|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 38MM SCREW GREEN EQUINOXE REVERSE SHOULDER 320-20-38
|
Facility
|
IP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$579.87 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$710.04
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
COMPRESSION SCREW/LOCKING CAP KIT 4.5 X 38MM SCREW GREEN EQUINOXE REVERSE SHOULDER 320-20-38
|
Facility
|
OP
|
$1,137.89
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6240155
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$331.35 |
| Max. Negotiated Rate |
$1,088.73 |
| Rate for Payer: Aetna Commercial |
$1,065.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,017.73
|
| Rate for Payer: Aetna Managed Medicare |
$331.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$769.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$568.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$627.20
|
| Rate for Payer: Cash Price |
$341.37
|
| Rate for Payer: Cigna Commercial |
$1,088.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$662.25
|
| Rate for Payer: Health EOS Commercial |
$1,053.23
|
| Rate for Payer: HFN Commercial |
$1,088.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$887.55
|
| Rate for Payer: Multiplan Commercial |
$946.72
|
| Rate for Payer: NAPHCARE Commercial |
$710.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,088.73
|
| Rate for Payer: Quartz Beloit One Network |
$579.87
|
| Rate for Payer: Quartz Commercial |
$769.21
|
| Rate for Payer: Quartz Medicare Advantage |
$710.04
|
| Rate for Payer: The Alliance Commercial |
$591.70
|
| Rate for Payer: WEA Trust Commercial |
$650.87
|
| Rate for Payer: WPS Commercial |
$876.52
|
|
|
Compression wrap charge
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
HCPCS A6448
|
| Hospital Charge Code |
2844906
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$40.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.20
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$87.36
|
| Rate for Payer: The Alliance Commercial |
$6.82
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
Compression wrap charge
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
HCPCS A6448
|
| Hospital Charge Code |
2844906
|
|
Hospital Revenue Code
|
623
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
COMPUTED TOMOGRAPHIC ANGIOGRAPHY
|
Facility
|
OP
|
$269.92
|
|
|
Service Code
|
EAPG 00302
|
| Min. Negotiated Rate |
$259.54 |
| Max. Negotiated Rate |
$269.92 |
| Rate for Payer: Anthem Medicaid |
$259.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$259.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.54
|
| Rate for Payer: Dean Health Medicaid |
$259.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$259.54
|
| Rate for Payer: Managed Health Services Medicaid |
$269.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$259.54
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$259.54
|
| Rate for Payer: United Healthcare Medicaid |
$259.54
|
|
|
COMPUTED TOMOGRAPHY- OTHER
|
Facility
|
OP
|
$191.30
|
|
|
Service Code
|
EAPG 00301
|
| Min. Negotiated Rate |
$183.95 |
| Max. Negotiated Rate |
$191.30 |
| Rate for Payer: Anthem Medicaid |
$183.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$183.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$183.95
|
| Rate for Payer: Dean Health Medicaid |
$183.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$183.95
|
| Rate for Payer: Managed Health Services Medicaid |
$191.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$183.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$183.95
|
| Rate for Payer: United Healthcare Medicaid |
$183.95
|
|
|
Concentration Fee
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
1654799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$61.26 |
| Rate for Payer: Aetna Commercial |
$61.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$6.95
|
| Rate for Payer: Anthem Medicare Advantage |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.95
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$61.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.95
|
| Rate for Payer: Health EOS Commercial |
$58.68
|
| Rate for Payer: HFN Commercial |
$61.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$10.42
|
| Rate for Payer: Preferred Network Access Commercial |
$61.26
|
| Rate for Payer: Quartz Beloit One Network |
$28.37
|
| Rate for Payer: Quartz Commercial |
$36.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6.95
|
| Rate for Payer: The Alliance Commercial |
$27.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$30.57
|
|
|
Concentration Fee
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
1654799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$6.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.95
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.95
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$10.42
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$6.95
|
| Rate for Payer: The Alliance Commercial |
$27.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare PPO |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: Wellcare Medicare |
$6.95
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
Concentration Fee
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
1654799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
CONCOMITANT AORTIC AND MITRAL VALVE PROCEDURES
|
Facility
|
IP
|
$298,136.80
|
|
|
Service Code
|
MSDRG 212
|
| Min. Negotiated Rate |
$83,782.77 |
| Max. Negotiated Rate |
$298,136.80 |
