|
CMV Genotype
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 87910
|
| Hospital Charge Code |
4732608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$358.76 |
| Max. Negotiated Rate |
$673.59 |
| Rate for Payer: Aetna Commercial |
$658.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.04
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$673.59
|
| Rate for Payer: Health EOS Commercial |
$651.62
|
| Rate for Payer: HFN Commercial |
$673.59
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: Preferred Network Access Commercial |
$673.59
|
| Rate for Payer: Quartz Beloit One Network |
$358.76
|
| Rate for Payer: Quartz Commercial |
$439.30
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: WPS Commercial |
$542.29
|
|
|
CMV Genotype
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 87910
|
| Hospital Charge Code |
4732608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,070.99 |
| Rate for Payer: Aetna Commercial |
$658.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.46
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$673.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$651.62
|
| Rate for Payer: HFN Commercial |
$673.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$267.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$673.59
|
| Rate for Payer: Quartz Beloit One Network |
$358.76
|
| Rate for Payer: Quartz Commercial |
$475.90
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,070.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare PPO |
$549.12
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$542.29
|
|
|
CNSLT BEFORE SCREEN COLONOSCOPY S0285
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
HCPCS S0285
|
| Hospital Charge Code |
6180167
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$50.39 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$50.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.82
|
| Rate for Payer: Health EOS Commercial |
$48.27
|
| Rate for Payer: HFN Commercial |
$50.39
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: Preferred Network Access Commercial |
$50.39
|
| Rate for Payer: Quartz Beloit One Network |
$23.34
|
| Rate for Payer: Quartz Commercial |
$30.23
|
| Rate for Payer: The Alliance Commercial |
$26.52
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$9,908.19
|
|
|
Service Code
|
APR-DRG 6612
|
| Min. Negotiated Rate |
$8,801.07 |
| Max. Negotiated Rate |
$9,908.19 |
| Rate for Payer: Anthem Medicaid |
$9,487.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,487.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,487.64
|
| Rate for Payer: Dean Health Medicaid |
$9,487.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,801.07
|
| Rate for Payer: Managed Health Services Medicaid |
$9,908.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,487.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,487.64
|
| Rate for Payer: United Healthcare Medicaid |
$9,487.64
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$7,190.01
|
|
|
Service Code
|
APR-DRG 6611
|
| Min. Negotiated Rate |
$6,386.62 |
| Max. Negotiated Rate |
$7,190.01 |
| Rate for Payer: Anthem Medicaid |
$6,884.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,884.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,884.83
|
| Rate for Payer: Dean Health Medicaid |
$6,884.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,386.62
|
| Rate for Payer: Managed Health Services Medicaid |
$7,190.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,884.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,884.83
|
| Rate for Payer: United Healthcare Medicaid |
$6,884.83
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$14,292.35
|
|
|
Service Code
|
APR-DRG 6613
|
| Min. Negotiated Rate |
$12,695.35 |
| Max. Negotiated Rate |
$14,292.35 |
| Rate for Payer: Anthem Medicaid |
$13,685.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,685.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,685.71
|
| Rate for Payer: Dean Health Medicaid |
$13,685.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,695.35
|
| Rate for Payer: Managed Health Services Medicaid |
$14,292.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,685.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,685.71
|
| Rate for Payer: United Healthcare Medicaid |
$13,685.71
|
|
|
COAGULATION AND PLATELET DISORDERS
|
Facility
|
IP
|
$22,797.61
|
|
|
Service Code
|
APR-DRG 6614
|
| Min. Negotiated Rate |
$20,250.26 |
| Max. Negotiated Rate |
$22,797.61 |
| Rate for Payer: Anthem Medicaid |
$21,829.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,829.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,829.96
|
| Rate for Payer: Dean Health Medicaid |
$21,829.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,250.26
|
| Rate for Payer: Managed Health Services Medicaid |
