payer: Health EOS Commercial |
$440.59
|
| Rate for Payer: HFN Commercial |
$455.44
|
| Rate for Payer: Multiplan Commercial |
$396.03
|
| Rate for Payer: Preferred Network Access Commercial |
$455.44
|
| Rate for Payer: Quartz Beloit One Network |
$242.57
|
| Rate for Payer: Quartz Commercial |
$297.02
|
| Rate for Payer: WEA Trust Commercial |
$272.27
|
| Rate for Payer: WPS Commercial |
$366.66
|
|
|
Chronic Lymphocytic Leukemia Panel, FISH
|
Facility
|
OP
|
$476.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5432849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$455.44 |
| Rate for Payer: Aetna Commercial |
$445.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$425.73
|
| Rate for Payer: Aetna Managed Medicare |
$22.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.98
|
| Rate for Payer: Anthem Medicare Advantage |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$262.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.28
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$455.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.28
|
| Rate for Payer: Health EOS Commercial |
$440.59
|
| Rate for Payer: HFN Commercial |
$455.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.28
|
| Rate for Payer: Multiplan Commercial |
$396.03
|
| Rate for Payer: NAPHCARE Commercial |
$33.42
|
| Rate for Payer: Preferred Network Access Commercial |
$455.44
|
| Rate for Payer: Quartz Beloit One Network |
$242.57
|
| Rate for Payer: Quartz Commercial |
$321.78
|
| Rate for Payer: Quartz Medicare Advantage |
$22.28
|
| Rate for Payer: The Alliance Commercial |
$89.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.28
|
| Rate for Payer: United Healthcare PPO |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$272.27
|
| Rate for Payer: Wellcare Medicare |
$22.28
|
| Rate for Payer: WPS Commercial |
$366.66
|
|
|
Chronic Lymphocytic Leukemia Panel, FISH
|
Professional
|
Both
|
$476.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5432849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$470.29 |
| Rate for Payer: Aetna Commercial |
$470.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$425.73
|
| Rate for Payer: Aetna Managed Medicare |
$22.28
|
| Rate for Payer: Anthem Medicare Advantage |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.28
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$470.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.28
|
| Rate for Payer: Health EOS Commercial |
$450.49
|
| Rate for Payer: HFN Commercial |
$470.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.28
|
| Rate for Payer: Multiplan Commercial |
$396.03
|
| Rate for Payer: NAPHCARE Commercial |
$33.42
|
| Rate for Payer: Preferred Network Access Commercial |
$470.29
|
| Rate for Payer: Quartz Beloit One Network |
$217.82
|
| Rate for Payer: Quartz Commercial |
$282.17
|
| Rate for Payer: Quartz Medicare Advantage |
$22.28
|
| Rate for Payer: The Alliance Commercial |
$87.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.28
|
| Rate for Payer: WEA Trust Commercial |
$272.27
|
| Rate for Payer: WPS Commercial |
$98.02
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$13,941.61
|
|
|
Service Code
|
APR-DRG 1404
|
| Min. Negotiated Rate |
$12,383.81 |
| Max. Negotiated Rate |
$13,941.61 |
| Rate for Payer: Anthem Medicaid |
$13,349.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,349.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,349.86
|
| Rate for Payer: Dean Health Medicaid |
$13,349.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,383.81
|
| Rate for Payer: Managed Health Services Medicaid |
$13,941.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,349.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,349.86
|
| Rate for Payer: United Healthcare Medicaid |
$13,349.86
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$5,787.08
|
|
|
Service Code
|
APR-DRG 1402
|
| Min. Negotiated Rate |
$5,140.45 |
| Max. Negotiated Rate |
$5,787.08 |
| Rate for Payer: Anthem Medicaid |
$5,541.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,541.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,541.45
|
| Rate for Payer: Dean Health Medicaid |
$5,541.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,140.45
|
| Rate for Payer: Managed Health Services Medicaid |
$5,787.08
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,541.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,541.45
|
| Rate for Payer: United Healthcare Medicaid |
$5,541.45
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$4,734.89
|
|
|
Service Code
|
APR-DRG 1401
|
| Min. Negotiated Rate |
$4,205.82 |
| Max. Negotiated Rate |
$4,734.89 |
| Rate for Payer: Anthem Medicaid |
$4,533.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,533.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,533.92
|
| Rate for Payer: Dean Health Medicaid |
$4,533.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,205.82
|
| Rate for Payer: Managed Health Services Medicaid |
$4,734.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,533.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,533.92
|
| Rate for Payer: United Healthcare Medicaid |
$4,533.92
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
OP
|
$56.04
|
|
|
Service Code
|
EAPG 00574
|
| Min. Negotiated Rate |
$53.88 |
| Max. Negotiated Rate |
$56.04 |
| Rate for Payer: Anthem Medicaid |
$53.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$53.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.88
|
| Rate for Payer: Dean Health Medicaid |
$53.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$53.88
|
| Rate for Payer: Managed Health Services Medicaid |
$56.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$53.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$53.88
|
| Rate for Payer: United Healthcare Medicaid |
$53.88
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
|
Facility
|
IP
|
$7,891.48
|
|
|
Service Code
|
APR-DRG 1403
|
| Min. Negotiated Rate |
$7,009.70 |
| Max. Negotiated Rate |
$7,891.48 |
| Rate for Payer: Anthem Medicaid |
$7,556.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,556.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,556.53
|
| Rate for Payer: Dean Health Medicaid |
$7,556.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,009.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7,891.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,556.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,556.53
|
| Rate for Payer: United Healthcare Medicaid |
$7,556.53
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC
|
Facility
|
IP
|
$23,807.68
|
|
|
Service Code
|
MSDRG 191
|
| Min. Negotiated Rate |
$6,962.63 |
| Max. Negotiated Rate |
$23,807.68 |