| Rate for Payer: Aetna Managed Medicare |
$83,782.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$237,264.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181,861.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$172,779.88
|
| Rate for Payer: Anthem Medicare Advantage |
$83,782.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83,782.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83,782.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$83,782.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191,801.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$83,782.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218,429.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83,782.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83,782.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$83,782.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$83,782.77
|
| Rate for Payer: NAPHCARE Commercial |
$125,674.16
|
| Rate for Payer: Quartz Medicare Advantage |
$83,782.77
|
| Rate for Payer: The Alliance Commercial |
$298,136.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83,782.77
|
| Rate for Payer: United Healthcare PPO |
$170,050.40
|
| Rate for Payer: Wellcare Medicare |
$83,782.77
|
|
|
CONCOMITANT LEFT ATRIAL APPENDAGE CLOSURE AND CARDIAC ABLATION
|
Facility
|
IP
|
$145,894.08
|
|
|
Service Code
|
MSDRG 317
|
| Min. Negotiated Rate |
$51,713.31 |
| Max. Negotiated Rate |
$145,894.08 |
| Rate for Payer: Aetna Managed Medicare |
$51,713.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$145,894.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111,826.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106,242.60
|
| Rate for Payer: Anthem Medicare Advantage |
$51,713.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51,713.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51,713.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51,713.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117,939.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51,713.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51,713.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51,713.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51,713.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51,713.31
|
| Rate for Payer: NAPHCARE Commercial |
$77,569.97
|
| Rate for Payer: Quartz Medicare Advantage |
$51,713.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51,713.31
|
| Rate for Payer: Wellcare Medicare |
$51,713.31
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$21,131.63
|
|
|
Service Code
|
APR-DRG 0574
|
| Min. Negotiated Rate |
$18,770.43 |
| Max. Negotiated Rate |
$21,131.63 |
| Rate for Payer: Anthem Medicaid |
$20,234.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,234.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,234.70
|
| Rate for Payer: Dean Health Medicaid |
$20,234.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,770.43
|
| Rate for Payer: Managed Health Services Medicaid |
$21,131.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,234.70
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,234.70
|
| Rate for Payer: United Healthcare Medicaid |
$20,234.70
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$8,943.68
|
|
|
Service Code
|
APR-DRG 0572
|
| Min. Negotiated Rate |
$7,944.33 |
| Max. Negotiated Rate |
$8,943.68 |
| Rate for Payer: Anthem Medicaid |
$8,564.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,564.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,564.06
|
| Rate for Payer: Dean Health Medicaid |
$8,564.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,944.33
|
| Rate for Payer: Managed Health Services Medicaid |
$8,943.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,564.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,564.06
|
| Rate for Payer: United Healthcare Medicaid |
$8,564.06
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$6,225.50
|
|
|
Service Code
|
APR-DRG 0571
|
| Min. Negotiated Rate |
$5,529.88 |
| Max. Negotiated Rate |
$6,225.50 |
| Rate for Payer: Anthem Medicaid |
$5,961.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,961.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,961.26
|
| Rate for Payer: Dean Health Medicaid |
$5,961.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,529.88
|
| Rate for Payer: Managed Health Services Medicaid |
$6,225.50
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,961.26
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,961.26
|
| Rate for Payer: United Healthcare Medicaid |
$5,961.26
|
|
|
CONCUSSION, CLOSED SKULL FRACTURE NOS, AND UNCOMPLICATED INTRACRANIAL INJURY, COMA < 1 HOUR OR NO COMA
|
Facility
|
IP
|
$12,538.68
|
|
|
Service Code
|
APR-DRG 0573
|
| Min. Negotiated Rate |
$11,137.64 |
| Max. Negotiated Rate |
$12,538.68 |
| Rate for Payer: Anthem Medicaid |
$12,006.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,006.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,006.48
|
| Rate for Payer: Dean Health Medicaid |
$12,006.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,137.64
|
| Rate for Payer: Managed Health Services Medicaid |
$12,538.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,006.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,006.48
|
| Rate for Payer: United Healthcare Medicaid |
$12,006.48
|
|
|
CONCUSSION WITH CC
|
Facility
|
IP
|
$32,127.68
|
|
|
Service Code
|
MSDRG 089
|
| Min. Negotiated Rate |
$8,920.08 |
| Max. Negotiated Rate |
$32,127.68 |
| Rate for Payer: Aetna Managed Medicare |