$22,797.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,829.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,829.96
|
| Rate for Payer: United Healthcare Medicaid |
$21,829.96
|
|
|
COAGULATION AND PLATELET DISORDERS AND CONGENITAL FACTOR DEFICIENCIES
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
EAPG 00781
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Anthem Medicaid |
$85.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$85.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.67
|
| Rate for Payer: Dean Health Medicaid |
$85.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$85.67
|
| Rate for Payer: Managed Health Services Medicaid |
$89.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$85.67
|
| Rate for Payer: United Healthcare Medicaid |
$85.67
|
|
|
COAGULATION DISORDERS
|
Facility
|
IP
|
$43,466.80
|
|
|
Service Code
|
MSDRG 813
|
| Min. Negotiated Rate |
$12,187.82 |
| Max. Negotiated Rate |
$43,466.80 |
| Rate for Payer: Aetna Managed Medicare |
$12,187.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,280.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,509.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,235.67
|
| Rate for Payer: Anthem Medicare Advantage |
$12,187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,187.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,187.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,903.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,187.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,636.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,187.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,187.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,187.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,187.82
|
| Rate for Payer: NAPHCARE Commercial |
$18,281.73
|
| Rate for Payer: Quartz Medicare Advantage |
$12,187.82
|
| Rate for Payer: The Alliance Commercial |
$43,466.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,187.82
|
| Rate for Payer: United Healthcare PPO |
$24,629.65
|
| Rate for Payer: Wellcare Medicare |
$12,187.82
|
|
|
Cobalt Level
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
1038893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.35 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$185.33
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
Cobalt Level
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
1038893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$293.44 |
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$22.84
|
| Rate for Payer: Anthem Medicare Advantage |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.84
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$293.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.84
|
| Rate for Payer: Health EOS Commercial |
$281.08
|
| Rate for Payer: HFN Commercial |
$293.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.84
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$34.26
|
| Rate for Payer: Preferred Network Access Commercial |
$293.44
|
| Rate for Payer: Quartz Beloit One Network |
$135.91
|
| Rate for Payer: Quartz Commercial |
$176.06
|
| Rate for Payer: Quartz Medicare Advantage |
$22.84
|
| Rate for Payer: The Alliance Commercial |
$90.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.84
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$100.49
|
|
|
Cobalt Level
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 83018
|
| Hospital Charge Code |
1038893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.84 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$22.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.91
|
| Rate for Payer: Anthem Medicare Advantage |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.84
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.84
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.84
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$34.26
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$200.77
|
| Rate for Payer: Quartz Medicare Advantage |
$22.84
|
| Rate for Payer: The Alliance Commercial |
$91.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.84
|
| Rate for Payer: United Healthcare PPO |
$231.66
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: Wellcare Medicare |
$22.84
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
Coban
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
3153477
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
Coban
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
3153477
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
COBRA ADHERE XL
|
Facility
|
IP
|
$33,832.00
|
|
| Hospital Charge Code |
2965109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17,240.79 |
| Max. Negotiated Rate |
$32,370.46 |
| Rate for Payer: Aetna Commercial |
$31,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,648.20
|
| Rate for Payer: Cash Price |
$10,149.60
|