| Rate for Payer: Aetna Managed Medicare |
$6,962.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,393.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,098.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,394.53
|
| Rate for Payer: Anthem Medicare Advantage |
$6,962.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,962.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,962.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,962.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,869.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,962.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,217.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,962.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,962.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,962.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,962.63
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6,962.63
|
| Rate for Payer: The Alliance Commercial |
$23,807.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,962.63
|
| Rate for Payer: United Healthcare PPO |
$13,404.22
|
| Rate for Payer: Wellcare Medicare |
$6,962.63
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC
|
Facility
|
IP
|
$30,802.72
|
|
|
Service Code
|
MSDRG 190
|
| Min. Negotiated Rate |
$8,989.76 |
| Max. Negotiated Rate |
$30,802.72 |
| Rate for Payer: Aetna Managed Medicare |
$8,989.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,169.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,525.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,600.38
|
| Rate for Payer: Anthem Medicare Advantage |
$8,989.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,989.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,989.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,989.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,538.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,989.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,348.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,989.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,989.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,989.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,989.76
|
| Rate for Payer: NAPHCARE Commercial |
$13,484.64
|
| Rate for Payer: Quartz Medicare Advantage |
$8,989.76
|
| Rate for Payer: The Alliance Commercial |
$30,802.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,989.76
|
| Rate for Payer: United Healthcare PPO |
$17,398.64
|
| Rate for Payer: Wellcare Medicare |
$8,989.76
|
|
|
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC
|
Facility
|
IP
|
$18,078.32
|
|
|
Service Code
|
MSDRG 192
|
| Min. Negotiated Rate |
$5,423.35 |
| Max. Negotiated Rate |
$18,078.32 |
| Rate for Payer: Aetna Managed Medicare |
$5,423.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,007.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,736.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,200.82
|
| Rate for Payer: Anthem Medicare Advantage |
$5,423.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,423.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,423.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,423.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,323.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,423.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,015.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,423.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,423.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,423.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,423.35
|
| Rate for Payer: NAPHCARE Commercial |
$8,135.03
|
| Rate for Payer: Quartz Medicare Advantage |
$5,423.35
|
| Rate for Payer: The Alliance Commercial |
$18,078.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,423.35
|
| Rate for Payer: United Healthcare PPO |
$10,132.90
|
| Rate for Payer: Wellcare Medicare |
$5,423.35
|
|
|
CHRONOS PHOSPHATE GRANULES 710.019.97S
|
Facility
|
IP
|
$6,765.00
|
|
| Hospital Charge Code |
2966161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,447.44 |
| Max. Negotiated Rate |
$6,472.75 |
| Rate for Payer: Aetna Commercial |
$6,332.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,050.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,728.87
|
| Rate for Payer: Cash Price |
$2,029.50
|
| Rate for Payer: Cigna Commercial |
$6,472.75
|
| Rate for Payer: Health EOS Commercial |
$6,261.68
|
| Rate for Payer: HFN Commercial |
$6,472.75
|
| Rate for Payer: Multiplan Commercial |
$5,628.48
|
| Rate for Payer: Preferred Network Access Commercial |
$6,472.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,447.44
|
| Rate for Payer: Quartz Commercial |
$4,221.36
|
| Rate for Payer: WEA Trust Commercial |
$3,869.58
|
| Rate for Payer: WPS Commercial |
$5,211.08
|
|
|
CHRONOS PHOSPHATE GRANULES 710.019.97S
|
Facility
|
OP
|
$6,765.00
|
|
| Hospital Charge Code |
2966161
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,969.97 |
| Max. Negotiated Rate |
$6,472.75 |
| Rate for Payer: Aetna Commercial |
$6,332.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,050.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,969.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,573.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,517.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,377.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,728.87
|
| Rate for Payer: Cash Price |
$2,029.50
|
| Rate for Payer: Cigna Commercial |
$6,472.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,937.23
|
| Rate for Payer: Health EOS Commercial |
$6,261.68
|
| Rate for Payer: HFN Commercial |
$6,472.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,276.70
|
| Rate for Payer: Multiplan Commercial |
$5,628.48
|
| Rate for Payer: NAPHCARE Commercial |
$4,221.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,472.75
|
| Rate for Payer: Quartz Beloit One Network |
$3,447.44
|
| Rate for Payer: Quartz Commercial |
$4,573.14
|
| Rate for Payer: Quartz Medicare Advantage |
$4,221.36
|
| Rate for Payer: The Alliance Commercial |
$3,517.80
|
| Rate for Payer: WEA Trust Commercial |
$3,869.58
|
| Rate for Payer: WPS Commercial |
$5,211.08
|
|
|
Chux
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040325
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Chux
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040325
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Chymotrypsin Spectrophotometry
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2794800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$37.07
|
|
|
Chymotrypsin Spectrophotometry
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
2794800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