$8,920.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,970.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,373.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,455.79
|
| Rate for Payer: Anthem Medicare Advantage |
$8,920.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,920.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,920.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,920.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,377.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,920.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,319.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,920.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,920.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,920.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,920.08
|
| Rate for Payer: NAPHCARE Commercial |
$13,380.12
|
| Rate for Payer: Quartz Medicare Advantage |
$8,920.08
|
| Rate for Payer: The Alliance Commercial |
$32,127.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,920.08
|
| Rate for Payer: United Healthcare PPO |
$18,154.90
|
| Rate for Payer: Wellcare Medicare |
$8,920.08
|
|
|
CONCUSSION WITH MCC
|
Facility
|
IP
|
$42,741.92
|
|
|
Service Code
|
MSDRG 088
|
| Min. Negotiated Rate |
$10,859.14 |
| Max. Negotiated Rate |
$42,741.92 |
| Rate for Payer: Aetna Managed Medicare |
$10,859.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,495.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,607.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,478.91
|
| Rate for Payer: Anthem Medicare Advantage |
$10,859.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,859.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,859.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,859.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,843.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,859.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,105.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,859.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,859.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,859.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,859.14
|
| Rate for Payer: NAPHCARE Commercial |
$16,288.71
|
| Rate for Payer: Quartz Medicare Advantage |
$10,859.14
|
| Rate for Payer: The Alliance Commercial |
$42,741.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,859.14
|
| Rate for Payer: United Healthcare PPO |
$24,216.00
|
| Rate for Payer: Wellcare Medicare |
$10,859.14
|
|
|
CONCUSSION WITHOUT CC/MCC
|
Facility
|
IP
|
$26,179.92
|
|
|
Service Code
|
MSDRG 090
|
| Min. Negotiated Rate |
$6,811.01 |
| Max. Negotiated Rate |
$26,179.92 |
| Rate for Payer: Aetna Managed Medicare |
$6,811.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,961.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,767.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,079.92
|
| Rate for Payer: Anthem Medicare Advantage |
$6,811.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,811.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,811.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,811.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,519.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,811.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,957.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,811.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,811.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,811.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,811.01
|
| Rate for Payer: NAPHCARE Commercial |
$10,216.52
|
| Rate for Payer: Quartz Medicare Advantage |
$6,811.01
|
| Rate for Payer: The Alliance Commercial |
$26,179.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,811.01
|
| Rate for Payer: United Healthcare PPO |
$14,758.85
|
| Rate for Payer: Wellcare Medicare |
$6,811.01
|
|
|
Conditional Play Audiometry
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
1230805
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Conditional Play Audiometry
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
1230805
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Conditional Play Audiometry
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
1230805
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$345.20 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$86.30
|
| Rate for Payer: Anthem Medicare Advantage |
$86.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.30
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.30
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.30
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$129.45
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$86.30
|
| Rate for Payer: The Alliance Commercial |
$215.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.30
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$345.20
|
|
|
CONDITIONING PLAY AUDIOMETRY 92582
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
3015338
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.43 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
CONDITIONING PLAY AUDIOMETRY 92582
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 92582
|
| Hospital Charge Code |
3015338
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
CONDYLOMA, CAUTERY OF
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959947
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
CONDYLOMA, CAUTERY OF
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959947
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