| Rate for Payer: Cigna Commercial |
$32,370.46
|
| Rate for Payer: Health EOS Commercial |
$31,314.90
|
| Rate for Payer: HFN Commercial |
$32,370.46
|
| Rate for Payer: Multiplan Commercial |
$28,148.22
|
| Rate for Payer: Preferred Network Access Commercial |
$32,370.46
|
| Rate for Payer: Quartz Beloit One Network |
$17,240.79
|
| Rate for Payer: Quartz Commercial |
$21,111.17
|
| Rate for Payer: WEA Trust Commercial |
$19,351.90
|
| Rate for Payer: WPS Commercial |
$26,060.79
|
|
|
COBRA ADHERE XL
|
Facility
|
OP
|
$33,832.00
|
|
| Hospital Charge Code |
2965109
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,851.88 |
| Max. Negotiated Rate |
$32,370.46 |
| Rate for Payer: Aetna Commercial |
$31,666.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30,259.34
|
| Rate for Payer: Aetna Managed Medicare |
$9,851.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,870.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,592.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,888.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,648.20
|
| Rate for Payer: Cash Price |
$10,149.60
|
| Rate for Payer: Cigna Commercial |
$32,370.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,690.22
|
| Rate for Payer: Health EOS Commercial |
$31,314.90
|
| Rate for Payer: HFN Commercial |
$32,370.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,388.96
|
| Rate for Payer: Multiplan Commercial |
$28,148.22
|
| Rate for Payer: NAPHCARE Commercial |
$21,111.17
|
| Rate for Payer: Preferred Network Access Commercial |
$32,370.46
|
| Rate for Payer: Quartz Beloit One Network |
$17,240.79
|
| Rate for Payer: Quartz Commercial |
$22,870.43
|
| Rate for Payer: Quartz Medicare Advantage |
$21,111.17
|
| Rate for Payer: The Alliance Commercial |
$17,592.64
|
| Rate for Payer: WEA Trust Commercial |
$19,351.90
|
| Rate for Payer: WPS Commercial |
$26,060.79
|
|
|
COBRA BIPOLAR INSERT
|
Facility
|
IP
|
$14,644.00
|
|
| Hospital Charge Code |
2965110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,462.58 |
| Max. Negotiated Rate |
$14,011.38 |
| Rate for Payer: Aetna Commercial |
$13,706.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,097.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,071.77
|
| Rate for Payer: Cash Price |
$4,393.20
|
| Rate for Payer: Cigna Commercial |
$14,011.38
|
| Rate for Payer: Health EOS Commercial |
$13,554.49
|
| Rate for Payer: HFN Commercial |
$14,011.38
|
| Rate for Payer: Multiplan Commercial |
$12,183.81
|
| Rate for Payer: Preferred Network Access Commercial |
$14,011.38
|
| Rate for Payer: Quartz Beloit One Network |
$7,462.58
|
| Rate for Payer: Quartz Commercial |
$9,137.86
|
| Rate for Payer: WEA Trust Commercial |
$8,376.37
|
| Rate for Payer: WPS Commercial |
$11,280.27
|
|
|
COBRA BIPOLAR INSERT
|
Facility
|
OP
|
$14,644.00
|
|
| Hospital Charge Code |
2965110
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,264.33 |
| Max. Negotiated Rate |
$14,011.38 |
| Rate for Payer: Aetna Commercial |
$13,706.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,097.59
|
| Rate for Payer: Aetna Managed Medicare |
$4,264.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,899.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,614.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,310.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,071.77
|
| Rate for Payer: Cash Price |
$4,393.20
|
| Rate for Payer: Cigna Commercial |
$14,011.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,522.81
|
| Rate for Payer: Health EOS Commercial |
$13,554.49
|
| Rate for Payer: HFN Commercial |
$14,011.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,422.32
|
| Rate for Payer: Multiplan Commercial |
$12,183.81
|
| Rate for Payer: NAPHCARE Commercial |
$9,137.86
|
| Rate for Payer: Preferred Network Access Commercial |
$14,011.38
|
| Rate for Payer: Quartz Beloit One Network |
$7,462.58
|
| Rate for Payer: Quartz Commercial |
$9,899.34
|
| Rate for Payer: Quartz Medicare Advantage |
$9,137.86
|
| Rate for Payer: The Alliance Commercial |
$7,614.88
|
| Rate for Payer: WEA Trust Commercial |
$8,376.37
|
| Rate for Payer: WPS Commercial |
$11,280.27
|
|
|
COBRA CABLE
|
Facility
|
OP
|
$9,015.00
|
|
| Hospital Charge Code |
2965111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,625.17 |
| Max. Negotiated Rate |
$8,625.55 |
| Rate for Payer: Aetna Commercial |
$8,438.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,063.02
|
| Rate for Payer: Aetna Managed Medicare |
$2,625.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,094.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,687.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,500.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,969.07
|
| Rate for Payer: Cash Price |
$2,704.50
|
| Rate for Payer: Cigna Commercial |
$8,625.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,246.73
|
| Rate for Payer: Health EOS Commercial |
$8,344.28
|
| Rate for Payer: HFN Commercial |
$8,625.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,031.70
|
| Rate for Payer: Multiplan Commercial |
$7,500.48
|
| Rate for Payer: NAPHCARE Commercial |
$5,625.36
|
| Rate for Payer: Preferred Network Access Commercial |
$8,625.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,594.04
|
| Rate for Payer: Quartz Commercial |
$6,094.14
|
| Rate for Payer: Quartz Medicare Advantage |
$5,625.36
|
| Rate for Payer: The Alliance Commercial |
$4,687.80
|
| Rate for Payer: WEA Trust Commercial |
$5,156.58
|
| Rate for Payer: WPS Commercial |
$6,944.25
|
|
|
COBRA CABLE
|
Facility
|
IP
|
$9,015.00
|
|
| Hospital Charge Code |
2965111
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,594.04 |
| Max. Negotiated Rate |
$8,625.55 |
| Rate for Payer: Aetna Commercial |
$8,438.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,063.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,969.07
|
| Rate for Payer: Cash Price |
$2,704.50
|
| Rate for Payer: Cigna Commercial |
$8,625.55
|
| Rate for Payer: Health EOS Commercial |
$8,344.28
|
| Rate for Payer: HFN Commercial |
$8,625.55
|
| Rate for Payer: Multiplan Commercial |
$7,500.48
|
| Rate for Payer: Preferred Network Access Commercial |
$8,625.55
|
| Rate for Payer: Quartz Beloit One Network |
$4,594.04
|
| Rate for Payer: Quartz Commercial |
$5,625.36
|
| Rate for Payer: WEA Trust Commercial |
$5,156.58
|
| Rate for Payer: WPS Commercial |
$6,944.25
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$7,190.01
|
|
|
Service Code
|
APR-DRG 7743
|
| Min. Negotiated Rate |
$6,386.62 |
| Max. Negotiated Rate |
$7,190.01 |
| Rate for Payer: Anthem Medicaid |
$6,884.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,884.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,884.83
|
| Rate for Payer: Dean Health Medicaid |
$6,884.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,386.62
|
| Rate for Payer: Managed Health Services Medicaid |
$7,190.01
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,884.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,884.83
|
| Rate for Payer: United Healthcare Medicaid |
$6,884.83
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,068.91
|
|
|
Service Code
|
APR-DRG 7741
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$3,068.91 |
| Rate for Payer: Anthem Medicaid |
$2,938.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,938.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,938.65
|
| Rate for Payer: Dean Health Medicaid |
$2,938.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,726.00
|
| Rate for Payer: Managed Health Services Medicaid |
$3,068.91
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,938.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,938.65
|
| Rate for Payer: United Healthcare Medicaid |
$2,938.65
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
OP
|
$104.82
|
|
|
Service Code
|
EAPG 00841
|
| Min. Negotiated Rate |
$100.79 |
| Max. Negotiated Rate |
$104.82 |
| Rate for Payer: Anthem Medicaid |
$100.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$100.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.79
|
| Rate for Payer: Dean Health Medicaid |
$100.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$100.79
|
| Rate for Payer: Managed Health Services Medicaid |
$104.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$100.79
|
| Rate for Payer: United Healthcare Medicaid |
$100.79
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$4,121.11
|
|
|
Service Code
|
APR-DRG 7742
|
| Min. Negotiated Rate |
$3,660.62 |
| Max. Negotiated Rate |
$4,121.11 |
| Rate for Payer: Anthem Medicaid |
$3,946.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,946.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,946.19
|
| Rate for Payer: Dean Health Medicaid |
$3,946.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,660.62
|
| Rate for Payer: Managed Health Services Medicaid |
$4,121.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,946.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,946.19
|
| Rate for Payer: United Healthcare Medicaid |
$3,946.19
|
|
|
COCAINE ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$17,887.35
|
|
|
Service Code
|
APR-DRG 7744
|
| Min. Negotiated Rate |
$15,888.66 |
| Max. Negotiated Rate |
$17,887.35 |
| Rate for Payer: Anthem Medicaid |
$17,128.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,128.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,128.13
|
| Rate for Payer: Dean Health Medicaid |
$17,128.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,888.66
|
| Rate for Payer: Managed Health Services Medicaid |
$17,887.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,128.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,128.13
|
| Rate for Payer: United Healthcare Medicaid |
$17,128.13
|
|
